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MATERIA MEDICA, PHARMACY, AND 
THERAPEUTICS. 



POTTER. 



NOTICES OF THE MEDICAL PRESS 

OF PREVIOUS EDITIONS OF 

POTTER'S MATERIA MEDICA, PHARMACY AND 

THERAPEUTICS. 



From the Medical Record: 

"This is an old and valued friend which needs no commendation, much less an intro- 
duction. It ought to be in the library of every physician and student. It is the most con- 
venient and most concise work on therapeutics and materia medica in the English language, 
and is at the same time thoroughly reliable. Though necessarily largely a compilation, 
nevertheless there is much that is original, the author being one of the most prominent of 
American therapeutists." 

From the American Journal oj the Medical Sciences: 

"The author has very skilfully steered his course between the pessimism that marks 
a system of therapeutics based solely on the results given by experiments and observations 
in the chemical and physiological laboratories, and the optimism of hasty empirical general- 
izations upon meagre clinical data, and upon this we consider that the greatest claim can 
be made, that this book is a safe one for the junior practitioner. . . . The author, then, 
has fully attained the purpose which he set before him at the commencement." 

From the Lancet, London, England: 

"The third part is entitled 'Special Therapeutics,' and in its compilation a very large 
number of the works of accepted authorities have been laid under contribution. It forms a 
very complete and reliable index of treatment which will be a godsend to many a busy practi- 
tioner who has no time to wade through the copious literature that accompanies each new drug 
into the market." 

From the Australasian Medical Gazette: 

" It is a monument of persistent industry. There is no better book in the English language 
for the student and practitioner. . . . Dr. Potter's book is thoroughly practical, and Part 
III contains an enormous amount of information, for which the student ought to be grateful. 
. . . The chapter on prescriptions is especially well done, in fact the best we have 
seen." 

From the Journal oj the American Medical Association: 

"Dr. Potter has embodied many original ideas in the preparation of this work, some, if 
not all of which will prove of very great value to the reader." 

From the Therapeutic Gazette: 

"The author has aimed to embrace in a single volume the essentials of practical materia 
medica and therapeutics, and has produced a book small enough for easy carriage and easy 
reference, large enough to contain a carefully-digested, but full, clear, and well-arranged mass 
of information. No new remedy of any acknowledged value is omitted from this list. Under 
each the section on physiological action and therapeutics has been written with care. . . . 
In the enumeration of drugs suited to different disorders a very successful effort at discrimina- 
tion has been made, both in the stage of disease and in the cases peculiarly suited to the remedy. 
It is no mere list of diseases followed by a catalogue of drugs, but is a digest of modern thera- 
peutics, and as such will prove of immense use to its possessor." 

From the New York Medical Journal: 

"Dr. Potter's Handbook will find a place, and a very important one, in our colleges 
and the libraries of our practitioners. It contains almost everything that can be found in 
the larger works in a more concise form and brought up to a rather more recent date. . . . 
Under the head of prescription writing considerable attention is paid to the subject of incom- 
patibilities, and the student will here find many valuable hints for his guidance in this difficult 
subject. Besides this, there are, under the head of special therapeutics, very many formulas 
for the treatment of particular diseases and abnormal conditions, arranged alphabetically for 
easy reference. This will be especially valuable to young practitioners, and will frequentlv 
save the trouble of looking through large works and monographs for suitable formulae in the 
treatment of special cases. This department is fuller in this book than in any with which we 
are acquainted." 

*** The price of this book is S5.00, net, in cloth binding, or $6.00, net, in full leather; 
for which it will be delivered free to any address. Thumb Index in each copy. 



MATERIA MEDICA, PHARMACY 
AND THERAPEUTICS, 



INCLUDING 



THE PHYSIOLOGICAL ACTION OF DRUGS, THE SPECIAL THERAPEU- 
TICS OF DISEASE, OFFICIAL AND PRACTICAL PHARMACY, 
MINUTE DIRECTIONS FOR PRESCRIPTION WRITING 
AND AVOIDING INCOMPATIBILITY, 



ALSO THE 



ANTIDOTAL AND ANTAGONISTIC TREATMENT 
OF POISONING. 



SAM'L O. L. POTTER, A.M., M.D., M.R.C.P. Lond., 

FORMERLY PROFESSOR OF THE PRINCIPLES AND PRACTICE OF MEDICINE IN THE COOPER MEDICAL 

COLLEGE OF SAN FRANCISCO ; AUTHOR OF THE " QUIZ-COMPENDS OF ANATOMY AND 

MATERIA MEDICA," " AN INDEX OF COMPARATIVE THERAPEUTICS," SEVERAL 

ARTICLES IN FOSTER'S " PRACTICAL THERAPEUTICS," AND " SPEECH 

AND ITS DEFECTS"; LATE MAJOR AND SURGEON OF 

VOLUNTEERS, U. S. ARMY. 



TENTH EDITION, 

Revised, and in Greater Part Rewritten. 



PHILADELPHIA: 
P. BLAKISTON'S SON & CO. 

I O I 2 WALNUT STREET. 
I906 



LI8RARY of CONGRESS 
Two Copies Received 

UAN 13 1906 

CoDyrlfcM Entry 

Coc^t-.y. /9ot> 

. fUSS Ct XXc. No. 

(J t 3 6~/ ?d 

^ COPY B. 



\ 






^ 



\ 



<V 



Copyright, 1906, 
By P. BLAKISTON'S SON & CO. 



"Authority to use for comment the Pharmacopoeia of the United States of America, Eighth 
Decennial Revision, in this volume, has been granted by the Board of Trustees of the United 
States Pharmacopoeia! Convention, which Board of Trustees is in no way responsible for the accu- 
racy of any translations of the official weights and measures or for any statements as to strength 
of official preparations." 



WM. F. FELL COMPANY 

ELECTROTYPER6 AND PRINTERS 

1220-24 6ANS0M STREET 

PHILADELPHIA, PA. 



TO MY WIFE 

WHOSE DEVOTED CARE AND 

PATIENT ENCOURAGEMENT 

HAVE SUPPORTED THE AUTHOR 

IN EVERY EXIGENCY OF HIS 

PROFESSIONAL LIFE. 



PREFACE TO THE TENTH EDITION. 



This edition, the tenth, is practically a new book; the former text having 
been largely re-written, expanded by the introduction of much new matter, 
and corrected to conform with the recent changes in the U. S. Pharmacopoeia. 
One hundred and thirteen new articles and paragraphs have been inserted, 
and nearly four hundred articles have been re-written. Material considered 
obsolete, or of slight comparative importance, has been removed, and a larger 
page adopted, thus keeping the size of the volume within its former limit. A 
change of type has greatly improved the appearance of the book. 

The new matter includes a List of Incompatibles for each important drug, 
also articles and paragraphs on Acetozone, Adrenalin, Agurin, Appendicitis, 
Aspirin, Atoxyl, Barium, Bromipin, Camphoric Acid, Carbon Monoxide, Chlo- 
retone, Cotarnine, Cundurango, Dysentery (Tropical), Echinacea, Enteroclysis, 
Ethyl Chloride, Euphthalamin, Ferropyrin, Filmaron, Gambir, Hedonal, Iodi- 
pin, Kaolin, Mercurol, Nitrous Oxide, Nutrient Serum, Orexin, Oxalic Acid, 
Oxycamphor, Sabal, Salts, Scopola, Spinal Sclerosis, Stovaine, Sublamin, Sul- 
phaminol, Taka-diastase, Tannalbin, Tannocol, Tannoform, Tetranitrin, Theo- 
cin, Theocol, Thigenol, Trichloracetic Acid, Veronal, Yohimbine, and sixty- 
five other drugs and preparations. 

The subjects formerly discussed under the titles Toxins and Antitoxins are 
now brought together under the title Sera, and their text has been carefully 
revised. Other re-written articles are those on Acetanilide, Acetphenetidin, 
Acids, Alkalies, Alkaloids, Aconite, Animal Extracts, Antiseptics, Argentum, 
Belladonna, Benzoin, Bromides, Caffeine, Calcium, Chloral, Chloroform, Cin- 
chona, Coca, Cuprum, Ergot, Formaldehyde, Gelsemium, Glycerin, Hydrargy- 
rum, Hyoscyamus, Opium, Phenol, Physostigma, Potassium, Salicin, Sulphur, 
Veratrum; and thirty-six others in the section on Materia Medica: also thirty- 
four in the section on Pharmacy, and two hundred and ninety-one in the sec- 
tion on Therapeutics. The last-named section has been expanded by the in- 
corporation of many hundred items from current medical literature, and from 
the author's personal experience. 

The nomenclature of the eighth revision of the U. S. Pharmacopoeia has 
been strictly followed in the sections on Materia Medica and Pharmacy, but 
in the section on Therapeutics the familiar trade-names of some drugs (Salol, 
Sulphonal, Trional, Urotropin, etc.) have been retained instead of their cum- 
bersome and unfamiliar official titles. Many preparations of the British 
Pharmacopoeia are mentioned. 



viii PREFACE TO THE FIRST EDITION. 

In preparing this edition the author has earnestly striven to merit the con- 
tinued favor of teachers, students and practitioners, which favor has been so 
markedly shown to his book during the nineteen years in which it has been 
before the medical profession. 

Samuel O. L. Potter. 

SAN FRANCISCO, CALIFORNIA, 
December, 1905 



EXTRACTS FROM THE PREFACE TO THE FIRST EDITION. 



The author's intention has been to produce a book which would embrace 
in a single volume the Essentials of practical Materia Medica and Therapeu- 
tics, treating of each subject in as concise phraseology as possible consistent 
with the delineation of every important feature. He has also endeavored to 
formulate such minute and definite directions for the framing of Prescrip- 
tions as might elucidate what to many is a very difficult problem. Further- 
more, he has tried to present as much information upon the subject of Phar- 
macy as every physician should possess, in order to handle the implements of 
his profession with confidence and to direct their use by others with pharma- 
ceutical accuracy. 

The complete fulfilment of these aims would be realized if the book should 
take rank as a working companion to the advanced student and the junior 
practitioner, and be deemed by them a reliable guide through the forest of ob- 
servations and experiments on drug actions and uses, which make progress 
slow for the already over-burdened mind, when ploughing through the more 
exhaustive and exhausting text-books. 

Although this book is essentially a compilation, as all books of its class must 
be, there will be found in its pages much original matter derived from the writer's 
own experience in professional life. The arrangement of the matter will be 
found to be in some respects unique. After full consideration of the many 
arrangements of the Materia Medica in vogue, a modified alphabetical plan 
was adopted, by which the advantages of the alphabetical order might be re- 
tained, while permitting the grouping together of agents which are closely re- 
lated, physiologically and therapeutically, under the title of the principal mem- 
ber of the class — the chief, as it were, of that particular clan. Thus, under 
the title Amylis Nitris will be found mention also of the Ethyl, Sodium and 
Potassium Nitrites, and their congener Nitro-glycerin, all of which are closely 



PREFACE rO nil: FIRST I mi ION. IX 

allied to the first named and to each other, in respect of their actions and uses. 
A very elaborate section on Drug Classification is placed before the Materia 
Medica, in order to supplement such deficiencies in grouping as are inevitable 
in an alphabetical arrangement. 

In detailing the characteristics of an important drug, its physical properties 
and chemical constituents are first briefly enumerated, then its preparations 
are described in the official language of the pharmacopoeia, usually somewhat 
abbreviated; any important unofficial preparations are also noted, and the com- 
pounds into which it enters are enumerated. Next the physiological action is 
taken up, its characteristic features being first described; then the actions 
resulting from an ordinary medicinal close, next those produced by small doses 
continued, and finally those from a toxic dose. A concise summary of its thera- 
peutical applications closes the article, — the whole presenting, it is hoped, a 
clearly defined word-picture of the drug under consideration. Every article 
and preparation comprised in the last edition of the U. S. Pharmacopoeia is 
fully noticed, while all the prominent unofficial agents receive such mention 
as their respective importance seems to demand. 

The second part of the book is devoted to Pharmacy, and has been written 
from the standpoint of a conviction that many young practitioners would gladly 
dispense their own medicines, if provided with a few practical directions on 
the subject; thereby saving many a dollar from the drug store, preventing in 
their own practices at least the "renewals" which constitute so bad a feature 
of modern pharmaceutics, and gaining for themselves a practical acquaintance 
with their professional weapons which cannot but make them better phys- 
icians and more accurate prescribers. In this section of the book Prescription 
Writing receives full consideration, and many standard formula? are given as 
samples of prescriptions of each kind in extemporaneous use. 

In the third part the subject of Special Therapeutics is treated of elaborately, 
in the form of an alphabetically arranged Index to the treatment of diseases, 
as laid down by the accepted authorities. Every indication for the use of a 
drug is referred to its author by his name or initial, and to the most prominent 
articles are appended a few selected formulae, to serve as guides to the neo- 
phyte in prescribing. 

The Appendix contains numerous Tables, comprising diagnostic hints, Latin 
terms and phrases, formulae for hypodermic use, and metric equivalents; also 
formulae representing the most noted patent medicines. 

The Index has received special attention, from a conviction that, if well 
made, it is the best part of a good book. Every title, synonym and other refer- 
ence of importance is included therein, double and treble entries being made 
in every instance which seemed to require such repetition. 

Cooper Medical College, San Francisco, 
December, 1886. 



TABLE OF CONTENTS. 



INTRODUCTION, 

Pharmacy 

Materia Medica 

Thki; 

Empirical Therapeutics 2 

Rational Therapeutics 2 

Constituents of Organic Drugs 4 

Ai live Principles, 5 

Carbohydrates 5 

Alkaloids 5 

Glucosides, 7 

Neutral Principles 8 

Organic Acid- 8 

Coloring Matters 8 

Resins, 9 

Fixed Oils and Fats 9 

Waxes 10 

Volatile or Essential Oils, 10 

Camphors 10 

Miscellaneous Compounds, n 

Albuminoids or Protein Bodies, n 

Ferments, 12 

Classification of Medicines (alphabetically arranged), 12-49 

Administration of Medicines, 50 

Transfusion, 51 

The Hypodermic Method, 52 

Dosage of Medicines 55 

Average Adult Doses of Official Preparations, 56 

PART I.— MATERIA MEDICA AND THERAPEUTICS, 58 

Abrus to Zingiber (alphabetically arranged), "8-500 

PART II.— PHARMACY AND PRESCRIPTION WRITING, 501 

Pharmacopoeias and Dispensatories 501 

Weights and Measures 502 

Metric System, 503 

Approximate or Domestic Measures •. 505 

Specific Gravity and Specific Volume, 505 

Prescriptions, 506 

Procedure in Writing a Prescription 507 

Analysis of a Prescription, 508 



Xli TABLE OF CONTENTS. 

PAGE 

Prescriptions, continued, 

of Latin in Prescriptions, 510 

Principles of Combination 512 

Metric Prescriptions, 5*3 

Abbreviations, 514 

Renewals of Prescriptions, 515 

Prescription Blanks, 517 

Incompatibility, 517 

Chemical Incompatibility, 517 

Pharmaceutical Incompatibility 520 

Therapeutical Incompatibility, 520 

Rules for Avoidance of the Dangers of Incompatibility, 521 

Extemporaneous Pharmacy, 522 

Filling a Prescription, 523 

Stock Solutions, 524 

Rules for the Pharmaceutical Student 524 

Official Pharmacy , 525 

Official Operations, 525 

Pharmaceutical Operations 525 

Preparations, 533 

Official Preparations 533 

Phamaceutical Preparations, 533 

Aceta to Vina, in alphabetical order, 533 _ 5°6 

Excipients for Emulsions, 538 

Excipients for Mixtures, 548 

Excipients for Pills, 552 

PART III.— SPECIAL THERAPEUTICS, 5 68 

References and Bibliography, 568 

Applied Therapeutics, 569 

Abasia to Yellow Fever, in alphabetical order, 569-S47 

Poisoning 764 

General Principles of Treatment. 765 

Antagonists, 765 

Antidotes, 765 

Poisons, their Antidotes and Antagonists, 769 

Temperature in Disease, 812 

Average Normal Temperature, 812 

Clinical Thermometry, 8! 2 

Abnormal Temperature, 812 

Temperature in Phthisis, 813 

Temperature in Typhoid Fever 813 

Temperature in Scarlatina, 813 

Temperature in Measles, 813 

Temperature in Diphtheria, 813 

Co-relation of Pulse and Temperature 813 

Clinical Examination of the Urine, 830 

Composition of the Urine, 830 

Color, Specific Gravity, etc ., 851 



i \ i ■- 1 I OF CONTENTS. xit i 

PAG! 

Clinicaj Examination oj rsa ' ■ ntinued, 

lY^t- for Acetone, Albumin, Bile, etc 831 83s 

Deposits in Urine > s .i5 

\i 1 essary Apparatus > s .i5 

APPENDIX, 849 

Latin Phrasi :, Con ractions, etc., used in Pbj scrlptions, 849 

l. \n\ Numerals 861 

Latin Verbs, Participles, Prepositions, etc 862 

iE-ENDINGS 862 

Hypodermic Formuj s. 863 

Pateni Mi pi ciMs 865 

Tab 1 Differential Diagnosis 869 

Forms of Bright'-- 1 lisease 869 

Cancer 870 

c larditis, Endocarditis and Pericarditis 870 

Cerebral Concussion and Compression, 870 

Chancre and Chancroid 870 

Cholera 871 

Croup and Diphtheria, 871 

Epilepsy and Hysteria, 871 

Gout and Rheumatism 871 

Pleurisy and Pneumonia, Intercostal Neuralgia, etc., 872 

Pneumonia, Lobular and Lobar, 872 

Scarlet Fever, Measles and Smallpox, 872 

Typhus and Typhoid Fevers, 873 

Varicella and Varioloid 874 

Yellow Fever and Bilious Remittent Fever, 874 

Tables: 

Table of Drops in and Weights of a Fluidrachm, 875 

Table of Weights and Measures, 875 

Table for Metric Conversions, 876 

Table of Equivalent Weights and Measures, Inside of Cover. 

Table of Prescription Doses and Quantities, Inside of Cover. 

INDEX, 877 



EXPLANATION. 



For Signs and Abbreviations used, see pages 503 to 515, and page 568. 

Average Adult Doses of the U. S. Pharmacopoeia, for each drug and preparation, are given 

in brackets, thus — [av. gr. x.]. 
Unofficial Synonyms arc placed in parentheses after the official synonyms. 

Numerals unqualified, under the subtitles Preparations in Part I, denote grammes for solids 
and cubic centimeters for liquids. 



ERRATA. 

Page 47, line 11 from bottom, — jor simple read similar. 

Page Si, line 17 from bottom, — jor NOi 2 read NO n . 

Page 141, line 20 from bottom, — jor Caffein read Caffeine. 

Page 169, line 2, — jor neurtisi read neuritis. 

Page 171, last line, — jor 5 read tijj. 

Page 172, line 22, — for Homolropine read Homatropine. 

Page 179, line 8 from bottom, — jor Bromine read Bromide. 

Page 220, line 23, — add Soap Liniment 5ij at end oj line. 

Page 249, line 12; page 308, line n; and page 418, line 26 from bottom, — jor gr. read nj>. 

Page 262, line 17 from bottom, — jor 50 read 5. 

Page 275, line 7 from bottom, — the paragraph relating to Sodium Glycocholate belongs on 

page 276, under the title Fel Bovis. 
Page 314, line 8 from bottom, — jor pyrrhol read pyrrol. 
Page 342, line 24, — jor carbon dioxide water read carbon dioxide and water. 
Page 355, headline, — jor Olive read Oliy.e. 
Page 356, line 12 from bottom, — jor Cryptomine read Cryptopine. 
Page 357, line 13, — jor Morphne read Morphine. 
Page 339, under Incompatibles, — jor 500 read 5, and jor 600 read 6. 
Page 364, line 2, — jor his read is. 

Page 398, line 10 from bottom, — jor official read unofficial. 
Page 534, line 8 from bottom, — jor oijss read ojss. 
Page 530, line 2 from bottom, — jor Pigments read Pigmenta. 
Page 376, line 9, — jor fort he read for the. 
Page 708, line 16, — jor Acetanilid read Acetanilide. 



INTRODUCTION. 



Drugs (drugan, to dry), — is a term which was formerly applied to dried 
medicinal plants, and is still employed by writers and others in that sense. By 
extension, however, it has been made to cover all material substances used for 
the treatment of disease, including remedial agents from the animal and min- 
eral kingdoms as well as those belonging to the vegetable kingdom. 

Pharmacology (<fdp,aay.ov, a drug, i.&yoq, a discourse), — is the science which 
treats of drugs and therefore properly embraces in its scope all of materia medica 
and therapeutics relating to drugs. By some writers this term is employed 
in a more restricted sense, including only the physiological action of drugs, a 
subject which is more correctly designated by the word Pharmacodynamics 
(see below). 

Pharmacy is the name of the art which supplements the science of phar- 
macology, namely — the art of preparing drugs according to the requirements 
of the pharmacologist and of dispensing them on the prescriptions of the ther- 
apeutist. It includes a thorough knowledge of the materia medica, an acquaint- 
ance with the theories and manipulations of chemistry and an intimate prac- 
tical experience in many operations peculiar to itself. 

Materia Medica is the branch of Pharmacology which treats of the sub- 
stances used as medicines and describes their origin, composition, physical 
characteristics, chemical properties, modes of preparation and administration, 
also their physiological and toxicological actions. Two of its divisions are — 

Pharmacodynamics ((pap^uaKov, a drug, Siiua/uf, power), means the discussion of the 
physiological action of drugs, which is their modifying power upon the normal physiological 
activity of the human organism. 

Toxicology (xosck6v, a poison, Xo-jroc, a discourse), describes the effects of drugs admin- 
istered in poisonous doses, and treats of the antagonists and antidotes by which their effects 
may be neutralized or the poisons themselves rendered innocuous and removed from the 
organism. 

Therapeutics {Ospa-svsiv, to attend upon), comprises all the science .and 
art of healing, and includes the use of medicines and all other agents and meas- 
ures which are 'known to alleviate or cure disease. The operations of Nature 
herself are properly embraced in the general term Therapeutics, which may 
be subdivided as follows: — 

Natural Therapeutics, includes the operations of the Vis Medlcatrix 
Natura, the healing power of Nature, — those modes and processes of heal- 



2 INTRODUCTION. 

ing which occur independently of art and tend to the spontaneous decline and 
cure of disease. There is no scientific dogma better established than this, 
that the living organism is in itself adequate to the cure oj all its curable disor- 
ders. This natural law sustains the medical skeptic in his infidelity as to the 
value of medicines, enables the homeopathist to report his sugar-cures, and 
helps all physicians out of more close places in practice than they are gener- 
ally willing to acknowledge. This part of the subject is taught only casually 
in the schools, in connection with pathology and the other subjects embraced 
in the chair of Principles and Practice of Medicine, but it deserves a special 
chair and more systematic treatment than it receives. 

Applied Therapeutics embraces the application by Art of agents foreign 
to the living organism, for the purpose of aiding Nature to restore the body 
to a healthy condition. This division is the portion of the subject which is 
taught separately and systematically in the schools, and therefore is alone con- 
sidered in the following pages. 

Other divisions of the general subject employed in professional literature 
and conversation are those entitled Empirical Therapeutics and Rational Ther- 
apeutics. 

Empirical Therapeutics is a term applied to the use of medicinal or other 
therapeutical agents for the sole reason that they have been tried previously 
with successful results in cases apparently identical with the one under treat- 
ment. By those who advocate this method it is styled the Therapeutics of 
Experience, and is claimed to be an accumulation of means of combating dis- 
ease simply by observation and experiment independently of physio-pathological 
reasoning (Hartshorne). It was necessarily the original method in therapeutics, 
has conferred many rich gifts upon medical science, and has been advocated 
by many great physicians, its latest and ablest expounder being the eminent 
and lamented Niemeyer. 

The use of Opium to relieve pain, of Cinchona for malarial fevers, of Colchicum in 
gout, of Potassium Iodide in syphilis, of the Bromides in epilepsy, and of Cod-liver Oil in 
phthisis, are examples of the empirical use of remedies. But, after all has been said for 
it that can be said, the fact remains that it is essentially an unscientific method, a mere ela- 
boration of the prevailing popular habit of recommending Mrs. A. to use pepper tea, because 
it cured Mrs. B. of "the very same trouble." Permitted to reign supreme, it would be de- 
structive to all exactness in therapeutical progress. The so-called "experience" of one ob- 
server is too often overbalanced by the experience of another equally competent and trust- 
worthy; and as few are encouraged to record their failures with remedies, there can be no 
scientific comparison of the failures with the reported successes. For this reason empirical 
methods would tend to a minimum degree of accuracy in a science which, in the very 
nature of things, can never be an exact one; — though undoubtedly such methods will always 
prevail to some extent. 

Rational Therapeutics means the use of remedies for reasons based on 
a knowledge of the pathological conditions present in the subject and the phy- 
siological action of the agent employed. This method is the very antithesis of 
empiricism, and has been the leading idea in every revolt against empirical 
therapeutics in the past. Humoralism, Chemicism, Solidism, Stimulism, Galen- 



INTRODUCTION. 3 

ism in the 2d century, Paracelcism in the 16th, and Hahnemannism in the 10th, 
all originated in efforts to find a more rational system of administering medi- 
rines than the prevailing empiricism of the day. 

The illustrious Albrecht von Haller, the father of Physiology and the author 
of the doctrine of Irritability, was the real originator of modern physiological 
therapeutics. In the preface to his Swiss Pharmacopoeia {circa A.D. 1755), 
occur the following remarkable directions, — the first recorded of their kind: — 

"Nempe primum in corpore sano mcdcla tcntanda est, sine peregrina ulla miscella; 
odoreque et sapore ejus exploratis, exigua illius dosis ingerenda ct ad omnes qua; inde con- 
tinguni atTi'itionos, quis pulsus, quis calor, quae respiratio, qurenam excretiones attendendum. 
Inde adductum phxnominorum in sano obviorum, transeas ad experimenta in corpore 
segroto." 

"In the first place the remedy is to be tried on the healthy body, without any foreign sub- 
stance mixed with it; having been examined as to its odor and taste, a small dose is to be taken, 
and the attention directed to all effects which thereupon occur; such as upon the pulse, the tem- 
perature, the respiration, the excretions. Having thereby adduced their obvious phenomena 
in health, you may pass on to experiment upon the sick body." 

Forty or more years after these rules were laid down ex cathedra by Haller, 
the central idea therein was incorporated as one of the main pillars into a med- 
ical edifice then being erected in Germany. In the course of construction this 
pillar became so hidden beneath a superstructure of palpable absurdities, that 
the medical profession, in its anxiety to steer clear of the whole mass, almost 
forgot the corner-stone of truth appropriated from the teachings of one of its own 
greatest teachers. While, however, the mass of the medical profession, blinded 
by prejudice, turned away from everything which savored of drug-experiment, 
a few physicians were quietly working on the lines of Haller's dogma that drug- 
proving is the only true basis 0} drug-using. As a result of their labors the 
present generation sees the development of an idea, announced nearly 150 
\ ears ago, but now inspiring the minds of teachers and students all over the 
civilized world. Medical colleges are recognizing physiological drug-experi- 
mentation as a part of their regular curricula; laboratories are fitted up in 
many of the schools with costly instruments of precision, for the more exact 
prosecution of this study; and under the direction of such men as* Wood, Ringer, 
Murrell, Brunton, Hildebrandt, Fraser, Binz, Liebermeister, Husemann, 
Schmiedeberg, etc., systematic researches are being conducted upon animals to 
ascertain the physiological action of every agent hitherto used in medicine. 
The alkaloids and other active principles of vegetable drugs, together with 
the numerous synthetic compounds which chemistry is giving to medicine, 
are subjected to the same rigid experimentation. The medical press of every 
civilized country is filled with the results of these labors, and no medical stu- 
dent is permitted to pass the graduating ordeal until he has mastered the essen- 
tial characteristics of the physiological action of the important medicaments 
so far as established. What has hitherto been the conviction of but a few, 
is daily gowing into a fixed canon of professional belief, that physiological ex- 
perimentation with drugs must be the basis of their therapeutical employment, 



4 CONSTITUENTS OF ORGANIC DRUGS. 

and that all real advance towards the establishment of therapeutics as a science, 
must be made upon the lines laid down by Haller, namely, drug-proving upon 
the healthy human organism. Still, in the words of Brown-Sequard, "Ther- 
apeutics will cease to be empirical, only when this last kind of knowledge shall 
be fully obtained;" but its fulness will never be fully realized unless the results 
have been thoroughly considered with regard to the differences due to the action 
of drugs in different doses on (he human organism in health and disease. 

A thoroughly-prepared materia medica of half-a-dozen standard drugs, such 
as Aconite, Arsenic, Belladonna, Mercury, Opium and Quinine, based upon 
their actions and uses in different doses and under different states of the organ- 
ism, would be of more real value to the physician who wishes to do his work 
accurately and with his eyes open, than all the contents of the dispensatories, 
plus the entire literature of the "new remedies," and every symptom in the ten 
quarto volumes of the largely discredited and partly repudiated homeopathic 
materia medica. If medical students would devote but one month of their 
annual college vacation to the personal investigation of some one feature of the 
action of some one drug, under such safe-guards against error as would secure 
the acceptance of the resulting observations, a mine of therapeutic gold would 
soon yield its solid truth to eager eyes. Formally laid down by Haller in 1755, 
cultivated to some extent by Alexander in 1768, Crumpe in 1793, Thommassini, 
Curtis, etc., urged by John Hunter, Sir Thomas Watson, Dr. King Chambers, 
and many other luminaries of the medical profession, the scientifically guarded 
proving of drugs on the human organism has lain, like the similar work of Jenner, 
neglected these many years, waiting for another Koch to re-inaugurate the work. 



CONSTITUENTS OF ORGANIC DRUGS. 



Drugs are derived from all the three kingdoms of nature. Those which be- 
long to the mineral kingdom may be termed inorganic drugs and are resolved 
by chemical analysis directly into their ultimate principles, the elementary bod- 
ies of which they are composed. Organic drugs are those which are taken from 
the animal and vegetable kingdoms. They are to some extent composed of 
inorganic materials (water, gases, salts, etc.), but chiefly consist of organic com- 
pounds (proximate principles) obtained by a proximate analysis. The further 
reduction of these proximate principles to their elementary constituents shows 
that Carbon plays the leading role therein, associated with Hydrogen, Oxvgen. 
Nitrogen and other elements. The proximate principles of vegetable drugs 
may be divided into insoluble and soluble groups; the first containing those 



CONSTITUENTS OF ORGANIC DRICS. 5 

which resist the action of ordinary solvents, the second including those which 
may be dissolved in suitable menstrua and thereby separated from those which 
arc not soluble in a particular menstruum. 

The Insoluble Constituents are substances which make up the cell-walls of vegetable 
drugs, namely — Cellulin (Cellulose), Lignin and Sclcrogen. They are extremely intract- 
able to the action of solvents and yet find places in the materia medica under various forms. 
Cellulin in the form of Cotton is used extensively by both the surgeon and the pharmacist, 
and by the action of strong acids or alkalies thereon, there is obtained Pyroxylin (Gun-cot- 
ton), which dissolved in ether makes Collodion. By the destructive distillation of cellulin 
and lignin a large number of solid, liquid and gaseous products are obtained, including acetic- 
acid, methylic alcohol, phenol, creosote and tar. From their natural decomposition result 
amber, coal, coal-tar and the many derivatives of the latter substance. The Soluble Con- 
stituents include some principles which are medicinally inert and also many active principles. 

The Active Principles include carbohydrates, alkaloids, glucosides, neutral 
principles, organic acids, resins, fixed oils and fats, waxes, volatile oils, camphors, 
miscellaneous principles (phenols, ketones, etc.), protein bodies (albuminoids) 
and ferments. Some of these are not proximate principles from the strict chem- 
ical point of view, as they are not simple bodies (e. g., fixed oils, fats, waxes, 
and many of the volatile oils), but for the purposes of the materia medica it is 
convenient to so classify them. Others are active chiefly as foods, though in 
some cases they are employed as medicinal agents. For the methods of ex- 
tracting the soluble principles from drugs see the articles entitled Maceration 
and Percolation, in Part II of this book. 

Carbohydrates are properly regarded as foods rather than as medicines, 
yet many of them possess remedial qualities due to their neutral, bland, demul- 
cent, lubricant, protective or soothing action. They include the Amyloids, 
cellulose, starch, dextrin, inulin, etc., the Sugars, as glucose, levulose, lactose 
(milk sugar), maltose (malt sugar), saccharose (cane sugar), etc., and the Gums 
and Pectin Bodies, as arabin, pectin, bassorin, cerasin, etc. 

Gums are not proximate principles but amorphous, transparent substances which are 
widely disseminated in plants and yield Muck Acid when treated with nitric acid. They 
form sticky preparations with water and are precipitated by alcohol. Arabin is the main 
constituent of soluble gums. Bassorin, which swells up in water, is one of the constituents 
of gum tragacanth, also of cherry and plum gums. [Compare the articles entitled Acacia 
and Tragacantha, in Part I.] 

Alkaloids (alkali, e\8o-;, resemblance) — are organic basic substances exist- 
ing in many plants, usually in combination with organic acids. They readily 
combine with acids to form crystalline salts which are soluble in water, the al- 
kaloids themselves being almost insoluble therein though dissolving in alcohol. 
They are odorless, of more or less bitter taste, and generally possess powerful 
physiological actions. They are easily decomposed by alkalies or alkaline 
carbonates, and are precipitated from their solutions by several reagents, in- 
cluding iodine in a solution of potassium iodide, potassio-mercuric iodide, auric 
chloride, also picric, tannic, phospho-molybdic and phospho-tungstic acids. 
Their Latin names terminate in — ina, their English names in — ine, as Mor- 
phina, Morphine. 



6 CONSTITUENTS OF ORGANIC DRUGS. 

Alkaloids are sometimes called organic or vegetable alkalies, to distinguish 
them from the inorganic or mineral alkalies, which they resemble in little ex 
cept their reaction and basic qualities. The term artificial alkaloid is applie 
to secondary alkaloids derived from natural ones, as Apomorphine. The term 
synthetic alkaloid should be restricted to those which occur in nature but have 
been prepared synthetically, and should never be applied to bases which are 
only obtained by synthesis and do not occur naturally, as Antipyrine, Thallin, 
etc. 

Chemically the alkaloids may be regarded as derivatives of Ammonia (NH,) or ammo- 
nias in which one or more atoms of H are replaced by various radicles. They are believed 
to be decomposition products of vegetable albumin occurring in the plant-cells during the 
process of growth. They all contain the elements C, H and N; most of them also con- 
tain O (amides), and usually occur as crystalline solids which (except Berberine) are color- 
less. A few containing O occur as liquids, namely — Lobeline, Lupuline, Muscarine, Pel- 
letierine and Pilocarpine. Some are devoid of O (amines) and occur as volatile, oily liquids, 
namely — Coniine, Nicotine, Piperidine, Pyridine, Sparteine and Trimethylamine In their 
chemical composition the latter are closely related to Pyridine, C 5 H 5 N, an alkaloid which 
seems to underlie the molecular structure of many others. Some of them may be synthetic- 
ally prepared from the pyridine bases (picoline, collidine, etc.). By changing the chemical 
constitution of an alkaloid its physiological action can be completely altered. 

Allied to the alkaloids are the organic products termed Leucomaines and Ptomaines, the 
former being alkaloidal substances produced by the decomposition of albuminous matter in 
the living animal tissues during the normal destructive metamorphosis, the latter being similar 
substances produced by the process of putrefaction. Many of the ptomaines are identical 
with certain vegetable alkaloids. 

Many so-called alkaloids are in reality mixtures of different alkaloids, e. g., Veratrine. 
Some plants contain more alkaloids than one, including a second which may be similar in 
action to the first but weaker (as Brucine) or antagonistic in action to the principal one 
(as Calabarine). 

The first alkaloid discovered was Morphine, isolated and described by the apothecary 
Sertiirner in 1816. Within sixteen years after that date Strychnine, Brucine, Quinine, Cin- 
chonine, Narcotine, Codeine, Veratrine, Coniine, Atropine, Nicotine, Aconitine and Hyos- 
cyamine were discovered by different chemists. 

Incompatible with the alkaloids are: Alkalies, Alkali Carbonates and Bicarbonate?, 
Benzoates, Bichromates, Bromides of the alkalies, Borax, Cyanides, Gold Chloride, Ichthyol, 
Iodides, Mercuric Chloride, Oxalic Acid, Picric Acid, Piperazin, Potassio-mercuric Iodide 
(when acacia is absent), Oxidizers, Salicylates, Sodium Phosphate, Tannic Acid. Many 
alkaloids are physiologically incompatible with others. 

Twenty-four alkaloids are official, under either their own names or those 
of their salts, including Pelletierine and Veratrine, which are described as mix- 
tures of alkaloids. They are as follows: — 

Aconitina, Aconitine, — from Aconitum Napellus. 

Apomorphina, Apomorphine, — a derivative of the alkaloid Morphine. 

Atropina, Atropine, — from Belladonna and some allied plants. 

Caffeina, Caffeine, — the active principle of Caffea, the coffee plant. 

Cinchonina, Cinchonine, — a minor alkaloid from Cinchona (Peruvian Bark). 

Cinchonidina, Cinchonidine, — another alkaloid from Cinchona. 

Cocaina, Cocaine, — from the plant Erythroxylon Coca. 

Codeina, Codeine, — the second in rank of the Opium alkaloids. 

Colchicina, Colchicine, — the active principle of Colchicum. 

Homatropina, Homatropine, — a derivative of the alkaloid Atropine. 

Hydrastina, Hydrastine, — from Hydrastis canadensis. 

Hydrastinina, Hydrastinine, — a derivative of Hydrastine. 

Hyoscina, Hyoscine, — one of the alkaloids of Hyoscyamus (Henbane) 

Hyoscyamina, Hyoscyamine, — another alkaloid from Hyoscyamus. 

Morphina, Morphine, — the principal alkaloid of Opium. 



! 



I'ONSl'UTKXTS oi- oruaxic drugs. 7 

• 

Pelletierina, PelleHerine, — a mixture of alkaloids obtained from Granatum (Pome- 
granate) 

Physostigmina, Physosligmine, — also called Eserine, — from Physostigma. 
Pilocarpina, Pilocarpine, — the principal alkaloid of Pilocarpus (Jaborandi) 
Piperina, Piperine, — a feeble base obtained from Pepper. 
Quinina, Quinine, — the principal alkaloid of Cinchona (Peruvian Bark). 
Scopolamina, Scopolamine, — from plants of the Solanacece, identical with Hyoscine. 
Sparteina, Sparteine, — a volatile alkaloid from Scoparius. 
Strychnina, Strychnine, — the principal alkaloid of Nux Vomica. 
Veratrina, Ycratrine, — a mixture of alkaloids from Asagnea officinalis. 

Unofficial but Important Alkaloids are the following: — 

Berberina, Berbcrine, — from Berberis, Hydrastis, Calumba, and other plants. 
Brucina, Brucine, — the second alkaloid of Nux Vomica. 
Coniina, Coniine, — the principal alkaloid of Conium (Hemlock). 
Curarina, Cnrarine, — the active ingredient of Curare (Woorara). 
Duboisina, Duboisine, — from Duboisia; identical with Hyoscyamine. 
Emetina, Emetine, — the alkaloid of Ipecacuanha. 
Gelsemina, Gehemine, — the active principle of Gelscmium. 
Muscarina Muscarine, — from the Fly-agaric, a poisonous mushroom. 
Quinidina, Quinidine, — a powerful but scanty ingredient of Cinchona. 

Glucosides (y/.u/.ui, sweet), — form a group of organic principles, existing 
in plants and generally neutral in character. They may be resolved by boiling 
with dilute acids or alkalies, or by the action of ferments, into glucoses (chiefly 
dextrose) or other bodies (mannite, phloroglucin) which themselves yield glu- 
coses, also one or more other bodies (alcohols, aldehydes, phenols, etc.) which 
are different in each case. Thus, Salicin, C 13 H l8 7 , which is a glucoside, by 
the action of a dilute acid is split up into glucose and saligenin, according to 
the following reaction, Ci 3 H )8 7 -f H 2 = C 6 H 12 O (glucose) + C 7 H 2 2 (sali- 
genin). Under the supposition that glucose and its congeners are alcohols it 
is probable that glucosides are the corresponding ethers. Few of them, if any, 
contain N, but they all contain C, H and O. They are often the most active 
of the principles in the plants containing them, but they are more frequently 
associated with other active principles, as alkaloids, oils, resins, etc. Like other 
neutral principles, the glucosides have Latin names which end in — inum, and 
English names ending in — in. The official glucosides are — 

Glycyrrhizinum, Glycyrrhizin, — from Licorice-root. 
Salicinum, Salicin, — obtained from Salix and Populus barks. 

Strophanthinum, Strophanthine — from Strophanthus, and one of the most powerful 
poisons known. 

Unofficial but important Glucosides are the following-named: — 

Adonidinum, Adonidin, — from Adonis vernalis. 
Arbutinum, Arbutin, — from Bearberry leaves. 
Cathartic Acid, — one of three glucosides in Senna leaves. 
Colocynthinum, Colocynthin, — the active principle of Colocynth. 
Convallamarinum, Convallamarin, — from Convallaria majalis. 

Digitalin, Digitalein, and Digitonin, — active principles contained in Digitalis, the last- 
named one anatogonizing the others. 
Ipecacuanhic Acid, — existing in Ipecacuanha. 
Jalapinum, Jalapin, — the active principle of Scammony. 
Saponinum, Saponin, — obtained from Quillaja, the Soap-bark. 



8 CONSTITUENTS OF ORGANIC DRUGS. 

Tannins, except Tannic Acid, which is an organic acid, are considered to be glucosides; 
the chief ones being Caffetannic Acid, CWnotannic Acid and Quercitannic Acid. 

Incompatible with the glucosides are: Acids, Alkalies, Ferments, Lead Acetate and Sub- 
acetate, Tannic Acid, Water (hot). 

Neutral Principles, — are all neutral in character, of various composition 
and powers, and characterized by the absence of basic or other properties which 
would place them in the other groups. Many have a very bitter taste and have 
been therefore called Amaroids or Bitter Principles. Like the glucosides their 
Latin names end in — iniim, their English names in — in. Those which are 
official are the following-named: — 

Aloinum, A loin, — from various species of Aloes. 

Chrysarobinum, Chrysarobin, — obtained from Goa-powder. 

Elaterinum, Elaterin, — extracted from Elaterium. 

Santoninum, Santonin, — the active principle of Santonica (Wormseed). 

Unofficial, but important Neutral Principles are — 

Anemoninum, Anemonin, — a camphoraceous principle from Pulsatilla. 
Cantharidinum, Canlharidin,—the active principle of Spanish Flies. 
Cotoinum, Cotoin, — an acrid principle in Coto Bark. 
Quassinum, Quassin, — a bitter principle in Quassia-wood. 

Besides the above-mentioned principles, there are several other medicinal 
substances bearing names ending in — inum or — in, which have no relation- 
ship to either of the groups previously described. Among them are — ■ 

Chinoidinum, Chinoidin, — an unofficial mixture of alkaloids from Cinchona. 
Gelatinum, Gelatin, — a product from certain animal tissues. 
Glycerinum, Glycerin, — a triatomic alcohol from fats and fixed oils. 
Kaolinum, Kaolin, — a native aluminum silicate. 
Lupulinum, Lupulin, — a glandular powder from Hops. 
Paraffinum, Paraffin, — a mixture of hydrocarbons from Petroleum. 
Vanillinum, Vanillin, — an aldehyde occurring in Vanilla. 

Also Abrin, a toxic albumose in Jequirity-seeds; Ricin, a poisonous ferment in Castor- 
oil seeds; and Benzin, Chinolin, Kairin, Lactophenin, Pancreatin, Pepsin, Phenacetin, 
Piperazin, Pyroxylin, Thallin, and other organic compounds not derived from either the 
animal or vegetable kingdoms but manufactured in the chemical laboratory. 

Organic Acids or Carbon-acids, contain the univalent group CO,H (car- 
boxyl) linked with a hydrocarbon residue. They contain no N, but have acid 
properties, forming salts with bases. The principal organic acids are — ■ 

Official. Unofficial. 

Acetic Acid. Oleic Acid. Agaricic Acid. Malic Acid. 

Benzoic Acid. Salicylic Acid. Angelic Acid. Meconic Acid. 

Camphoric Acid. Stearic Acid. Butyric Acid. Oxalic Acid. 

Citric Acid Tannic Acid. Cerotic Acid. Succinic Acid. 

Gallic Acid. Tartaric Acid. Formic Acid. 

Lactic Acid. Trichloracetic Acid. 

Coloring Matters form a group of bodies having very different properties, 
the nature of many being not yet understood. Among them are — Carminic 
Acid, in the cochineal insect, also in some plants; Carthamin, from the safflower; 



CONSTITUENTS OF ORGANIC DRUGS. 9 

Chlorophyll, in all green parts of plants; Curcumitl, the coloring matter of tur- 
meric; and I hematoxylin, from logwood. 

Resins. The proximate principles called by this name are neither the 
commercial resins nor the resins of pharmacy (see under Resins in Part II), 
all of which are complex bodies, but include only the chemical individuals of 
resinous character existing in nature, as those in Copaiba, Cannabis, Gamboge, 
Guaiac, Gurgun, etc. Even these, in their commercial form, are accompanied 
by other principles. It is difficult to define the resins correctly, but they are 
generally considered to be oxidation products of hydrocarbons, such as terpenes. 
They are mostly brittle, amorphous, uncrystallizable solids, insoluble in water 
but soluble in alcohol, ether, chloroform, benzin, etc. Most of them are of 
acid character, combining with alkalies to form a kind of soap, these "resin- 
soaps" being soluble in water and giving up their resins again to the action of 
acids. They soften or melt when heated and solidify again on cooling. They 
may be obtained from oleo-resins, as turpentine, by simple distillation, the vol- 
atile oil passing over and the resin remaining behind; or by heating the part 
of the plant in which they are contained, as in the case of guaiacum resin. 

The substances ordinarily called Resins are usually classified as follows: — ■ 

True Resins are hard, compact products of oxidation, and are made up chiefly of resin 
acids. Such are Copal, Damar, Mastic, Sandarach, Dragon's blood, Gum-lac and Amber. 

Gum-resins are natural mixtures of gum and resin. When they are rubbed up with 
water the gummy matter dissolves and the resin is suspended in the form of an emulsion. 
[Compare the title Emulsa, in Part II, also the subtitle Gums, p. 5.] Such are Olibanum 
(frankincense), Myrrh, Ammoniac, Asafetida, Galbanum and Tragacanth. 

Oleo-resins include all mixtures of volatile oils and resins of whatever consistency, 
also the Balsams or mixtures of resins with benzoic and cinnamic acids. Such are Copaiba, 
crude Turpentine, Storax, and the true balsams — Benzoin, Balsam of Peru and Balsam of 
Tolu. There are six official oleo-resins, which are described under the title Oleoresin.e in 
Part II. 

Pharmaceutical Resins are solid preparations obtained by precipitating the resinous 
principles of plants from their alcoholic solutions by the agency of water. Three such prep- 
arations are official in the U. S. Pharmacopoeia, and are described under the title Resin.e in 
Part II. 

Fixed Oils and Fats, though usually placed among the constituents of 
animal and vegetable drugs, are not proximate principles, being compound 
bodies containing the radicle Glyceryl, C 3 H 3 , in combination with anhydrides 
of the various fatty acids. The decomposition of these bodies by heating with 
water and an alkali yields the triatomic alcohol Glycerin, C 3 H 5 (OH) 3 , and one 
or more fatty acids (stearic, palmitic, oleic, etc.). The latter combine with the 
alkali, forming soaps, and the glyceryl is converted into glycerin, a portion of 
the water being consumed in the reaction. An exception to this rule is the 
case of Cod-liver Oil, which does not yield glycerin when saponified but oxide 
of propyl. The following-named fixed oils and fats are those which are chiefly 
employed in medicine, viz. — 

Adeps, Lard, — the abdominal fat of the hog. 

Adeps Lanae, Wool Fat, — the purified fat of the sheep's wool. 

Sevum, Suet, — the abdominal fat of the sheep. 



IO CONSTITl ENTS OF ORGANIC DRUGS. 

Cetaceum, Spermaceti,— obtained from the sperm whale. 

Oleum Adipis, Lard. Oil, — expressed from lard. 

Oleum Amygdalae, Almond Oil, — expressed from almonds. 

Oleum Gossypii Seminis, Cottonseed Oil, — from cottonseed. 

Oleum Lini, Linseed Oil, — expressed from flaxseed. 

Oleum Morrhuae, Cod-liver Oil, — from the liver of the cod-fish. 

Oleum Olivae, Olive Oil, — expressed from ripe olives. 

Oleum Ricini, Castor Oil,— from the seed of the castor-oil plant. 

Oleum Theobromatis, Oil of Theobroma, Cacao-butter , — expressed from the seed of 

the Chocolate-tree. 
Oleum Tiglii, Crotnn Oil, — expressed from the seed of Croton Tiglium. 

Waxes are compound bodies, closely allied to fats but containing no gly- 
ceryl, and are usually placed among the proximate principles for sake of con- 
venience. The official wax (Cera) is prepared by the honey-bee. Chinese 
insect wax is the secretion of a coccus upon a variety of ash. Japanese wax is 
obtained from the fruits of several varieties of Rhus. Myrtle wax is obtained 
from the fruits of various species of Myrica. Wax is used in pharmacy; intern- 
ally it is practically inert and harmless. 

Volatile or Essential Oils form a large group of organic bodies existing 
in plants, from which they are usually extracted by distillation with water, 
being volatilizable at the temperature of boiling water. They are generally 
liquid at ordinary temperatures, and when exposed to cold many of them sepa- 
rate into a solid, crystalline portion, called stearoplen, and a liquid portion, 
called elaopten. They are highly odorous, oily, sparingly soluble in water, more 
or less soluble in alcohol and in ether, colorless or yellowish, inflammable, and 
prone to become resinous on exposure to the air. A few consist of but a single 
proximate principle, for example Oil of Betula, which is wholly methyl sali- 
cylate. Most of them are complex bodies, consisting of two or more principles 
which can be separated from each other. The list of the volatile oils is quite 
an extensive one, 33 being official in the U. S. Pharmacopoeia and described 
in Part I of this book under the titles of their respective sources. The group 
may be subdivided into the following classes, viz. — 

Hydrocarbon Oils (or Terpenes), — consist of C and H, most of them having the formula 
C 10 H 16 and being therefore isomeric with rectified Oil 0} Turpentine, which is the type of this 
class. 

Oxygenated Oils, — contain C, H and O, are highly aromatic and usually consist of a 
terpene mixed with an oxygenated principle (an acid, an aldehyde, etc.). The oils of Cin 
namon and Peppermint are examples of this class. 

Sulphuretted Oils, — contain Sulphur in addition to their other elementary constitu- 
ents, and are pungent and disagreeable in odor and taste; as the oils of Garlic and Mus- 
tard. In the latter case the oil is formed by the reaction of the constituent principles in the 
presence of water and does not preexist in the plant. 

Nitrogenous Oils, — contain N, as the compound Cyanogen, CN, in the form of Hydro- 
cyanic Acid, which is formed only after maceration with water. Examples are the oils of 
Bitter Almond, Peach-kernels, etc. 

Camphors are volatile, aromatic principles, composed of ten atoms of C 
with various proportions of H and O. They are solid and crystalline at ordin- 
ary temperatures, and are closely related to the terpenes, with which they are 



CONSTITUKNTS OK OKt.WtC HRUGS. M 

associated in plants and by the oxidation of which they seem to be formed. 
The principal member of the group is the official Camphora, C l0 II 10 O, which 
is described under its own title in Part I. Stearoptens obtained from various 
essential oils are often, though incorrectly, called camphors, as Borneol, Men- 
thol, Eucalyptol, etc. 

Borneol, or Borneo-camphor, C 10 H, s O, — is a secondary alcohol occurring in a tree 
which grows in Borneo anil Sumatra, it may tic formed artificially by healing common 
camphor with alcoholic potash or by treating it with sodium. 

Menthol, or Mint-camphor, C 10 H ;o O, occurs in Oil of Peppermint together with a ter- 
pene and separates in crystals on cooling the oil. It is a secondary alcohol, is official, and 
is described under the title Mentha Piperita, in Part I. 

Miscellaneous Compounds include several organic bodies (phenols, ke- 
tones, etc.) which occur as proximate principles in plants but are not referable 
to the other groups. Among them are — 

Ancthol, C 10 H,,O,— from the oils of Anise and Fennel. 

Apiol, C,,H 14 0~,,,— from the Oil of Parsley. 

Carvol, C 10 HnO, — -from the Oil of Caraway. 

Cineol, Cajuputol or Eucalyptol, C 10 H I3 O, — a liquid obtained from the volatile oils of 

several species of Eucalyptus, also from the oils of Cajuput, Myrtle, Rosemary, Sage 

and Wormseed 
Eugenol, C 10 H 12 O, — from Oil of Cloves and other volatile oils. 
Guaiacol, C 7 H s 2 , — the essential constituent of Creosote. 
Sajrol, C 10 H 10 O 2 , — obtained from the oils of Sassafras and Camphor and the bark of 

several plants. 
Thymol, C 10 H 14 O, — a phenol from Oil of Thyme and other volatile oils. 

Albuminoids or Protein Bodies all contain N, as well as C, O, H and 
Sulphur. They are formed exclusively in plants, in every part of which they 
occur in small amounts but in larger quantities in the seeds. When consumed 
and assimilated by animals they undergo little alteration but enter into the ani- 
mal tissues and form the chief part of the solid constituents of the blood, muscles, 
nerves, glands and other organs. They are chiefly valuable as foods, and may 
be conveniently divided into the following classes: — 

Native Albumins, are soluble in water; as Serum-albumin, Egg-albumin, Plant 
albumin (in the juices of plants). 

Derived Albumins or Albuminates, are insoluble in water but soluble in very dilute 
acids or alkalies; as Syntonin (acid-albumin), Alkali-albumin, Casein, the chief proteid in 
milk, Legumin or plant-casein. Gluten, the chief nitrogenous constituent of the seeds of 
cereals (wheat, rye, etc.), is believed to be a combination of four albuminoids, gluten-fibrin, 
gluten-casein, gliadin and mucedin. 

Globulins, are insoluble in water but soluble in dilute saline solutions and in very di- 
lute acids or alkalies, and include — Globulin (Crystallin), Myosin, Fibrinogen, Vitellin, 
Para-globulin and Globin (residue of Hemoglobin, which forms the chief part of the red 
blood-corpuscles; contains Iron and is closely related to the proteids). 

Fibrin (Animal Gluten), is insoluble in water and sparingly soluble in neutral saline 
solutions and in dilute acids and alkalies. It has a filamentous structure and possesses 
remarkable elasticity. 

Coagulated Proteid, is formed from albumin, fibrin, etc., by the action of heat or alco- 
hol, and is insoluble in water or alcohol but soluble in strong hydrochloric acid and gradually 
in acetic acid. 

Peptones, are formed from albumins by the action of the acid gastric juice. They 
are highly diffusible and readily soluble in water, but are insoluble in alcohol or ether. 

Amyloid Substances, include Ichthin, Ichthidin, Ichthulin and Emydin, which occur 
in the eggs of fishes and amphibii also Lardacein or Amyloid Substance, a pathological 
infiltration into various organs. 



> 



12 CLASSIFICATION OF MEDICINES. 

Collagenes and Mucilaginous Bodies, include Ossein, Collagen (and their derivative 
Gelatin), also Elastin, Chondrin, Keratin and Mucin. 

Ferments are known only by their power of effecting peculiar changes 
in other organic bodies. The true ferment-substances have not yet been iso- 
lated, but they are present in certain preparations obtained from animals and 
plants, the most important of which are named in the following list, viz. — 

Pepsin, — contained in the gastric juice of animals. 
Pancreatin, — obtained from the pancreas of animals. 
Papayotin (Papain), — from the sap of Carica papaya. 
Bromelin, — contained in the juice of the Pineapple. 
Plyalin, — the peculiar ferment of animal saliva. 
Diastase, — formed during the germination of seeds. 
Emulsin, — the ferment occurring in almonds. 
Myrosin, — the ferment contained in mustard-seeds. 

The first four above-named are described under the title Pepsinum, Diastase under 
Amylum, Emulsin under Amygdala, and Myrosin under Sinapis, in Part I of this book. 



CLASSIFICATION OF MEDICINES. 



In the present state of knowledge respecting the actions and uses of medi- 
cinal agents, no really scientific classification of these substances is possible. 
Some writers have adopted a system based on the natural relations of the various 
articles to each other, while many classify them according to their effects on the 
human system, and others make no attempt at arrangement but treat of them 
in alphabetical order. The latter method has been chiefly followed in this 
work, from a conviction that every medicine should first be studied as an in- 
dividual, both with respect to its physiological actions and its therapeutical 
applications. When the student has thus made himself familiar with the char- 
acteristic features of each article of the materia medica, he may begin, by com- 
paring one with another, to seek acquaintance with their more delicate lights 
and shades. Some system of classification then becomes imperative as an aid 
to the memory, and as the titles of the groups to which the various agents belong 
in any physiological classification are also used to express their actions and 
uses, the following synopsis is inserted as an appropriate introduction to the 
section on Materia Medica and Therapeutics. 

Accommodation of the Eye is impaired or paralyzed by the following 
named drugs, acting upon the ciliary muscle, viz. — 

Atropine. Homatropine. Cocaine. 

Daturine. Physostigmine. Gelsemine. 

Hyoscyamine. Pilocarpine. Coniine. 



CLASSIFICATION OF MEDICINES. 13 

Intraocular tension is increased by Atropine (large doses), Hyoscyamine and Daturine; 
and is decreased by Physostigmine and by Cocaine. Gelsemine paralyzes the external 
ocular muscles, especially the levator palpebral and external rectus, by its action on the 
terminal nerve filaments. 

Acids are compounds containing the electro-positive element Hydrogen 
united directly to strongly negative elements, or as the negative radicle Hydroxyl 
(HO) united to positive elements. The terminal syllables of their names indi- 
cate the comparative amount of oxygen or other electro-negative constituent 
present, those terminating in -ic having the greater quantity, those ending 
in -ons having the lesser quantity. When there are more than two such com- 
binations the prefix hyper- is affixed to the highest, and hypo- to the lowest. 
Many strong acids (as hydrochloric) contain no oxygen, but all contain hydro- 
gen. They change the color of litmus from blue to red, and unite with bases 
to form salts. Their physiological actions are chiefly due to their powers of 
neutralizing alkalies, withdrawing water from the tissues, and precipitating 
the globulins and some other proteids. They are poisonous to protoplasm, 
somewhat antiseptic, and many of them are powerfully corrosive to the tissues. 
Taken internally in dilute solution they have a sour taste, and cause an astrin- 
gent sensation in the mouth and throat, induce a reflex flow of saliva, and in 
the stomach displace weaker acids from their combinations. Applied to the 
mouths of ducts from glands having an alkaline secretion they stimulate the 
latter, but check the secretion of glands producing acid secretions. This doc- 
trine has but a limited application, as they do not pass beyond the stomach 
in their own form, though they increase the flow of the alkaline pancreatic juice 
by reflex action. In the blood and tissues they exist as salts by combination 
with the alkalies of the body, and if administered in sufficient quantity to neu- 
tralize the latter the animal dies, its blood being unable to carry carbon dioxide 
from the tissues to the lungs. They are rapidly excreted by the kidneys as 
acid salts, increasing the acidity of the urine. Therapeutically they are em- 
ployed locally as caustics, styptics and anhydrotics, and internally in very di- 
lute form as refrigerants, stomachics, astringents, hemostatics, and antidotes 
in poisoning by alkalies. 

Incompatible with Acids generally are: Alcohol with strong acids; Alkalies, Alkaloids; 
Benzoates and Borates with strong acids; Bismuth and Ammonium Citrate, Bicarbonates, 
Bromides of weak bases, Carbonates, Chlorides of weak bases, Glucosides, Iodides of weak 
bases, Metallic Salts with organic acids, Pancreatin, Potassium and Sodium Tartrate, Potas- 
sium Tartrate, Salicylates, Silicates. [See also the particular Acids in Part I.] 

Alkalies are compounds possessing certain properties in common, viz. — 
solubility in water, neutralizing acids and with them forming salts, saponify- 
ing fats, changing reddened litmus back to its original blue color, and altering 
the color of turmeric from yellow to brown. The alkalies proper are the five 
fixed alkalies, Potassa, Soda, Lithia, Caesia, and Rubidia, which are hydrated 
oxides of the corresponding alkali metals, and the volatile alkali Ammonia, a 



> 



14 CLASSIFICATION OF MEDICINES. 

gaseous compound of N and H 3 . They are strong, electro-positive bases, unit- 
ing with acids to form salts. The oxides of calcium, barium, strontium and 
magnesium are called alkaline earths, are but slightly soluble in water, and 
much less corrosive than the alkalies proper. In medicine the term alkali 
includes also such salts as have an alkaline reaction, as carbonates, bicarbon- 
ates, and borates. 

The physiological action of the hydrates and carbonates of the alkali metals 
is due entirely to their powerful hydroxyl constituent, and depends chiefly on 
their powers of neutralizing acids, dissolving proteids, saponifying fats, and 
abstracting water from the tissues. In solid form or concentrated solutions 
they are energetic corrosives, destroying all living tissues with which they come 
into contact, the hydrates being the most powerful in this respect. In weak 
solutions locally they stimulate the cells of the skin and soften the epidermis. 
Taken internally in dilute solution they have a characteristic taste, and dissolve 
the superficial layers of the mucous membrane of the mouth and the mucus 
of the secretions. Small quantities are neutralized in the stomach by the hydro- 
chloric acid of the gastric juice, larger ones neutralize or alkalinize the stomach 
contents and stop the gastric digestion, slightly irritate the walls of that viscus, 
improve its circulation, and dissolve its mucus. Applied to the mouths of ducts 
of glands they are said to stimulate acid secretions and check alkaline secre- 
tions, but this is denied by experimental physiologists for the gastric juice, and 
is shown to be true for the pancreatic secretion only indirectly by diminishing 
the acidity of the fluid passing through the pylorus. The prolonged admin- 
istration of large doses of the alkaline carbonates and bicarbonates causes chronic 
gastro-enteritis in animals. Concentrated solutions of alkalies corrode the walls 
of the esophagus and stomach, and may prove fatal by causing perforation into 
the peritoneal cavity. Alkalies have but little influence on metabolism and 
uric acid excretion, other than that due to their action on digestion. They are 
rapidly excreted by the kidneys as bicarbonates, rendering the urine less acid 
or even alkaline in reaction. 

Incompatiblcs. Alkalies are incompatible with many substances. They neutralize free 
acids, and precipitate alkaloids and soluble non-alkaline metallic salts. Caustic alkalies 
decompose Bromoform, Chloroform, Chloral, Copaiba, Glucosides, and Resin. Strong al- 
kalies decompose salts in solution which have weak or volatile bases. [See also the individual 
alkalies, Potassium Hydroxide, etc., in Part I.] 

Alkalies may be subdivided into two groups, named, from their physiological 
actions, Direct Antacids, those which lessen acidity in the stomach, and Indirect 
or Remote Antacids, which have no power over acidity in the stomach, but are 
oxidized in the blood, and excreted as carbonates in the urine, decreasing its 
acidity. The following List of Alkalies comprises the chief members of both 
groups, and also some which have the actions of both. They should all be 
largely diluted before administration. 



CLASSIFICATION OF MEDICINES. 15 

Direct Antacids. Remote Antacids. 

(Lessen Acidity in the Stomach.) (Lessen Acidity oj the Urine.) 

Liquor Potassii Hydroxidi. Liquor Potassii'IIydroxidi. 

Liquor Sodii Hydroxidi. Liquor Sodii Hydroxidi. 

Carbonates and Bicarbonates of Potas- Carbonates and Bicarbonates of K, Na, 

sium, Sodium, Lithium, Magnesium Li, Mg and NH,. 

and Ammonium. Potassium Acetate and Citrate. 

Lime-water. Chalk. Magnesia. Sodium Acetate and Citrate. 

Aromatic Spirit of Ammonia. Sodium Phosphate. Lithium Citrate. 

Alteratives are remedies which alter the course of morbid conditions in 
some way not yet understood, perhaps by promoting metabolism. They cer- 
tainly modify the nutritive processes and thereby cure many diseases of chronic- 
type. Mercury and Iodine are the most prominent agents of this class, the 
former being endowed with the power of breaking up newly deposited fibrin 
and disorganizing syphilitic deposits, while the latter acts energetically upon 
the lymphatic system and promotes absorption. Arsenic also is almost speci- 
fic in many chronic skin affections, and has remarkable power over chronic 
pulmonary consolidations, probably producing fatty degeneration and soften- 
ing of the effusion, so that it may be absorbed or expectorated. The principal 
alteratives are — 

Arsenic. Mercury. Iodine. 

Antimony. Colchicum. Iodides. 

Aurum. Guaiacum Stillingia. 

Mezereum. Sanguinaria. Sarsaparilla. 

Sulphur. Xantho.xylum. Cod-liver Oil. 

Sulphides. Calcium Chloride. Phosphorus. 

Amblyopia, or impairment of vision from nerve-changes, is produced 
temporarily by Quinine, and may be permanently induced by Tobacco and 
Alcohol, also by Lead and Urea poisoning. 

The sensibility of the eye is increased by Strychnine, the field of vision becoming en- 
larged, and the vision rendered more acute. If the drug be administered hypodermically 
the improvement will be more marked in the eye corresponding to the side of the body whei e 
the injection was made. The sensibility for color is affected by drugs, Strychnine increas- 
ing the field for blue, Eserine diminishing it for red and green, and Santonin causing objects 
to appear at first of a violet and afterwards of a greenish-yellow color. 

Analgesics or Anodynes («», without, akyoq^ pain, 6d6v7j f pain), — are rem- 
edies which relieve pain either by direct depression of the centres of perception 
and sensation in the cerebrum, or by impairing the conductivity of the sensory 
nerve fibres. Opium is the most efficient of all analgesics, because it arrests 
the afferent impressions at every step of their track — at their formation, along 
the course of their conduction, and at the point where they impinge on the sen- 
sorium. The Local Anodynes are described under Anesthetics; the list of 
General Anodynes includes the following-named agents: — 

Opium, Morphine. Antipyrine. Aconite. 

Belladonna, Atropine. Acetanilide. Chloroform, Ether, etc. 

Cannabis Indica. Phenacetin. Conium 

Stramonium. Phenocoll. Hydrated Chloral 

Hyoscyamus. Exalgin. Croton-chloral. 

Gelsemium. Lupulus. 



; 



1 6 CLASSIFICATION OF MEDICINES. 

Anaphrodisiacs (d», without, A(ppo5izr h Venus), — are medicines and meas- 
ures which lower the sexual function and diminish the sexual appetite. They 
act by lessening the excitability of the nerves of the genital organs, by depress- 
ing the genital centres in the brain and cord, or by decreasing the local circu- 
lation. The principal anaphrodisiacs are named in the following list. [Com- 
pare Aphrodisiacs.] 

Bromides. Tobacco. Nauseants. 

Potassium Iodide. Digitalis. Purgation. 

Camphor (at last). Conium. Venesection. 

Opium (at last). Belladonna. Ice, locally. 

Lupulin. Stramonium. Cold Baths. 

Cocaine. Gelsemium. Vegetable Diet. 

A few drops of a 4 per cent, solution of Cocaine upon the glans penis will destroy all 
erection-power for a quarter to half an hour. 

Anesthetics (av, without, 'uaOrjUK;, perception), — are agents which tem- 
porarily destroy sensation. The Local Anesthetics are described below. The 
General Anesthetics include certain volatile substances, mostly belonging to the 
chemical groups named alcohols and ethers, which when inhaled sufficiently 
produce complete unconsciousness and loss of sensation (anesthesia), also less- 
ened motor power. Narcotics also produce more or less anesthesia, but this 
term is usually restricted to the effects of the volatile agents referred to above. 
The principal members of this group are — 

Ether (Ethyl Oxide). Chloroform. 

Methylene Bichloride. Ethyl Chloride. 

Ethylene Bichloride. Ethyl Bromide. 

Xilrous Oxide. Pental (Tri-methyl-ethylene). 
The list of General Anesthetics also includes Alcohol and many substitution products 

derived from alcohols and ethers. [Compare the articles entitled Alcohol, ^Ether axd 
Chloroform in Part I.] 

Local Anesthetics and Anodynes (dv, without, odwyj, pain), — reduce the 
functions of the sensory nerves until they lose the power of receiving or con- 
ducting sensations. Some act by direct depression of the end-organs in the skin, 
etc., others by impairing the conductivity of the sensory nerves, while some act 
indirectly by reducing the local circulation. The Anodynes diminish, and the 
Anesthetics destroy, for a time, the sensibility of the skin and mucous mem- 
branes to which they are applied. The chief members of this class are named 
in the following list: — 

Local Anesthetics. Local Anodynes. 

Extreme Cold. Ice. Aconite, Aconitine. 

Ether Spray. Belladonna, Atropine. 

Ethyl Chloride. Opium, Morphine. 

Cocaine, Eucaine. Veratrine. 

Tropacocainc. Menthol. 

Chloretone. Hydrocyanic Acid. 

Ouabain. Phenol. 

Antipyrine, Acetanilidc. Chloroform, Ether, Alcohol. 

Erythrophkrin. Hydrated Chloral. 

Hydrocyanic Acid. Sodium Bicarbonate. 

Creosote, Guaiacol. Zinc Oxide. 

Iodoform. Oil of Turpentine. 

Orthoform. Volatile Oils. 

Phenol. Galvanism. 



a OSSIFICATION OF MEDICINES 17 

Anhidrotics («v, without, ?<V'"<v sweat), — arc agents which check perspi 
ration, and arc the opposites of the Diaphoretics, which promote tins secre- 
tion. They usually act either — 

1. By depressing the action of the sweat-glands, 

.'. By depressing the excitability of the sweat-centres, 

3. By reducing the circulation in the skin. 

The most important agents of this class are those named in the following 
list, the figures indicating their mode of action as above arranged. 

Belladonna. 1 Acids, locally. 8 Chloralformamide. 

Atropine. 1 Pilocarpus. Quinine (?). 

Hyoscyamus. 1 Pilocarpine. Picrotoxin. 

Stramonium. 1 Nux Vomica. Dover's Powder. 

Muscarine. 2 Strychnine. Opium 2 (small doses). 

Agaricus Albus. 3 Ergot. 3 Zinc Salts. 3 

Salvia (Sage). Sulphuric Acid. Local Cold. 3 

Strychnine, Atropine, Dover's Powder, Pilocarpine, Picrotoxin and Zinc Salts are all 
respiratory stimulants, and very efficient against the sweating of phthisis, though most of 
them are classed as diaphoretics. This is explained by the theory of accumulation of car- 
bonic acid in the blood by depressed respiration caused by severe coughing, this stimulat- 
ing the sweat-centres, and being opposed by agents which stimulate the respiratory centre. 

Antagonists are agents which directly oppose each other in some or all 
of their physiological actions, and may be used against each other to counter- 
act their effects upon the organism. Antagonistic action takes place in the 
blood and tissues, after the absorption of both the poison and the antagonist; 
it is available against poisons administered hypodermically as well as by other 
channels, and so far as drugs are concerned it is applicable chiefly to vegetable 
poisons or to those which produce their toxic effects after absorption. In most 
cases of poisoning by vegetable principles absorption has proceeded so far be- 
fore professional assistance is obtained that the time for antidotes has passed, 
and reliance can be placed only upon the physiological antagonists and such 
antagonistic measures as may support vitality until the poison can be eliminated 
by the excretory organs of the body. There may be an exception to this rule 
in the case of Morphine, which, after making the round of the circulation, con- 
stantly returns in part to the stomach until finally eliminated, so that repeated 
washing of that organ with a solution of potassium permanganate, or the in- 
gestion thereof from time to time, may have a continuous antidotal action on 
such portion of the poison as may have been absorbed. [Compare Antidotes.] 

Antagonistic Measures include all such procedures as may tend to antag- 
onize any remote effects of poisons, as artificial respiration, faradization of the 
respiratory muscles, constant motion or absolute repose, application of heat 
or cold, douching, etc. 

Thus, in the case of poisoning by Digitalis the antagonists which will counteract the 
effects of such portion of the drug which has been absorbed are the following: Aconite or 
Morphine against the cardiac action, the former for the effects of large doses, the latter for 
those of the long-continued use of the drug. Saponin and Senegin are the most complete 
antagonists against Digitalis, their counteraction extending throughout nearly its entire range 
of action. Alcohol is also indicated, as a cardiac stimulant, and absolute Rest in the recum- 



> 



l8 CLASSIFICATION OF MEDICINES. 

bent posture is an antagonistic measure of prime importance, by reason of the liability to 
sudden cessation of the lowered cardiac action on the assumption of the erect posture by 
the patient. 

In Part I of this book, under the several titles of the poisonous drugs, their most effi- 
cient Antidotes and Antagonists are not mentioned; but these are fully described and 
arranged in a form suitable for reference under the caption Poisoning in Part III. 

Physiological Antagonism means a balance of opposed actions on particular 
organs or tissues, excited by medicinal agents and measures or by disease. It 
may extend throughout the whole or the greater part of the range of action of 
the opposing agents, or, as is usually the case, may be limited to a few points 
thereof. There is no instance in which the antagonism of two drugs is abso- 
lutely complete along their whole line of action. In a few cases it is nearly 
so; as with Morphine and Atropine (except as to narcotism), Digitalis and 
Saponin, and Atropine and Muscarine, the latter being considered the most 
complete instance known. In most cases the antagonism extends only to cer- 
tain definite spheres of action, and the antagonists therein may be synergists 
to each other in other spheres, as the narcosis produced by both Morphine and 
Atropine. It may be local, affecting a single organ or function, or it may ex- 
tend to a group of organs, to several associated functions, or over the distri- 
bution of the nerves proceeding from a single nerve-trunk (as the vagus) or 
controlled by a single nerve-centre. Antagonism implies a balance of func- 
tional disturbance, not an alteration of structure. 

Drugs are rarely antagonistic to each other in the same degree, but, by 
reason of differences in their mode and time of action, the action of one pre- 
ponderates over that of the other, so that the latter will not counteract the former 
to the extent of averting a fatal result, though in the reverse order their counter- 
action may be most satisfactory. For example, while Chloral is the antagonist 
to Strychnine, opposing as it does the spinal action of the latter drug, the reverse 
is true to a very limited extent; and, while Atropine may prevent death from 
a lethal dose of Aconitine, Morphine or Bromal Hydrate, no one of these three 
will do so in atropine poisoning. 

Two mutually antagonistic principles may exist in the same plant, as the 
alkaloids Pilocarpine and Jaborine in pilocarpus, and the glucoside constituents 
of digitalis, one of which, Digitonin, antagonizes the actions of the other three, 
Digitalin, Digitoxin and Digitalein. 

Toxicological Antagonism is a very ancient idea in medicine. Mithridates of Pon- 
tus (b. c. 164-124) and other monarchs of the heathen world occupied themselves with the 
study of poisons and their antidotes and antagonists, established botanical gardens for the 
purpose of their investigation, and gave their names to what were supposed to be universal 
preventives against the results of poisoning. In the 16th century Prosper held that theriaca 
(opium) was an antagonist to all poisons. From 1570 to 1677 many observations were 
made and published on the treatment of belladonna poisoning by opium, and in 1810 the 
same matter was made the subject of an inaugural thesis by Lipp. The scientific investi- 
gation of drug action and antagonism was not possible until the discovery and isolation 
of the alkaloids, but followed immediately thereafter, and was begun in 1809 by Magendie 
upon the upas poison (nux vomica) and its newly discovered alkaloid, strychnine. In 1869 
Schmiedeberg and Koppe made their researches on muscarine and atropine, and Liebrich 
discovered chloral and proved the antagonism of strychnine to its action, the converse of 



II \SS1I U'VIIOX OV MKhll'lM S. 



19 



which was shown bj Bennett in 1 S75. In 1870 Fraser published his investigations upon 
atropine and physostigma, and Preyer his on the antagonistic influence of atropine and 
hydrocyanic acid on respiration. In 1875 a committee of the British Medical Association 
made an extended investigation and report on the antagonisms of several drugs, which was 
supplemented by the work of Vulpian on atropine and pilocarpine in the same year, that 
of Fothergill in 1877 on aconite, atropine and digitalis, and that of lluseman on the antag- 
onisms of chloral. Much good work has also been done in England by Brunton and Rin- 
ger, and in the United States by Wood and Bartholow, on the same lines. The name of 
Brunton is unalterably associated with the antagonism between amy] nitrite and the spas- 
modic paroxysm of angina pectoris, a discovery in therapeutic antagonism which was made 
by him through the exercise of purely scientific reasoning and which has since been applied 
to the similar paroxysm induced in poisoning by certain drugs, as cocaine. 

The following table, modified from Brunton, gives the antagonistic poisons, also their 
mutual antagonistic and lethal doses in each case in which they have been determined. The 
doses are expressed in grains or fractions of a grain per pound weight of the animal. 

Table of Antagonistic Poisons. 



\\ l'AGONISTS. 



II. 



Aconitine and Atropine,. . 

" " Digitalin,.. 

" Strychnine, 

Alcohol and Strychnine,.. 

Atropine and Aconitine,.. 

Chloral,. 



" Hydrocyanic Acid,. 

" Muscarine 

" Morphine 

" Pilocarpine, 

" Phytolaccine, 

" Phvsostigmine, 

" Quinine, 

Bromal Hydrate and Atropine,.. 

Chloral and Atropine 

" Picrotoxin, 

" Physostigmine, 

" Strychnine, 

Chloroform and Amyl Nitrite, . . . 

Digitalin and Aconitine, 

" Muscarine 

" Saponin, 

Gelsemium and Opium, 

" Atropine, 

Morphine and Caffeine, 

" Chloroform, 

Muscarine and Atropine, 

Opium and Atropine 

" Gelsemium, 

" Veratrum Viride, 



ANTAGONIS- 
TIC DOSE. 



II. 



LETHAL 
DOSE. 



7 


Stiff 


7 


7 


7 





7 





7 


3 


7 


. . .. 


7 




7 
7 


53 
1* 


55TT 


7 


7 


7 


7 





7 


2o 


7 





7 







2"ff7 

■5<nr 


i 


1 


3 
i 


7 
if 


— 


7 


— 


7 



: 



Anthelmintics («kt£, against, iX/nvt;, a worm), — are agents which destroy 
(vermicides) or expel (vermifuges) worms inhabiting the intestinal canal. The 
principal vermifuges are the purgatives Castor Oil, Jalap and Scammony; while 
the vermicides are classed according to the worm they are each most efficient 
against, thus, — 



> 



20 CLASSIFICATION OF MEDICINES. 

Thread Worms Round Worms Tape Worms 

(Oxyuris Vermicularis). (Ascaris Lumbricoides). (Tenia, etc.). 

Alum. Santonica. Aspidium. 

Sulphate of Iron. Santonin. Kamala. 

Lime Water. Spigelia. Kousso. 

Quassia. Chenopodium. Granatum. 

Eucalyptol. Senna 1 with the Pelletierine. 

Hum Chloride. Calomel / above. Pepo. 

Tannin. Naphthalene. Turpentine. 

Veg. Astringents. Papain. Chloroform. 

Naphthalene. Naphthalene. 

The substances enumerated in the first column are all used locally by enema. Adjuncts 
to these remedies are such agents as prevent the excessive secretion of intestinal mucus, which 
affords a nidus for the worms. Such are Bitter Tonics and preparations of Iron, also Am- 
monium Chloride and Sodium Chloride. Thymol is specific against the hook-worm (an- 
kylostomum duodenale). 

Antidotes (avri, against, SiSmfit, I give), — are agents which affect a poison 
either physically or chemically, or both, so as to remove it from the body or 
alter its character by forming with it an insoluble or inert compound before 
its absorption, with the object of preventing its toxic action upon the organism. 
Antidotes do their work in the alimentary canal or in the respiratory passages, 
and are applicable to vegetable as well as mineral poisons, but are not avail- 
able against poisons administered hypodermically. They include sundry chem- 
ical substances, also measures of various kinds, and may be divided into two 
classes: (i) Chemical or True Antidotes, which unite chemically with the poison, 
converting a soluble and absorbable substance into a compound which is more 
or less insoluble and non-absorbable, or harmless though soluble; (2) Mechan- 
ical Antidotes or Antidotal Measures, which include such medicinal or mechan- 
ical processes as tend to remove a poison from the body, either before or after 
the use of an antidote; and include emesis, the use of the stomach-pump, pur- 
gation, etc. The term Antidotal Treatment covers the employment of both 
antidotes and antidotal measures, and is often used in a still wider sense, namely, 
to mean all the treatment of a case of poisoning, including the use of Antagon- 
ists as well as that of Antidotes. [Compare Antagonists.] 

Thus, Tannic Acid is the antidote for poisoning by Digitalis, as it forms with the active 
toxic principles of the drug chemical compounds (tannates) which are almost insoluble and 
therefore comparatively harmless. But as these tannates are not entirely inert, an antidotal 
measure, evacuation of the stomach, must also be employed, by the administration of Zinc 
Sulphate or any other emetic, or by the use of a stomach-pump. 

Antiperiodics are remedies which affect certain periodical febrile diseases, 
lessening the severity of their paroxysms or preventing their return. They act 
probably by arresting the development in the blood of successive crops of patho- 
genic organisms, upon which the disorders are supposed to depend. The prin- 
cipal antiperiodics are — 

Cinchona Bark and its alkaloids, especially Quinine. Arsenic. 

Bebeeru Bark and its alkaloid Berberine. Eucalyptol. 

Salicin, Salicylic Acid, Salicylates. Iodine. 

Opium and its alkaloid, Narcotine. 
Quinine is the most powerful antiperiodic and Arsenic ranks next in order of efficiency. 



CLASSIFICATION OF MKWCINF.S. 



21 



Antiphlogistics (avri, against, yXoyiZio, I burn), — are measures and medi 
tines which are supposed to have some specific power in reducing inflamma- 
tion. The term is becoming obsolete, but frequent references arc still seen to 
the influence of Mercury and Opium in inflammations of serous membranes, 
Antimony and Aconite in inflammations of the respiratory tract and organs, 
and to the power of Ycratrum Viride over puerperal metritis. The chief anti- 
phlogistics are — 



Aconite. Opium. 
Veratrum Viride. 

Tartar Emetic. 

Mercury. 

Gelsemium. 



Digitalis. 

Ergot. 

Ipecacuanha. 

Potassium Nitrate. 

Rest (recumbent position). 



Venesection. 
Local Depiction. 
Purgation. 
Counter-irritation. 
Cold (locally). 



Antipyretics (avri, against, 7ruperd<;, fever), — are agents or measures which 
reduce the body-temperature when abnormally high. This may be done by 
two principal methods, and the agents doing either accomplish the result by 
five different actions, as follows, viz. — 

, -, t • ,7 t> j , • : ht , l f i- Diminishing tissue-change. 

(a) Lessening the Production of Heat, by . . { „ , ,? ■ , .. & 

ft ' J \ 2. Reducing the circulation. 

r 3. Dilating the cutaneous vessels, and pro- 
ducing increased radiation. 

(b) Promoting the Loss 0} Heat, by J 4. Producing perspiration, and its evap- 

j oration. 

v. 5. Abstracting heat from the body. 

The following list contains nearly all the antipyretics, the numbers follow- 
ing each referring to its proper method of action, as enumerated above: — 



: 



Quinine. 1 

Quinidine. 1 

Cinchonine. 1 

Cinchonidine. 1 

Berberine. 1 

Benzoic Acid. 1 

Phenol. 1 - 3 

Picric Acid. 1 

Salicin. 1 

Eucalyptol. 1 

Thymol. 1 

Other Essential 

Alcohol. 1 - 3 

Digitalis. 2 

Aconite. 2 

Camphor. 1 



Oils. 1 



Salicylic Acid. 1 
Sodium Salicylate. 1 ' 1 
Quinine Salicylate. 1 
Methyl Salicylate. 1 

(Oil of Gaultheria.) 
Trimethylamin . 2 
Salol. 1 

Acetanilide. 1 ' 4 
Antipyrine. 1 ' 4 
Antimonials. 2 ' 4 
Veratrine. 2 
Colchicum. 2 
Leeching. 2 
Cupping. 2 
Blistering. 2 
Poulticing. 2 



Acetphenetidin. 1 ' 4 
Chinolin. 1 
Resorcinol. 1 
Kairin. 1 ' 4 
Kairolin. 1 ' 4 
Hydroquinon. 1 
Thallin. 1 ' 4 
Pyrocatechin. 1 
Pheno-resorcin. 1 
Nitrous Ether. 3 ' 4 
Dover's Powder. 4 
Cold Bath. 5 
Cold Drinks. 5 
Ice to Surface. 5 
Cold Sponging. 5 
Wet Packing. 5 



Purgation and Venesection produce antipyretic results, but their mode of action is doubt- 
ful (Brunton). The Body-temperature is raised by Belladonna (or Atropine) and by Co- 
caine, but not to such a degree as to constitute fever or enable them to be classed as pyretics. 
Tuberculin, various albumoses, and certain animal poisons, as that of shell fish, will also 
produce a rise of temperature. 

Antiseptics and Disinfectants. Antiseptics, (avri, against, <?#<?, putre- 
faction), are agents which arrest the development of the micro-organisms which 
produce decomposition. In stronger solutions than those required for their 
antiseptic action, most of the antiseptics are germicidal and are therefore dis- 
infectants; while all disinfectants are antiseptics. The chief antiseptics are 



22 



CLASSIFICATION OF MEDICINES. 



named in the following list, the figures giving the minimum strength of their 
effective solutions, though these figures cannot be applied to all bacteria and 
their spores indiscriminately: — 



) 



Mercuric Chloride, i : 50,000 
Mercuric Iodide, 1 : 40,000 
Formaldehyde, 1 : 25,000 
Silver Nitrate, 1 : 12,500 
Aluminum Acetate, 1 : 6,000 

olin, r : 5,000 
Chlorine, 1 : 4,000 
Creosote, 1 : 3,000 
ISTaphthol, 1 : 3,000 
Copper Sulphate, 1 : 2,000 
I'voktanin, 1 : 2,000 
Bromine, 1 : 1,666 
Thymol, 1 : 1,500 
Salicylic Acid, 1 : 1,500 
Eucalyptol, 1 : 1000 
Hydrogen Dioxide, 1 : 1,000 
Calcium Hypochlorite, 1 : 1,000 
Trikresol, 1 : 1,000 
Benzoic Acid, 1 : 900 
Sulphuric Acid, 1 : 800 
Quinine Sulphate, 1 : 800 



Zinc Chloride, 1 : 500 
Phenol, 1 : 333 
Alcohol (absolute), 1 : 333 
Potassium Permanganate, 1 
Acetic Acid, 1 : 250 
Alum, 1 : 222 
Ferrous Sulphate, 1 : 200 
Coffee (freshly roasted), 1 : 
Arsenic Trioxide, 1 : 166 
Boric Acid, 1 : 143 
Hydrated Chloral, 1 : 107 
Resorcinol, 1 : 100 
Antipyrine, 1 : 25 
Calcium Chloride, 1 : 25 
Zinc Sulphate, 1 : 20 
Sodium Borate, 1 : 14 
Potassium Bromide, 1 : 10 
Potassium Iodide, 1 : 10 
Ammonium Chloride, 1 : 9 
Sodium Chloride, 1 : 6 
Glycerin, 1 : 4 



300 



The best antiseptics for surgical use are those which act sufficiently on micro-organisms 
without injuring or irritating the tissues. The Mercuric Salts are very poisonous. Chlorine, 
Bromine, and Iodine are too irritant. Benzoyl-acetyl Peroxide, though actively germicidal, 
has no antiseptic power, on account of its proneness to break up in the presence of organic 
substances (Novy). Salol is of little value itself, but the products of its decomposition in 
the intestines are active germicides, and it is one of the best intestinal antiseptics (Wood). 
Benzoic Acid and Naphthol are good intestinal antiseptics, but complete asepsis in this situ- 
ation is impossible. 

Disinfectants are agents which destroy the specific germs of infectious dis- 
eases. Many antiseptics do not possess germicidal power, and therefore are 
not disinfectants; but all disinfectants are antiseptics. Disinfectants act in 
several ways, some as oxidizants, others by combining with albumin, others by 
chemical combination forming substitution-compounds, others by arresting 
molecular changes, and still others by altering the reaction of the media con- 
taining the germs. The principal disinfectants are named in the following 
list, the figures following each giving the strength of its aqueous or aerial solu- 
tion necessary for rapid and certain action: — 



Fire, the most efficient. 

Heat, moist, at 212 F. 

Heat, dry, at 302° F. 

Benzoyl -acetyl Peroxide, 1 : 1,000 

Mercuric Chloride, 1 : 1,000 

Iodine, 1 : 500 

Bromine, 1 : 500 

Benzoic Acid, 1 : 250 

Salicylic Acid, 1 : 200 

Formaldehyde, 1 : 100 

Hydrogen Dioxide, 1 : 100 

Potassium Permanganate, 1 : 100 

Chlorine, 1 : 100 



Chloretone, 1 : 100 
Calcium Hypochlorite, 1 
Eucalyptol, 1 : 100 
Creolin, 1 : 100 
Lysol, 1 : 100 
Trikresol, 1 : 50 
Phenol, r : t,^ 
Sulphurous Acid, 1 : 25 
Liq. Soda Chlorinatae, 1 
Ferrous Sulphate, 1 ■ 20 
Acetic Acid, 1 : 14 
Lime, fresh, 1 : 4 
Zinc Chloride, 1 : 2 



Many good disinfectants are not available by reason of cost or some side action, as Hy- 
drogen Dioxide, Bromine, Iodine, Potassium Permanganate. Formaldehyde is the best 



il VSSIIK'ATION OK MI'.DICINES. 2$ 

surface disinfectant, but has slight penetrating power. It has the advantage oi being 

toxic and not retarded in action D) albuminoid matter. Sulphurous Icidfooi verj doubtful 
value, even when present in the extent of \o per cent, in moist air (Koch). Chlorine is used 
rather as a deodorant than a disinfectant, its germicidal power being uncertain (Munson). 

Burnetts Fluid is a 50 per rent, solution of Zinc Chloride, and equivalent t<> tin offi< i J 
Liquor Zinci Chloridi. Labarraque's Solution is the same as the official Liquor Sodae Chloi 
inats. Both these preparations depend for their efficacy upon tin- amount of free chlorine 
which they give out. Condy's fluid is a 2 per cent, aqueous solution of Potassium Perman- 
ganate; and though a good antiseptic and deodorant, il is practically useless as a disinfectant, 
Being constantly expended in oxidizing the organic matter of the infective substance, and 
would he required in enormous and impracticable quantities (I)avies). 

The popular idea of disinfecting the air of a room by burning sulphur, etc., is an absurd- 
ity, because foul air is easily removed by simple ventilation. In disinfecting a room in 
which there has been a case of contagious or infectious disease, the true aim is to kill the 
germs contained in the dust on ledges, in the crevices between the boards, or adhering to 
the walls, and a dry gas is powerless for this purpose, which is best accomplished by using 
a Corrosive Sublimate Solution of the strength of 1 in 1000; or by Lime washing, provided 
that the lime be freshly burnt, and caustic; or by spraying with Formalin, or by dropping 
the latter on hot plates or sheets of hot metal. 

Antispasmodics (avri, against, ^raff^r, a spasm), — are agents which pre- 
vent or allay spasm of voluntary or involuntary muscles in any portion of the 
organism. Some of the agents belonging to this class act by tonic stimulation 
of the higher nervous centres, the coordinating power, and the circulation; as 
Alcohol and Ether in small doses, Camphor, Musk, Valerian: others by a de- 
pressant influence on the motor centres, as the Bromides; and still others by 
paralysis of the end-organs of the vaso-motor nerves, as Amyl Nitrite. A few 
depress all the vital functions, as Aconite, Tobacco, Lobelia, Hellebore, and 
Prussic Acid; and a number stimulate the muscular fibres of the intestines to 
expel gaseous accumulations, namely — Asafetida, Cajuput, Valerian, Musk, 
Aromatic Oils, etc. They are used in convulsive affections, especially asthma 
and other spasmodic diseases of the respiratory organs, hysteria, chorea, angina 
pectoris, epilepsy, etc. The principal antispasmodics are named in the follow- 
ing list: — 

Alcohol. Ether. Aconite. Ammoniac. 

Paraldehyde. Lobelia. Castor. 

Chloroform. Tobacco. Musk. 

Amyl Nitrite. Hellebore. Galbanum. 

Nitrites. Opium. Sumbul. 

Bromides. Belladonna. Ipecacuanha. 

Potassium Iodide. Stramonium. Senega. 

Potassium Nitrate. Hyoscyamus. Silver Salts. 

Arsenic. Hydrocyanic Acid. Zinc Salts. 

Valerian. Physostigma. Copper Salts. 

Conium. Curare. Asafetida. 

Antizymotics {A^i, against, Co,uaj<nV, fermentation), — are agents which 
arrest the fermentative processes, the action of these depending on unorganized 
ferments (enzymes), as diastase, ptyalin, pepsin, etc., or upon that of organized 
ferments, as the yeast-plant, bacteria, etc. The Antizymotics are usually sub- 
divided into two groups, respectively entitled Antiseptics and Disinfectants, 
(which see). 

Fermentation is a general name for those processes of decomposition, during which 
certain carbon compounds called Ferments act upon other carbon compounds, as on their 



24 CLASSIFICATION OF MEDICINES. 

food, — splitting these latter up, setting free their elementary constituents, and thereby lead- 
ing to the formation of still other carbon compounds, by the rearrangement of the freed 
molecules. These processes are of two kinds, viz.: — 

(i) — Those in which water is taken up, (hydration), — chiefly carried on by enzymes. 

(2) — Those in which O is transferred from the H to the C association, as in lactic and 

alcoholic fermentation, and the putrefactive processes, which are chiefly carried on 

by the agency of organized ferments. 

The Ferments producing these fermentative changes are also carbon compounds, and 

are divisible into two groups, viz. : — 

Enzymes, or Organic Ferments, — have no definite structures, and are unorganized, *. «., 

not living, — as Diastase, Ptyalin, Pepsin, etc. 
Organized Ferments, — are minute, living organisms, as the moulds, yeast-plant, bac- 
teria, and other members of the Protophytes, the lowermost class of plants, which, 
in the course of their life history, split up the carbon compounds in which they live, 
appropriating some part of their elements. 
Antizymotic Drugs are drugs which arrest or inhibit these fermentative processes, 
either by destroying or by rendering inactive the causative ferments. 

Aphrodisiacs (A<ppoS(Tr Jt Venus), — are medicines which stimulate the sex- 
ual appetite and power. They act by reflex or by direct action upon either the 
cerebral or the spinal genital centre. Tonics are indirectly aphrodisiac, as are 
all measures which promote the general bodily nutrition. The chief agents 
used as direct aphrodisiacs are named in the following list. [Compare An- 

APHRODISIACS.] 

Strychnine. Cimicifuga. Ergot. 

Cannabis. Serpentaria. Iron. 

Cantharis. Sanguinaria. Alcohol. 

Phosphorus. Opium (at first). Bitter Tonics. 

Aurum. Camphor (at first). Flagellation. 

Yohimbine. Damiana (?). Meat Diet. 

Strychnine acts by increasing general nutrition and exalting the reflex excitability of 
the genital centres. Hemp probably only causes a mild delirium which may or may not 
take a sexual direction. Cantharides acts by direct irritation of the mucous lining of the 
urethra, and is dangerous in aphrodisiac doses. Alcohol in small doses excites the genital 
centre in the brain; so also Opium and Camphor, the latter being decidedly anaphrodisiac 
after a time. The power of Damiana is doubtful. Urtication and Flagellation of the nates 
produce priapism by irritation of the genital centre in the cord through the sensory nerves 
of the part. Ergot is considered useful by contracting the dorsal vein of the penis, preventing 
its emptying too rapidly. 

Astringents {ad, to, stringo, I bind), — are agents which produce contrac- 
tion of muscular fibre and condensation of other tissues, the first probably by 
direct irritation, the second by precipitating their albumin and gelatin. They 
also lessen secretion from mucous membranes. The principal astringents are — 

Acids. Tannic Acid. Bismuth Subnitrate, etc. 

Alcohol. Gallic Acid. Cadmium Sulphate. 

Alum. Catechu. Gambir. Copper Sulphate. 

Chalk. Galls. Ferric Chloride. 

Lime. Kino. Lead Acetate. 

Creosote. Oak-bark. Silver Nitrate. 

Phenol. Uva-Ursi. Zinc Sulphate. 

Sulphuric Acid, Gallic Acid, and Lead Acetate are examples of Remote Astringents, 
acting on internal organs through the blood. Those which affect the part to which they 
are applied are Local Astringents, and include the others named above. 

Cardiac Sedatives lessen the force and the frequency of the heart's action. 
They are used to control palpitation and overaction of that organ, and to slow 









CI.ASSII'KWTION 11V Ml ■Dli'IM S. 25 

the pulse in febrile conditions in sthenic subjects, especially when local inflam- 
mation is the exciting cause of the fever. The chief cardiac sedatives are — 

Aconite. Pilocarpine. Senega, Saponin. 

Antimony. Digitalis. Hydrocyanic Acid. 

Veratrum. Ouabain. Potassium Salts. 

Muscarine. Emetine. Cold. 

Quinine in full doses. Chloral. 

Aconite, Veratrum, Muscarine, Pilocarpine, Saponin and Hydrocyanic Acid, are direct 
cardiac poisons, depressing the heart muscle and the cardiac motor ganglia; Muscarine 
and Pilocarpine also stimulate the inhibitory ganglia. Digitalis stimulates the vagus centre 
and the cardiac muscle, and acts as a sedative in many cases by slowing the cardiac rate and 
giving it a regular rhythm. Aconite is said by some authorities to relax inhibition, by others 
in stimulate the vagus centre. Antimony depresses the motor ganglia, Potassium depresses 
the cardiac muscle. 

Cardiac Stimulants rapidly increase the force and frequency of the pulse 
in depressed conditions of the cardiac apparatus. One of the most useful agents 
of this class is Alcohol in some form, its action being largely due to a reflex in- 
luence excited through the nerves of the mouth and stomach. It should there- 
fore be given in but slightly diluted form, and in small quantities frequently. 
Ether is next in value and still more rapid in action, and the local application 
of Heat is one of the most powerful and available. Ammonia has an energetic 
action as a stimulant to the vaso-motor centre, as well as a reflex one upon 
the heart similar to that of Alcohol. The chief cardiac stimulants are — 

Adrenalin. Hydrastinine. Sparteine. 

Alcohol. Cocaine. Camphor. 

Ammonia Ether. Chloroform. Aromatic Oils. 

Atropine. Heat (locally). 'Turpentine. 

Nitroglycerin. Continuous Galvanic Current. Opium and Morphine, in 

Spermine. , Counter-irritation. small doses. 

Cardiac Tonics, when given in moderate doses, stimulate the cardiac 
muscle, slowing and strengthening its contractions. In large doses they are 
apt to produce irregular action of the heart, and some of them have more or less 
of a tendency to cause sudden death by syncope if pushed to any great extent. 
The most important of these agents are — 

Digitalis. Squill. Strophanthus. 

Convallaria. Erythrophlcein. Strychnine. 

Cimicifuga. Caffeine. Helleborein. 

Sparteine. Saponin. Adonidin. 

Digitalis acts partly by stimulation of the vagus end-organs in the heart, thus increas- 
ing cardiac inhibition, and partly by direct stimulation of the cardiac centre in the medulla, 
as well as by a direct influence on the heart muscle itself. It contracts the aterioles and 
raises the blood-pressure greatly. Convallaria, Erythrophlxin, Squill, and Cimicijuga act 
similarly but less powerfully, and are correspondingly safer. Strophanthus is still better, 
as it does not affect the vessels, and therefore does not raise the blood-pressure. 

Carminatives (carmino, I soothe), — promote the expulsion of gas from 
the stomach and intestines by increasing peristalsis, stimulating the circulation, 
and relaxing the cardiac and pyloric orifices of the stomach. They also act as 
diffusible stimulants, both of the bodily and mental faculties. The principal 



: 



) 



26 CLASSIFICATION OF MEDICINES. 

carminatives belong to the aromatic oils, alcohols or ethers, and are named 
in the following list: — 

Asafetida. Mace. Oil of Cloves. 

phor. Mustard. Oil of Coriander. 

Capsicum. Pepper. Oil of Eucalyptus. 

Cardamom. Serpentaria. Oil of Fennel. 

Chloroform. Spirits. Oil of Peppermint. 

Ether. Oil of Anise. Oil of Spearmint. 

inel. Oil of Cajuput. Oil of Nutmeg, 

dinger. Oil of Caraway. Oil of Pimento. 

Horse-radish. Oil of Cinnamon. Oil of Valerian. 

Cathartics or Purgatives (xaffaipio, purgo, I cleanse), — are agents which 
increase or hasten the intestinal evacuations. According to their respective 
degrees and direction of action they are subdivided into several groups, as fol- 
lows: — 

Laxatives (laxo, I loose), or Aperients (aperio, I open), — include those which 
excite moderate peristalsis, and produce softened motions without irritation. 
Sulphur is the typical laxative. 

Simple Purgatives, — cause active peristalsis, and stimulate the secretions 
of the intestinal glands, producing one or more copious and semifluid motions 
with some irritation and griping. Senna is the type of this group, which also 
includes Aloes, Rhubarb, Castor Oil, etc. 

Drastic Purgatives (Spdetv, to draw), — act still more intensely, producing 
violent peristalsis and watery stools, with much griping pain, tenesmus, and 
borborygmi. They irritate the intestinal mucous membrane, cause exosmosis 
of serum from its vessels, and in large dose set up inflammation and symptoms 
of irritant poisoning. Jalap is a typical drastic. 

Saline Purgatives. — This group includes the neutral salts of metals of the 
alkalies or alkaline earths. They stimulate the intestinal glands to increased 
secretion, and by their low diffusibility impede reabsorption, causing an accu- 
mulation of fluid in the intestinal tract, which, partly from the effect of gravity 
and partly by gentle stimulation of peristalsis excited by distention, reaches 
the rectum and produces a copious evacuation. Magnesium Sulphate and 
Sodium Sulphate are the typical salines. They should be given in plenty of 
water and during active movement (as in walking) in order to produce their 
best effects. 

Hydragogue Purgatives (i>dmp } water, ayca, I bring away), — include the most 
active of the drastic and saline groups, especially those which remove a large 
quantity of water from the vessels. Elaterium is a typical hydragogue cath- 
artic. 

Cholagogue Purgatives (x"?-y, bile, aya, I bring away), — are those agents 
which stimulate the discharge of bile and produce free purgation at the same 
time, the stools being green-colored ("bilious") and liquid. Podophyllin is 
the type of this group. 

The principal Cathartics are the following-named : — 



i I VSSD tC VTION 01 \n I'll l\i S. 



2 7 



I., IX,: 

Sulphur. 

Magnesia. 

Cassia, 

Manna. 

Figs. Prunes. 

Tamarinds. 

I [one] . 

Cascara s. 

Physostigma. 

Ergot. 

Belladonna. 

Stramonium. 

I [yoscyamus. 

Almond Oil. 

Olive Oil. 

Soap. 

Taraxacum. 

Glycerin. 

1 >atmeal. 

Bran Biscuit. 

Brown Bread. 



Simple Purgah 

Senna. 

Aloe--. 

Rhubarb. 

Castor Oil. 

Rhamnus Frangula. 

ill. 
Calomel. 

Small doses of drastics, salines 
or cholagogues. 

StiUnc Purgatives. 

Magnesium Sulphate. 
Magnesium Citrate. 
Potassium Sulphate. 
Potassium Tartrate. 
Potassium Bitartrate. 
Sodium Sulphate. 
Sodium Phosphate. 
Sodium Chloride. 
Pot. and Sodium Tartrate. 
Manganese Sulphate. 



Drastics. 

Jalap. Gamboge. 

t !ol 11 ynth. 
Elaterium. 
Scammony. 
Croton Oil. 

Cathartii \i id, hypodei 
mically. 

Hydragogues. 
Elaterium. 
Gamboge. 

Potassium Bitartrate. 

Croton Oil. 

Salines in large doses. 

Cholagogues. 
Podophyllin. 
Mercurials. 
Aloes. Rhubarb. 
Euonymin. 
Iridin. 



Cerebral Depressants lower or suspend the functions of the higher cere- 
brum after a preliminary stage of excitement. Under this head may be in- 
cluded the Hypnotics, Narcotics, General Anesthetics, and several of the Anti- 
spasmodics, all acting on the cells of the convolutions; at first stimulating the 
brain-functions, they produce after a time stupor, coma and insensibility. 

The most useful of this class are the Bromides, Zinc Salts and Caffeine, as they also 
diminish reflex excitability and thus secure rest of the nervous system. Some of them are 
decidedly dangerous, as they may paralyze the heart or the medulla and its centres of or- 
ganic life before the consciousness is much disturbed; such being Chloroform, Chloral, 
Phenol, Aconite, Opium, and the irritant poisons. 

Cerebral Excitants are remedies which increase the functional activity 
of the brain, without producing any subsequent depression, or any suspension 
of the cerebral functions. They act partly by increasing the action of the heart 
and consequently the rapidity of the circulation, partly by a direct action upon 
the gray matter of the brain. The chief members of this group are — 



; 



Acetic Acid (inhaled). 


Cannabis. Camphor. 


Ether. 


Alcohol (at first). 


Coffee, Caffeine. 


Quinine. 


Ammonia (inhaled). 


Tea, Theine. 


Tobacco. 


Ammoniac. 


Guarana, Guaranine, 


Strychnine 


Asafetida. 


Coca, Cocaine. 


Valerian. 



The Cerebellum is markedly disturbed by the few drugs which affect it specifically, 
their action upon its different lobes producing various disturbances of coordination and 
equilibrium. Alcohol in considerable dose causes a staggering gait, and a tendency to fall; 
and different preparations thereof seem to affect different portions of the cerebellum . In- 
toxication by wine or beer is said to be accompanied by a tendency to fall sideways, — that, 
by whiskey, especially Irish whiskey, an inclination to fall on the face, — and that by cider 
a backward tendency; and these disturbances correspond exactly with those caused by 
injury to different lobes of the cerebellum (Brunton). Apomorphine in large doses seems 
to act upon the cerebellum or corpora quadrigemina, as the animal poisoned by it does not 
vomit, but moves round and round in a circle. 

Ciliary Excitants are substances which, when dissolved in the mouth, 
promote the expectoration of bronchial mucus by their reflex excitation of the 



I 



28 CLASSIFICATION OF MEDICINES. 

tracheal and bronchial cilia. This group includes such agents as the Chlorides 
of Ammonium and Sodium, Potassium Chlorate and Gum Acacia. 

Deliriants excite the functions of the higher brain to such a degree as to 
disorder the mental faculties, producing intellectual confusion, loss of will- 
power, delirium and even convulsions. They are all narcotics (though all nar- 
cotics are not deliriants), and the most important may be listed as follows: — 

Cannabis Indica. 
Lupulus (at first). 
Opium (at first). 
Nitrous Oxide Gas. 

Demulcents (demulceo, I soothe), — are substances usually of oleaginous 
or mucilaginous nature, which soothe and protect the parts to which they are 
applied. This term is generally used for substances employed for mucous 
membranes, and the term Emollients for similar agents used on the skin. The 
chief agents belonging to this class are: — 



Belladonna. 


Alcohol. 


Stramonium. 


Chloral. 


Hyoscyamus. 


Ether. 


Turpentine. 


Chloroform. 



Acacia. 


Starch. 


Honey. 


Olive Oil. 


Cetraria. 


Glycerin. 


Marsh-mallow. 


Isinglass. 


Barley. 


Flaxseed. 


White of Egg. 


Tragacanth. 


Licorice. 


Gelatin. 


Almond. 


Bland Oils. 



Dental Anodynes are substances employed locally in toothache due to 
caries exposing a nerve filament. Such are Aconite, Opium and Cocaine salts, — 
also Creosote, Chloral, Phenol, and Potassium Chlorate. A solution, contain- 
ing the three first named, applied on a pledget of cotton, will promptly relieve 
whenever the nerve is accessible. Chloral should never be employed for this 
purpose, as in solution sufficiently strong to be of any service it is very apt to 
cause sloughing of the gum, especially if injected thereinto by a hypodermic 
syringe, as is frequently done by ignorant dentists, who advertise the "extrac- 
tion of teeth without pain." 

Dentifrices (dens, a tooth, jrico, I rub), — are medicated powders or pastes 
applied with a stiff brush to cleanse the teeth and gums. Chalk is the basis 
generally used, for its mechanical action and its alkaline quality. Antiseptics, 
as Borax, Quinine, Phenol, etc., should also be employed, so as to prevent the 
acid fermentation of food products between the teeth and the consequent decay 
of the dentine. Tincture of Myrrh is an excellent ingredient, being an aro- 
matic local stimulant and disinfectant. 

Many drugs affect the teeth injuriously, such being the Mineral Acids, Persalts of Iron 
and Alum. The first two should be taken through a glass tube, and the mouth should be 
rinsed afterwards with a weak alkaline solution. 

Deodorants are agents which destroy foul odors. The Volatile Deodorants 
are chiefly oxidizing and deoxidizing substances, acting chemically on the ob- 
noxious gases; while the Non-volatile ones are mainly absorbents, which con- 
dense and decompose the effluvia. The deodorants in general use are the fol- 
lowing-named : — 



CLASSIFICATION OK MKDICINES. 29 

Formaldehyde. Hydrogen Dioxide. Charcoal. 

Chlorine c'..is. Potassium Permanganate. Earth. Lime, 

Sulphurous Acid I'.. is. Coffee, freshly roasted. Ferrous Sulphate. 

For removing the fetid exhalations emitted by the feces, the following powder is a very 
efficient and cheap deodorizing and disinfecting agent. Zinc Sulphate, lbs. ij, Sulphuric 
Acid. 3jss to r>i.iss, Essence of Mirbane, 7>j. Indigo Blue, gr. ij. About a dessert-spoonful 
of this is placed in the bed-pan or chamber utensil before it is used. Contacl with urine 
or a liquid stool causes its prompt solution, deodori/ation is instantaneous, the tiquid ex- 
creta an- at once sterilized, and the fetor is changed to a rather agreeable odor. Oil <>) Eu- 
calyptus has the property of spreading rapidly over water in a thin film, and if a few drops 
are sprinkled over the water in the pan of a water closet before using the latter, no fecal odor 
will arise therefrom. 

Destructive Metamorphosis of the tissues is promoted by a number of 
agents, most of which are classed as Alteratives or as Astringents, the most im- 
portant of which are the following-named: — 

Alkalies. Sulphides and Iodides. 

Vegetable Acids. Sarsaparilla. 

Metals and their salts. Stillingia. 

Colchicum. Xanthoxylum. 

Tannic and Gallic Acids, and substances containing them. 

Destructive Metamorphosis may be diminished by many substances, the 

following-named being the chief ones: — 

Alcohol. Salicin. Resorcinol. 

Glycerin. Salicylates. Chinolin. 

Oils and Fats. Quinine. Cocaine 

Diaphoretics and Sudorifics (8ia<pop&u), I carry through; sudor, sweat, 
facto, I make), — are remedies which increase the action of the skin and pro- 
mote the secretion of sweat. When they act energetically, so that the perspira- 
tion stands in beads upon the surface, they are known as Sudorifics. They 
may be subdivided into the following groups, viz. — 

(i) Simple Diaphoretics, which enter the circulation and are eliminated by the sudor- 
iferous glands, which they stimulate to increased action. 

(2) Nauseating Diaphoretics, which produce relaxation and the dilatation of the super- 
ficial capillaries. 

(3) Refrigerant Diaphoretics, which reduce the circulation, at the same time acting di- 
rectly on the sweat-centres in the spinal cord and medulla. 

The principal diaphoretics are the following-named, the figures referring 
to their respective supposed modes of action as indicated above; — 

Aconite. 3 Ipecacuanha. 2 Mezereon. 1 

Yeratrum. 3 Opium 2 ' 3 (large doses). Sarsaparilla. 1 

Tobacco. 2-3 Dover's Powder. 2 Guaiacum. 1 

Lobelia. 2 ' 3 Tartar Emetic. 2 Serpentaria. 1 

Alcohol. 2 ' 3 Sulphur. 1 Sassafras. 1 

Ether. 2 ' 3 Camphor. 1 Senega. 1 

Nitrous Ether. 2 ' 3 Cocaine. 3 Vapor Bath. 2 

Salicylates. 1 Ammonium Acetate. 1 Turkish Bath. 2 

Pilocarpus. 1 ' 3 Ammonium Citrate. 1 Wet Pack. 2 

Pilocarpine. 1 ' 3 Potassium Salts. 3 Warm Drinks. 2 

Diluents (diluo, I dilute), — are indifferent substances which, after their 
absorption, dilute the excretory fluids and enable the latter to hold more solid 
material in suspension. Water is the one true diluent, whatever form it may 
be disguised in, as teas, weak fluid foods, acid drinks, etc. 



\ 



30 CLASSIFICATION OF MEDICINES. 

Discutients or Sorbefacients (disaitio, I dissipate; sorbere, to suck), — 
are agents which promote absorption, and may be divided into two classes; 
(1) those which stimulate the lymphatics to the removal of morbid or inflam- 
matory deposits, (2) those which promote the imbibition of nutritive or medi- 
cinal material into the system. [Compare Alteratives.] These agents include 
the following-named: — 

Arsenic. Ichthyol. Vapor Bath. 

Mercury. Lanolin. Hot Water Bath. 

Iodine. Oleic Acid. Poultices. 

Iodides. Cacao Butter. Counterirritation. 

Cadmium. Massage. Galvanism. 

Lanolin and Okie Acid have remarkable power of penetration through the skin and 
are used as excipients for drugs which are to be administered by cutaneous absorption. 
Cacao Butler possesses the same penetrative property, and is usually employed in making 
medicated suppositories. 

Diuretics (dtouprjms, urination), — are agents which promote the secretion 
of urine, either by raising the local or general blood-pressure and so increasing 
the renal circulation, by stimulating the secreting cells or nerves of the kidneys, 
or by flushing the kidneys with water. Diuretics may be classified according 
to their physiological action or according to the different purposes for which 
they are employed. Refrigerant Diuretics, especially the salines, excite the renal 
epithelium, induce a hyperemic condition of the kidneys and increase the water 
of the urine. They possess a sedative action upon the heart and the general 
circulation, but used to excess they depress the heart and impoverish the blood. 
Potassium Chlorate is a decided renal irritant, and should never be used as a 
diuretic. Hydragogue Diuretics increase the water of the urine largely, and 
in general act by raising arterial pressure, either — (a) throughout the body, or 
(b) locally in the kidneys. This they accomplish in various ways, direct and 
indirect, — increasing the action of the heart, contracting the efferent vessels 
or dilating the afferent vessels, so as to raise the blood-pressure in the glomeruli, 
etc. The action of the Stimulant Diuretics is directly upon the renal tissue, 
by which they are largely eliminated from the body. In small or moderate 
doses they dilate the renal arterioles, increase the renal blood-supply, and so 
induce diuresis, but in large doses they irritate the renal epithelium, contract 
the renal arterioles, diminish the renal blood-supply, excite renal inflammation, 
render the urine albuminous and bloody, and may even induce suppression of 
the urine. All the members of this division should be used with caution. 

Individual members of the diuretic class act in various modes, some of them 
in more than one manner, and probably as follows, viz. — 

1. By increasing the action of the heart (Alcohol, Digitalis, etc.) or by contracting the 
intestinal and other vessels, thus raising the general blood-pressure. 

2. By dilating the afferent renal vessels, thereby increasing the renal blood -supply and 
raising the pressure in the glomeruli. 

3. By contracting the efferent vessels, raising the pressure in the glomeruli and lessening 
absorption in the tubules, or both. 

4. By stimulating the secreting cells or nerves of the kidnevs. 

5. By flushing the kidneys, as by the ingestion of Water in large quantity. 



(.1 \SSII ICAl'IOX OF Ml niCIM'S. 



31 



The following list contains the most important agents >>i this group, which 

are usually subdivided into the three classes indicated by the subtitles. The 
numbers refer to the probable modes of action of the drug in tin- above synop- 
sis: — 



Refrigerant Diuretics. 
Potassium Acetate. 4 
Potassium Bitartrate. 4 
Potassium Citrate. 4 

Potassium Chlorate. 4 
Potassium Nitrate. 4 
Sodium Acetate' 
Sodium Chlorate. ' 
Sodium Chloride.' 
Ammonium Acetate. 4 
Calcium Chloride. 4 
Lithium Carbonate. 1 
Lithium Citrate. 4 
Magnesium Citrate. 4 
Magnesium Sulphate. * 
Water. 5 Milk. 5 
Carbonic Acid. 
Cold to surface. 1 



Hydragogue Diuretics. 
Digitiilis. 1 '- 

Strophanthus. 2 

Convallaria. 1 

Cimicifuga. 1 '' 

\donis vernalis. 1,2 

Erythrophlceum. 1 

Squill. 1 ' 2 

Broom. 3 Sparteine. 3 

Calomel. 4 

Caffeine. 1 ' 4 Theocin. 4 

Theobromine. 4 Agurin. 4 

Apocynum. 1 ' 2 

Nitrous Ether. 2 Nitrites. 2 

Strychnine. 1 

Colchicum. 4 

Tobacco. 3 

Sugar of Milk. 1 ' 4 



Stimulant Diuretics. 

Alcohol. 2 

Blatta orientalis. 4 

Cantharides. 4 

Turpentine. 4 

Juniper. 4 

Savin. 1 

Copaiba. 4 

Cubeb. 4 

Cannabis. 4 

Capsicum. 4 

Buchu. 4 

Asparagus. 4 

Guaiac. 4 

Fennel. 4 

Urea. 4 

Uva Ursi. 4 

Zea. 4 



Diuretics are employed in medicine for certain definite purposes, as fol- 
lows: — to remove fluid from the tissues and cavities of the body in cases of 
dropsy; to promote the elimination of waste-products and other poisons from 
the blood; to maintain the action of the kidneys; to dilute the urine, and to 
alter morbid conditions of that excretion. 

In Dropsies from Cardiac Disease, or other dropsies due to venous congestion, the most 
efficient diuretics are those which act on the general vascular system, as Digitalis, Strophan- 
tus, Squill, etc. Calomel is often very efficient in this form of dropsy, also Theobromine 
Sodio-Salicylate (Diuretin). 

In Dropsy from Renal Disease, Diuretin, Broom-tops, Nitrous Ether, Oil of Juniper, 
Digitalis and Squill are the most reliable diuretics, in the order named. 

In Ascites from Hepatic Cirrhosis, Copaiba is the best diuretic when the kidneys are 
healthy. In this form and the previous ones a little Pil. Hydrargyri given occasionally will 
often aid the diuretic action of the other agents. 

To eliminate Waste-products from the Blood, Potassium Nitrate and Bitratrate, Turpen- 
tine, Juniper, Caffeine, and Water in large quantity. [Compare Lithontriptics.] 

To Dilute the Urine, Water is the best agent, its most efficient form being Distilled Water 
charged with Carbonic Acid gas. 

As Adjuvants to Diuretics, when pressure on the uriniferous tubules or venous congestion 
prevent their action, — paracentesis abdominis, purgation, cupping over the loins, and even 
venesection, are often necessary to start the diuretic action. 

The activity of the renal cells is directly depressed by the Renal Depressants, 
which thereby lessen or suspend the secretion of urine. Morphine, Quinine 
and Ergot act in this manner through their influence on the circulation. In- 
stead of acting as a diuretic Digitalis may stop the secretion of urine, by so 
stimulating the vaso-motor centre as to greatly contract the renal vessels, and 
arrest the renal circulation (Brunton). This it might do if a preparation were 
used which was deficient in Digitoxin or Digitale'in, the dilators of the renal 
arteries: (see under Digitalis.) The same is true of Caffeine and Strychnine, 
hence it is well to combine these with other diuretics which dilate the renal 






32 CLASSIFICATION OF MEDICINES. 

Is, as the Nitrites, (Nitrous Ether, etc.), and Alcohol. Digitalis contains 
in itself the power of doing both these actions, and hence it is the ideal diuretic. 

Emetics (i/<«u, I vomit), — are agents which produce vomiting. They may 
be subdivided into two groups, Local Emetics, or those which act by irritating 
the end-organs of the gastric, pharyngeal or esophageal nerves, and General 
or Systemic Emetics, which act through the medium of the circulation. The 
members of both these groups produce emetic action by irritation of the vomit- 
ing centre in the medulla, the first by reflex, the second by direct stimulation. 
The principal emetics are the following named: — 

Local Emetics. General Emetics. 

Alum, Mustard, Salt. Ipecacuanha. Emetine. 

\mmonium Carbonate. Apomorphine. 

Zinc and Copper Sulphates. Tartar Emetic. 

Subsulphate of Mercury. Veratrine. 

Tepid Water, in quantity. Senega. 

Vegetable Bitters, as Quassia, Squill. 

in strong infusions. Ouabain. 

Tartar Emetic, Ipecacuanha and probably Apomorphine, act locally as well as systemi- 
cally, for if injected subcutaneously they are excreted by the stomach in part, thus irritating 
the gastric nerves as well as the vomiting centre. Pilocarpus is a local emetic, and Digitalis 
and its congeners, also Muscarine, are systemic emetics, but none of these agents are used 
medicinally for that purpose. Opium, Morphine, and Codeine usually produce emesis as one 
of their after effects. 

Vomiting is an evacuant act which consists in compression of the stomach by the simul- 
taneous spasmodic contraction of the diaphragm and abdominal muscles; also in relaxation 
of its cardiac orifice by contraction of the radiating muscular fibres in the gastric wall. If 
both acts occur at the same time, the contents of the stomach are expelled and vomiting occurs; 
if, however, the two acts do not take place simultaneously, the contents of the stomach are 
retained, and the abortive efforts are called retching. These acts are controlled and regu- 
lated by a nerve-centre in the medulla oblongata, which is closely connected with the respira- 
tor}' centre, the muscular movements of vomiting being merely modified respiratory move- 
ments. This vomiting centre is ordinarily excited in two ways, — (i) by the peripheral 
stimulation of afferent nerves going to it from other parts of the body, (2) by impulses sent 
down to it from the brain (Brunton). 

Nausea and vomiting are diminished by agents termed Anti-emetics, includ- 
ing gastric sedatives and general sedatives; some of which act by means of a 
local sedative influence upon the end-organs of the gastric nerves, others by 
reducing the irritability of the vomiting centre in the medulla. The act of 
vomiting being occasioned by irritation of afferent nerves from many regions 
of the body or impulses from the brain excited by impressions on the nerves 
of special sense, the measures and agents by which it may be combated are 
very diversified. [Compare the article entitled Vomiting, in Part III.] The 
most important anti-emetics are named in the following lists: — 

Local Gastric Sedatives. General Sedatives. 

Alcohol. Creosote. Opium. 

Alum. Ether. Morphine. 

Arsenic. Ice. Codeine. 

Belladonna. Opium. Hydrocyanic Acid. 

Bismuth. Hydrocyanic Acid. Bromides. 

Carbonic Acid. Silver Nitrate. Chloral. 

Cerium Oxalate. Calomel \ small Nitro-glycerin. 

Chloroform. Ipecac j doses. Alcohol. 

Phenol. Hot water. Amyl Nitrite. 

Potassium Nitrate. Cocaine. Food. 



CLASSIFICATION OK MKDICINES. 33 

lee, swallowed in small pieces, is probably the most efficient of tin- local sedatives. Phe- 
nol ami Cocaine arc also effective anti-emetics, given in small (loses by the mouth at short 
intervals. Astringents are very useful where there is congestion of the gastric mueous mem- 
brane, as in the vomiting of alcoholism ami phthisis, when Silver Nitrate and Alum are espe- 
cially to be recommended. Opium and its principal alkaloid, Morphine, will produce nausea 
and vomiting in many persons, even when given in very small doses. 

Emmenagogues (I/i/^i/mx, the menses, a\j-w } I move), — are remedies which 
re-tore the menstrual function, either directly by stimulation of the uterine 
muscular fibre, or indirectly by improving the blood and toning up the nervous 
system. Some of the direct emmenagogues are oxytocic in large doses. The 
principal members of this class are named in the following list: — 

Direct Emmenagogues. Indirect Emmenagogues. 

Ergot. Apiol. Iron. 

Savin. Borax. Myrrh. Manganese. 

Tansy. Rue. Guaiacum. Cinnamon. 

• Digitalis. Polygonum Hydropip. Quinine. 

Cantharis. Potass. Permanganate. Strychnine. 

Pulsatilla. Manganese Dioxide. Aloetic Purgatives. 

Asafetida. Cimicifuga. Cod-liver Oil. 

Alcohol. Oxalic Acid. Hot Hip-baths. 

Indigo. Hedeoma. Leeching the genitals. 

Hydrargyrum Biniodide. Origanum. Rubefacients to thighs. 

Caulophyllum. Yiscum Flavescens. Tonic Remedies. 

Emollients (emollio, I soften), — are substances which soften and relax 
the tissues to which they are applied. They relieve tension, dilate vessels, 
diminish pressure on the nerves, and protect inflamed surfaces from the air and 
from friction. The principal articles which may be classed under this heading 
are the following: — 

Hot Fomentations. Linseed Oil. Petrolatum. 

Poultices. Olive Oil. Soap Liniment. 

Glycerin. Spermaceti. Starch. 

Lard. Almond Oil. Cacao Butter. 

Errhines and Sternutatories (&>, in, pn>, the nose; sternuto, I sneeze), — ■ 
are agents which produce increased nasal secretion and sneezing, when locally 
applied to the mucous membrane of the nose. The first term is usually ap- 
plied to substances which cause increase of the mucus without sneezing, the 
latter to those which invariably produce sneezing. The drugs should be ap- 
plied in powder. The stimulus produced by these agents is transmitted by 
the nasal branches of the fifth nerve to the respiratory centre, exciting the sud- 
den and forcible expiratory effort called sneezing; also to the vaso-motor centre, 
contracting the smaller vessels throughout the body and producing a general 
rise in the blood-pressure. The principal agents of this class are — 

Tobacco, as snuff . Euphorbium. Capsicum. 

Ipecacuanha. Sassy Bark. Hellebore. 

Sanguinaria. Saponin. Ammonia. 

Yeratrum Album. Ginger. Cubebs. 

The last two named may be used as simple Errhines, as the vapor of dilute Ammonia- 
water or the smoke of burning Cubebs do not excite sneezing generally. 

4 



> 



34 CLASSIFICATION OF MEDICINES. 

Escharotics or Caustics (io/upa, a slough or scab; mlco, I burn), — are 
agents which destroy a tissue to which they are applied, and produce a slough. 
They may be divided into two classes, the actual, or those in which heat is the 
active agent, and the potential, by which a chemical process is called into play. 
Escharotics act usually in one of the following modes: — 

i. By abstracting the water of the tissues. 

2. By combining with the albumin of the tissues. 

3. By corrosive deoxidation of the tissues. 

4. By conversion of the tissues into carbon or gaseous bodies. 

The principal escharotics are named in the following list, the numbers point- 
ing out the mode of action as stated above: — 

Mineral Acids. 1 Caustic Potash. 1 Mercuric Chloride. 2 

Glacial Acetic Acid. 1 Caustic Soda. 1 Mercuric Oxide. 2 

Phenol. 1 Dried Alum. 2 Mercuric Nitrate. 2 

Chromic Trioxide. 3 Silver Nitrate. 2 Bromine. 3 

Arsenic Trioxide. 1 Copper Sulphate. 2 ( Cautery. 4 

Antimony Chloride. 1 Zinc Sulphate. 2 High Heat. ■< Moxa.'" 

Lime. 1 Zinc Chloride. 2 ( Boiling Water. * 

Nitric Acid and Zinc Chloride are probably the safest and most generally useful of the 
potential caustics where any decided escharotic action is desired. Silver Nitrate is the best 
for superficial use, its action being limited to the part with which it comes in contact, and being 
stopped at once by the application of a solution of common salt. Chromic Trioxide is one of 
the most efficient escharotics, but it must be carefully used. 

Expectorants (ex, out of, pectus, the breast), — are remedies which modify 
the secretion of the broncho-pulmonary mucous membrane, and promote its 
expulsion. They may be divided into the following groups: 

Nauseating Expectorants in large doses act mechanically by expelling the 
mucus in the act of vomiting, in small doses by increasing osmosis from the 
inflamed mucous membrane. The members of this subdivision generally in- 
crease secretion and tend to lower the blood-pressure. The chief ones are the 
following named: — 

Antimony, Tartar Emetic. Apomorphine. Potassium Iodide. 

Ipecacuanha, Emetine. Quebracho. Lobelia. 

Pilocarpus (Jaborandi). Alkalies. Lobeline. 

Stimulant Expectorants are largely eliminated by the bronchial mucous 
membrane, which they stimulate, altering the secretion and facilitating ex- 
pectoration. These remedies generally diminish secretion and increase blood- 
pressure. This subdivision includes the following named: — 

Ammonium Chloride. Acids. Nux Vomica. 

Ammonium Carbonate. Squill. Strychnine. 

Benzoin and Benzoic Acid. Garlic. Senega. 

Balsams of Peru and Tolu. Onion. Saponin. 

Wood Tar, and Tar. Turpentine. Licorice. 

Oleum Pini Sylvestris. Sulphur. Saccharine Substances. 

Besides the above many other remedies may act as expectorants, some by relieving bron- 
chial spasm, as Opium, Stramonium, and Tobacco; others by soothing the irritable respiratory 
centre, as Opium and Chloral; and the ciliary excitants by reflex action through their im- 
pression on the nerves of the mouth. 



I I \sSiK1CATI0N OF MEDICINES. 



35 



Galactagogues (?«"<", milk, arw, I bring away), are agents which are 
supposed to increase the lacteal secretion. The value of most of them is very 
doubtful, probably the only efficient one being Pilocarpus (Jaborandi), but its 
influence is very transient and the excessive perspiration and salivation caused 
by it are objectionable. The leaves of Ricinus communis, the castor-oil plant, 
locally applied, have been highly recommended; but general measures are 
more trustworthy, such as the correction of anemia, attention to sore nipples, 
administration of tonics and good food. [Compare the article entitled Lac- 
tation in Part III.] Other agents reputed to have galactagogue properties are 
the following-named: — 

Anise. Gallega. Beer, Ale, Porter. 

Dill. Physostigma. Black Tea. 

Fennel. Strychnine. Sinapisms. 

Vanilla. Potassium Chlorate. Electricity. 

Galactophyga (r^a, milk, feu-rcu, I shun), — are agents and measures which 
diminish or arrest the secretion of milk. Belladonna or its alkaloid Atropine 
is the most efficient, acting whether applied locally or administered internally. 
Antipyrine has similar power, so also has Camphor applied locally and Potas- 
sium Iodide, Colchicum with Magnesium Sulphate, Tobacco, Sage, Quinine, 
Tannin, etc. Compression of the breasts, by bandaging or strapping with 
adhesive plaster, has positive antigalactic action. 

Hearing is affected by several drugs. Strychnine and Morphine increase 
the excitability of either the auditory nerve or the centre for hearing in the 
superior temporo-sphenoidal convolution, making that faculty much more 
acute. Quinine, Antipyrine and the Salicylates produce hyperemia of the 
auditory apparatus, causing subjective noises, as humming, buzzing, or ring- 
ing, which are very unpleasant. Hydrobromic Acid and the Bromides, also 
Ergot, will diminish the congestion and thus neutralize or prevent these noises 
to a great extent. 

Quinine in large doses is believed by some to have produced permanent injury of the 
sight and the hearing, but authentic cases of such action are extremely rare, if indeed they 
can be found at all. Temporary deafness is often caused by Quinine, but it usually disap- 
pears soon after the administration of the drug is stopped. 

Hepatic Depressants lower the functional activity of the liver, some re- 
ducing the secretion of bile, others lessening the production of glycogen, and 
others diminishing the production of urea. Lead Acetate is a direct hepatic 
depressant, especially in large doses, and is probably the only drug which les- 
sens the biliary secretion without causing purgation. Many Purgatives diminish 
the secretion of bile by lowering the blood-pressure in the liver and by carrying 
off material from which bile may be formed. Contrary to the general opinion 
Opium and Morphine do not affect the biliary secretion (Murrell). The list 
of hepatic depressants includes the following-named agents: — 



: 



36 CLASSIFICATION OF MEDICINES. 

Lessening Bile. Diminishing Glycogen. Lessening Urea. 

Lead Acetate. Opium. Opium. 

Atropine. Morphine. Morphine. 

Calomel. Chloral. Codeine. Codeine. 

Castor Oil. Arsenic. Alcohol. 

Gamboge. Antimony. Colchicum. 

Magnesium Sulphate. Phosphorus. Quinine. 

Hepatic Stimulants and Cholagogues O^, bile, d'rw, I bring away),— 
are two groups of agents acting upon the biliary secretion, the first-named in- 
creasing the functional activity of the liver-cells and the amount of bile formed, 
the second removing the bile from the duodenum and preventing its reabsorp- 
tion into the portal circulation. Some hepatic stimulants are also cholagogues, 
others are not, while cholagogues proper generally act indirectly as hepatic 
stimulants by carrying off the bile and thereby urging the liver to secrete more. 
The discovery of the enterohepatic circulation of -bile has cleared up many of 
the discrepancies formerly existing with regard to the action of drugs upon this 
gland and its secretion, yet neither this subject nor hepatic chemistry has yet 
attained such results as would enable us to formulate positive doctrines thereon. 
Bile, Bile Salts and Sodium Salicylate are at present the only agents which 
have been experimentally proven to have the direct power of increasing the 
biliary secretion, though a number of drugs are believed to act in this manner 
upon clinical and other evidence. The following list includes the principal 
agents which are generally credited with the actions defined above: — 

Hepatic Stimulants. Cholagogues. 

Bile, Bile Salts. Ipecacuanha. Mercury with Chalk. 

Sodium Salicylate. Colocynth. Calomel. 

Nitro-hydrochloric Acid. Colchicum. Pil. Hydrargyri. 

Mercuric Chloride. Podophyllin. Sodium Phosphate. 

Mineral Acids. Arsenic. Euonymin. Sodium Sulphate. 

Sulphurated Antimony. Iridin. Jalapin. Potassium Sulphate. 

Benzoic Acid. Scammony. Aloes. Rhubarb. 

Sodium Benzoate. Rhubarb. Podophyllin. 

Sodium Phosphate. Aloes. Colchicum. 

Sodium Sulphate. Sanguinarine. Colocynth. 

Sodium Phenolsulphonate. Hydrastin. Jalapin. 

To secure the best cholagogue effect it is advisable to combine an hepatic stimulant with 
an intestinal stimulant which shall produce increased secretion from the intestinal mucous 
membrane and excite peristalsis. Hydrochloric Acid which has been kept long and has 
become a light or golden-yellow color, is relatively inert as an hepatic stimulant, but the 
freshly combined, deep red acid is active and valuable (Wood). 

The glycogenic function of the liver, and the production of urea are stimu- 
lated by the following-named drugs: — 

Increasing Glycogen. Increasing Urea. 

Amyl Nitrite. Arsenic. Iron. 

Sodium Bicarbonate. Antimony. Phosphorus. 

Nitro-hydrochloric Acid. Ammonium Chloride. 

Hypnotics (y-^oc, sleep), — are remedies which produce sleep. In this wide 
sense the term includes the narcotics and the general anesthetics, but it is usually 
restricted to those agents which, in the doses necessary to cause sleep, do not 
disturb the normal relationship of the mental faculties to the external world 
(Brunton). Another definition of hypnotics is — that they produce sleep with- 



l-I VSSIKU'Al'lON OK MI-'|i|('IM S. 



37 



tint suspending the consciousness of pain, narcotics doing both. Hypnotics 
mav be subdivided into the following classes: 

Pitrc Hypnotics, — which directly induce a sleep closely resembling the 
normal, without causing narcotic or other dangerous cerebral symptoms. The 
Bromides are the type of this subdivision, but the list is constantly growing 
smaller as experience reveals toxic powers in the action of its members. 

Narco-hypnotics, — which induce sleep by direct depression of the cerebral 
functions and in larger doses are narcotic, suspending the consciousness of 
pain and producing coma. Opium is the type of this class. 

Indirect Hypnotics, — which induce sleep by removing or suppressing any 
cause (not mental) which interferes therewith. Such are the non-narcotic 
analgesics,* acting against pain; the respiratory stimulants, j relieving dyspnea; 
the pulmonary sedatives, J relieving cough; the motor depressants, \ restrain- 
ing excessive motor activity; also the vascular and cardiac tonics,^ antagoniz- 
ing cerebral hyperemia and regulating the cardiac action. 

The principal members of each of the above subdivisions are named in the 
following lists: — 



: 



Pure Hypnotics. 
Potassium Bromide. 
Sodium Bromide. 
Paraldehyde. 
Sulphonmethane. 
Sulphonethylmethane. 
Veronal. 

Ethyl Carbamate. 
Chloralformamide. 
Hedonal. 



Indirect Hypnotics. 

* Antipyrine. 

* Acetanilide. 

* Acetphenetidin. 
t Strychnine. 

J Hydrocyanic Acid. 
§ Conium. 
§ Gelsemium. 
1 Ergot. 
lj Digitalis. 



Narco-hypnotics. 
Hydra ted Chloral. Chloretone. 
Opium, Morphine, Narceine. 
Hyoscine. Duboisine. 
Cannabis Indica. 
Pellotine. 

Passiflora Incarnata. 
Piscidia Erythrina. 
Amylene Hydrate. 
Alcohol. 

Hydrated Chloral is undoubtedly the most efficient of all hypnotics. Paraldehyde is one 
of the most reliable and safe, but its sleep is transient, lasting only a few hours. Sulphon- 
methane and Sulphonethylmethane are very efficient in some cases, but often fail entirely. 
Ethyl Carbamate is feeble and uncertain, and the same may be said of Humulus and some 
other agents which are not mentioned above. Piscidia is also somewhat uncertain in action, 
though its hypnotic and anodyne powers have proved very decided in many cases. 

Dr. Wilcox rejects the dangerous, unreliable and objectionable hypnotics, and retains 
four as amply sufficient for all ordinary cases of insomnia. These he classifies as follows: 
As to Potency: Paraldehyde, Chloralformamide, Pellotine, Sulphonethylmethane. 
As to Rapidity: Pellotine, Paraldehyde, Chloralformamide, Sulphonethylmethane. 
As to not causing Habituation: Pellotine, Sulphonethylmethane, Chloralformamide, 

Paraldehyde. 
As to Safety: Chloralformamide, Pellotine, Paraldehyde, Sulphonethylmethane. 

Intestinal Astringents contract the walls of the intestinal vessels, dimin- 
ishing the exudation therefrom, and lessening the fluidity of the fecal discharges. 
The more powerful members of this group have also a constringing action on 
the intestinal mucous membrane. The principal agents of this class are named 
in the followina; lists: — 



Astringents. 
Phosphoric Acid. 
Nitric Acid. 
Sulphuric Acid. 
Acetic Acid. 
Lead Acetate. 
Silver Nitrate. 



Diluted. 



Constringents. 
Tannic Acid. 
Vegetable Astringents. 
Alum. 
Zinc Oxide. 
Copper Sulphate. 
Persalts of Iron. 



38 



CLASSIFICATION OF MEDICIM S. 



Irritants are substances which, when applied to the skin, produce a greater 
or less degree of vascular excitement. When used to produce a reflex influence 
on a part remote from their site, they are termed counter-irritants. They may 
be subdivided into the following groups: — 

Rubefacients, are those which produce temporary redness and congestion 
of the skin, unless left too long in contact with the surface, when they may 
cause exudation between the cuticle and the true skin (vesicants), or may de- 
stroy the tissue and form a slough (escharotics). They may also induce mus- 
cular atrophy. 

Vesicants, Epispaslics or Blisters, are those which cause decided inflam- 
mation of the skin and the outpouring of serum between the epidermis and 
the derma. Cantharides is the agent generally used for blistering purposes. 

Pustulants, affecting isolated parts of the skin, namely — the orifices of the 
sweat-glands, giving rise to pustules. 

The following list includes the principal agents and measures belonging 
to these three groups:— 

Vesicants. 

Cantharides. 

Euphorbium. 

Mezereon. 

Iodine. 

Rhus Toxicodendron. 

Ammonia (the confined vapor) . 

Glacial Acetic Acid. 

Volatile Oil of Mustard. 

Heat I Boilin g Water. 

(. Corrigan's Hammer. 

Lithontriptics and Antilithics (MOoc, a stone, Tplficu, I wear down), — 
are agents which are supposed to promote the solution of concretions in the 
excretory passages (lithontriptics) or to prevent their formation (antilithics). 
These terms are generally restricted to remedies affecting the urinary calculi, 
but those directed against the biliary form are included in this arrangement 
for the sake of consistent classification. The chief agents coming under these 
titles are the following-named: — 



Rubefacients. 


Rubefacients. 


Mustard. 

Capsicum. 

Camphor. 


Oil of Cajuput. 
Oil of Turpentine 
Volatile Oils. 


Ammonia. 


Pitch. Friction. 


Mezereon. 


Hot Water. 


Arnica. 
Alcohol. 


Pustulants. 


Ether. 


Croton Oil. 


Chloroform. 


Tartar Emetic. 


Iodine. 
Menthol. 


Ipecacuanha. 
Silver Nitrate. 



Biliary Calculi. 
Ether and Turpentine. 
(Durande's Solvent.) 
Sodium Bicarbonate. 
Sodium Salicylate. 
Sodium Phosphate. 
Castile Soap. 
Alkaline Waters, especially Vichy. 

Calcium Oxalate Calculi. 
Dilute Nitro-hydrochloric Acid. 
Carbonated Water 
Lactic Acid (for digestion) . 



Uric Acid Calculi. 
Distilled Water. 
Potassium Salts. 
Lithium Salts. 
Magnesium Citroborate. 
Piperazin. 
Lysidin. 
Lycetol. 

Phosphalic Calculi. 
Ammonium Benzoate. 
Benzoic Acid. 
Dilute Nitric Acid. 






There is probably little or no solvent value to the agents recommended for biliary cal- 
culi. In the case of uric acid calculi the administration of Potassium or Lithium Salts is 
based on their power of combining with the acid in the calculus, thus forming urate of potas- 



CLASSIFICATION 01 Ml DII i\i S. 



39 



sium or of lithium, which salts are more soluble than uric arid itself. Piparasin is still m 
efficient in this respect, forming a piperozin urate which is seven nun-, more toluble than 
lithium urate. Lysidin is still more powerful. 

Motor-Depressants lower the functional activity of the spinal cord and 
other parts of the motor apparatus and in large doses paralyze them. Drugs 

which depress the cerebral motor convolutions, the motor centres in the medulla, 
tiie motor nerve-trunks and nerve-endings, or the muscular contractility itself, 
produce impairment of the motor power, and in large doses may cause com- 
plete paralysis of the part or parts involved. Some act indirectly by reducing 
the spinal circulation, as Aconite, Digitalis and large doses of Quinine, others 
by a direct paralyzant action on the centres. The principal members of this 
class are named in the following list: — 



Curare. 
Physostigma. 
Conium. 
Gelsemium. 
Opium, Morphine, 

Apomorphine. 
Belladonna, Atropine. 
Stramonium. 
Hyoscyamus. 
Muscarine. 
Pulsatilla. 
Grindelia. 
Phytolacca. 
Pilocarpus. 
Quebracho. 



Aconite. 

Veratrum. 

Tobacco. 

Lobelia. 

Digitalis. 

Arnica. 

Ailanthus. 

Saponin. 

Sparteine. 

Ergot (at last). 

Quinine (large doses). 

Camphor. 

Alcohol (large doses) . 

Ether (large doses). 

Chloroform (large). 



Chloral. 

Bromides. 

Potassium Salts. 

Many metallic Salts. 

Amyl Nitrite. 

Nitroglycerin. 

Hydrocyanic Acid. 

Potassium Cyanide. 

Methyl-strychnine. 

Many Methyl compounds. 

Ammonium Cyanide. 

Ammonium Iodide. 

Many compound Ammonias. 

Galvanism. 

Cold. 



. 



The motor centres in the medulla are powerfully depressed by Opium, Morphine, Aco- 
nite, Conium, Chloral, Physostigma, and large doses of Alcohol, Ether and Chloroform. 
These last three are also paralyzers of the motor convolutions in the brain, arresting all vol- 
untary movements when administered in sufficient quantity. The anterior comua of the 
cord are greatly depressed by Physostigma, Phenol, and other agents, and the motor nerves 
by Conium, Methyl-strychnine, etc., both actions resulting in paralysis of the limbs. Curare, 
even in small doses, paralyzes the end-organs of the motor nerves, and Belladonna, the com- 
pound Ammonias, Methyl compounds, etc., exercise a similar but less powerful influence. 
Galvanism is an effective local depressant of motor activity. 

Motor-Excitants are agents which increase the functional activity of the 
spinal cord and the motor apparatus, producing disturbances of motility, height- 
ened reflex excitability, and tetanic convulsions when given in large doses, their 
ultimate effect being motor paralysis from over-stimulation. The most important 
motor-excitants are those named in the following list: — 



Xux Vomica. 

Ignatia. 

Strychnine. Brucine. 

Thebaine. 

Morphine (large dose). 

Atropine (large dose). 

Cocaine. 



Alcohol (small dose) . 

Ether (small dose). 

Chloroform (small dose). 

Ammonia. 

Absinthe. 

Buxine. 

Calabarine. 



Ergot . 

Ustilago. 

Gossypium. 

Picrotoxin. 

Aconitine. 

Nicotine. 

Camphor. 



Digitalis. 

Convallaria. 

Cimicifuga. 

Pilocarpine. 

Pyridine. 

Rhus Toxicod. 

Electricity. 



The principal members of this class are Nux Vomica and Ignatia, with their alkaloids 
Strychnine and Brucine, also Thebaine, the tetanizing alkaloid of Opium. The group also 
includes Morphine and Atropine, which, though at first sedative, when given in large doses 
produce convulsions. The respiratory centre in the medulla is stimulated by Strychnine, 



40 CLASSIFICATION OF MEDICINES. 

Atropine, Ammonia, and small doses of Alcohol, Ether and Chloroform. The motor con- 
volutions in the brain are stimulated by Alcohol and Cocaine in moderate doses, also for a 
brief period by Ether and Chloroform. The end-organs oj the motor nerves are stimulated 
by the local use of Electricity, Strychnine and friction; and are irritated by the internal ad- 
ministration of Aconitine, Nicotine, Camphor, Pilocarpine and Pyridine. 

Mydriatics {nudpiaocc, mydriasis), — are agents which cause dilatation of the 
pupil of the eye. They are used by ophthalmologists to prevent or break down 
adhesions of the iris, and to dilate the pupil for ophthalmoscopic and other 
examinations. Most of the mydriatics produce paralysis of the ciliary muscle 
(cycloplegia), resulting in temporary loss of accommodation, the eye remaining 
focussed for distant objects only, and the intra-ocular tension being increased. 
The principal mydriatics are named in the following list: — 

Atropine. Duboisine. Cocaine. 

Homatropine. Hyoscyamine. Gelseminine. 

Daturine. Coniine. Euphthalmin. 

Atropine and its congeners act as mydriatics by paralyzing the terminations of the 3rd 
nerve in the circular fibres of the iris, and stimulating the sympathetic filaments which supply 
its radiating fibres. Atropine paralyzes the ciliary muscle completely, leaving the eye ad- 
justed for the far point only. Its effects last from 10 to 14 days. Homatropine paralyzes 
the muscle less completely, its effects lasting only a day or two. Cocaine acts as a mydriatic 
by stimulating the sympathetic filaments, and has very slight action on the ciliary muscle. 
Its effects last only a few hours. Euphthalmin is a rapid and safe mydriatic, neither impair- 
ing accommodation nor increasing intra-ocular tension. The General Anesthetics cause 
mydriasis by central action, both early and late in the course of their administration. [See 
under Myotics.] 

Myotics (fideiv, to close), — are agents which cause the contraction of the 
pupil. They act by stimulating the motor oculi nerves supplying the circular 
muscular fibres of the iris, and produce this effect when locally applied or in- 
ternally administered, except Morphine, which acts centrally, and does not 
affect the pupil when applied locally. Physostigmine (Eserine) is the chief 
myotic for local use, and the only one employed in ophthalmic practice. Others 
are Muscarine, Pilocarpine, and Nicotine. 

Physostigmine also contracts the ciliary muscle, leaving the eye accommodated for the 
near point only, and lessens intra-ocular tension, antagonizing exactly the eye-actions of 
Atropine. Morphine given internally produces myosis by stimulation of the oculo-motor 
centres probably, the dilatation which occurs as death approaches being due to final paralysis 
of the same (Wood). The General Anestlietics dilate the pupil in the first and last stages of 
their action, but contract it in the middle stage, that of complete anesthesia. When in this 
stage dilatation occurs, it is a dangerous sign of failing respirator}- power, unless it is accom- 
panied by symptoms of returning consciousness, as reflex movements and vomiting. 

Narcotics ^apui), stupor), are agents which lessen the relationship of the 
individual to the external world. At first more or less excitant to the higher 
brain and stimulant to the mind and to all the bodily functions, the next stage 
of their action is one of profound sleep characterized by increasing stupor, and 
this, if the dose has been sufficient, is followed by coma and insensibility (nar- 
cotism), and finally death occurs from paralysis of the medullary centres which 
govern respiration and the other functions of organic life. Narcotics and 
stimulants are closely related, Alcohol and Opium affording good illustrations, 
in the different stages of their action, of stimulation followed bv narcosis. Nar- 






CLASSIFICATION OF MIl'UIMs ,| I 

cotics, in proper medicinal doses, give us the power of lowering morbidl) 

acute perception, of relieving pain and allaying irritation, nervous agitation and 
spasm, of inducing sleep, and of regulating the vital functions by rest — all of 
which are means of great therapeutical value. The chief narcotics are: — 

Opium, Morphine. Alcohol. Phenol. 

Belladonna, Atropine. Ether. Hydrocyanic Acid. 

Hyoscyamus. Chloroform. Oil of Turpentine. 

Stramonium. Hydrated Chloral. Other Essential Oils. 

Cannabis liulica. Bromal Hydrate. Carbonic Acid Gas. 

Opium is the typical member of the group, llitmithts (hops) and Lactucarium (lettuce) 
are generally included among the narcotics, but their action is so feeble that they are seldom 
used for that purpose. 

Oxytocics or Ecbolics (tfbc, quick, tSkoc, childbirth; iK t %M), abortion), — 
are agents which stimulate the muscular fibres of the gravid uterus to contrac- 
tion, and may therefore produce abortion. In small doses the same remedies 
are emmenagogue as a rule. Their mode of action has not been clearly made 
known, but it is generally believed to be due in some cases to direct stimula- 
tion of the uterine centre in the cord, in others to congestion of the uterus pro- 
ducing reflex stimulation. The principal oxytocics are those named in the fol- 
lowing list: — 

Ergot. Hydrastis. Pilocarpine. 

Ustilago. Borax. Viscum Flavescens. 

Savin. Cotton-root Bark. Strong Purgatives. 

Potassium Permanganate. Oil of Rue. 

Any drastic purgative, or gastro-intestinal irritant, may produce abortion by reflex action. 
The Volatile Oils act in this manner, also Colocynth and many other agents used by women 
to produce abortion, as Tansy, Pennyroyal, etc., all of which are dangerous to life in doses 
sufficient to excite the action of the gravid uterus. 

According to Boissard there are no abortifacient drugs in the strict sense of the term, 
though some drugs given in toxic doses may cause abortion and the death of the woman. 
Such drugs are therefore useless in any except the most reckless hands. The oxytocic and 
ecbolic drugs belong to another class, having the power of strengthening the intensity of the 
uterine contractions after they have been aroused (oxytocics), or of arousing and aiding uterine 
contractility (ecbolics). The action of the former is certain, that of the latter is very doubtful. 

Pancreatic Stimulation may be obtained by the administration of Ether, 
or by galvanism of the gland itself. The secretion is depressed by Atropine, 
also by any agent inducing nausea and vomiting. 

Parasiticides (napaokoc, a parasite, ccedo, I kill), — are agents which de- 
stroy the animal and vegetable parasites found upon the human body. They 
are generally applied in the form of lotions, ointments or oleates, and include 
the following-named substances: — 

Sulphur. Mercury. Phenol. 

Sulphides. Ammoniated Mercury. Petroleum. 

Sulphurous Acid. Mercuric Chloride. Storax. 

Sulphur Iodide. Mercuric Nitrate. Staphisagria. 

Iodine. Mercuric Oxide. . Balsam of Peru. 

Protectives are agents of a mechanical nature employed to cover and pro- 
tect an injured part from the air, water, friction, etc. Collodion and GiMa- 



, 






42 CLASSIFICATION OF MEDICINES. 

percha are those in general use, but certain plasters, as the adhesive, the lead 
or the soap plaster, may be employed for this purpose, also cotton. 

Pulmonary Sedatives diminish cough and dyspnea by lessening the irrit 
bility of the respiratory centre or that of the nerves of respiration. Some act 
by directly depressing the respiratory centre; others by removing some irritant 
from the passages, or by lessening local congestion, as the expectorant group; 
and others by lowering the excitability of the vagus end-organs in the lungs 
and that of other afferent filaments throughout the respiratory tract. The 
principal pulmonary sedatives are named in the following list: — 

Opium. Hydrocyanic Acid. Turpentine. 

Morphine. Codeine. Potassium Cyanide. Ethyl Iodide. 

Belladonna. Amy] Nitrite. Conium. 

Stramonium. Quebracho. Tobacco. 

Hyoscyamus. Cannabis. Lobelia. 

Opium has the most powerful influence as a sedative to the respiratory centre, and mucil- 
aginous or saccharine substances soothe the local irritation, hence the latter are so frequently 
used as vehicles for the former in cough mixtures. Hydrocyanic Acid has a similar sedative 
action, hence the use of Prunus Virginiana and other substances containing it against cough. 
Belladonna stimulates the respiratory centre, but at the same time lessens the excitability of 
the vagus terminations in the lungs, and completely arrests secretion from the bronchial 
mucous membrane. Stramonium acts similarly. 

Refrigerants (refrigero, I cool), — are remedies which allay thirst and im- 
part a sensation of coolness. They include the Vegetable Acids, the Mineral 
Acids (greatly diluted), Ice, Water if cold, effervescing drinks, fruit juices, and 
many diaphoretics. 

Respiratory Depressants lower the activity of the respiratory centre, ren- 
dering the respirations slow and shallow. The chief agents of this class are: — 



Opium (large dose). 


Gelsemium. 


Alcohol. 


Caffeine. 


Physostigma. 


Aconite. 


Ether. 


Colchicine. 


Muscarine. 


Veratrine. 


Chloroform. 


Nicotine. 


Lobeline. 


Hydrocyanic Acid. 


Chloral. 


Quinine. 


Phenol. 


Conium. 


Saponin. 


Camphor. 



The ten last named first excite the centre for a brief period and then depress it. 

Respiratory Stimulants exalt the function of the respiratory centre, quick- 
ening and deepening the breathing. Such agents are: — 

Strychnine. Opium (small dose). Quebracho. 

Brucine. Thebaine. Zinc and Copper Salts. 

Atropine. Apomorphine. Tobacco (briefly). 

Duboisine. Ammonia. Alcohol (briefly). 

Emetine. Hydrocyanic Acid. Ether (briefly). 

Chloralformamide. Digitalis. Cold Douche. 

Strychnine also stimulates the vagus tract. Electricity, applied to the nerve-trunks or 
to the inspiratory muscles, is a direct respiratory stimulant. Veratrine, Physostigmine and 
Muscarine stimulate the vagus terminations, quickening the respiration, but afterwards 
slow it by depressing the respiratory centre. Aconite stimulates the end-organs of the vagus 
when given in small doses. 

The Respirator)' Centre is situated in the medulla oblongata, close to the termination 
of the calamus scriptorius. It probably consists of thoracic and diaphragmatic Inspiratory 



CLASSIFICATION (IT MIDHINKS. 4;, 

■ of expiration being considered normally a passive "in-, due to tin- natural 
contraction of the walls of the air vesicles, and the return of the diaphragm and thoracal 
to the position from which they were moved by the inspiratory effort. An Expiratory ( 'entre 
must exist for the initiation of forced expiration, as in the production of voice, COUgh, n< ' '" 
ete. The chief Inspiratory Nerves are the pulmonary branches of the vagus. The Expira 

lory are the nasal branches of the fifth, the superior and inferior laryngeal, and the 

cutaneous nerves oi the chesl and abdomen. 

Restoratives arc agents which promote constructive metamorphosis, in- 
cluding the Foods, Hematics and Tonics, as well as many agents called Stimu 
lants in other classifications. 

Foods, are substances which, when introduced into the body, supply ma- 
terial to renew some structure or to maintain some vital process; being distin- 
guished from medicines in that the latter modify some vital action but supply 
no material to sustain it. 

The food of man is derived from all three of the kingdoms of nature, the animal, vegetable, 
and mineral, and includes many substances treated of in the Materia Mcdica, as Oils and Fats, 
Sugar. Starch, Gum, Alcohol, Beverages like Coffee and Tea, Water, Calcium Phosphate, 
Sodium Chloride. 

Hematics (dl/ia, the blood), are medicines which augment the quantity 
of hematin in the blood, and thus restore the quality of that tissue by enrich- 
ing its red corpuscles. They consist chiefly of Iron and Manganese and their 
compounds. 

Tonics (rovof, tension), are agents which improve the tone of the tissues 
on which they have specific action, restoring energy and strength to debilitated 
subjects by a scarcely perceptible stimulation of all the vital functions, their 
effects being apparent in an increased vigor of the entire system. The chief 
tonics are enumerated in the foregoing lists under the heads of the organs or 
tissues particularly affected by them. [Compare Stimulants, Respiratory 
Stimulants, Cardiac Tonics, Vascular Tonics, Gastric Tonics, etc.] 

The most typical medicinal agents which impart general tone and strength are Strych- 
nine, Quinine, Iron, and \ r egetable Bitters. Those especially acting upon the stomach, are 
Arsenic, Bismuth, Cinchona, Hydrastis, and Nux Vomica; on the spinal cord and general 
circulation, Strychnine, ; on the heart, Digitalis, Squill, Convallaria and Cimicifuga; on the 
nervous system, Phosphorus, Quinine and the Valerates; on muscular tissue, Tannin; on the 
blood, Iron, Manganese, Cod-liver Oil and other fats. 

Salts are compound bodies formed: — (i) by the interaction of an acid and 
a base, which may be an element, an oxide, or a compound containing a weaker 
acid radicle than the acid employed; the base displacing some of the hydrogen 
from the acid, as N0 3 and K, forming KN0 3 Potassium Nitrate: (2) by the 
interaction of two elements, as Na with CI, forming NaCl Sodium Chloride or 
common salt: (3) by the union of two or more oxides of elements having oppo- 
site electrical states, as S0 3 and BaO, forming BaS0 4 Barium Sulphate. Most 
alts contain three elements, one being Oxygen, and its comparative amount 
is shown by the terminal of the name of the salt; those ending in — ate being 
formed by an — ic acid and having the greater quantity of oxygen, those ending 
in — ite being formed by an — ous acid and having the lesser amount of oxygen. 



. 






44 CLASSIFICATION OF MEDICINES. 

The prefixes hyper- (or per-) and hypo- indicate respectively a greater or lesser 
amount of oxygen than can be represented by the terminations -ate and -ile. 
Salts formed by the union of two elements and containing no oxygen have the 
termination — ide, which indicates that they contain nothing but the elements 
designated in their names. Salts may be divided into six classes, viz. — 

Normal Sails, — in which the Hydrogen of the acid is fully displaced by a 
single element? as KNO s Potassium Nitrate. 

Acid Sails, — in which some displaceable Hydrogen still remains, as KHC0 3 
Acid Potassium Carbonate. 

Mixed Sails, — in which two or more bases are present, as KNa (C 4 H 4 6 ) 
Potassium Sodium Tartrate. 

Double Sails, — in which two complete salts unite to form a definite compound, 
generally crystalline, as K 2 S0 4 . A1 2 (S0 4 ) 3 Potassium Aluminum Sulphate. 

Oxy-salts, — also called subsalts or basic salts, in which oxygen takes the 
place of one or more of the acid radicles, as Bi N0 3 Bismuth Oxy-nitrate or 
Bismuth Subnitrate. 

Haloid Salts, — are salts formed by the Halogen (salt-forming) elements 
(Chlorine, Bromine, Iodine, Fluorine) and the compound radicle Cyanogen, 
uniting with other elements, without the aid of oxygen, as NaCl Sodium Chloride, 
common salt. Their names have the termination — ide, indicating that they 
contain nothing but the elements represented in their names. 

Sedatives (sedo, I allay), — -are agents which exert a soothing influence 
on the system by lessening functional activity, depressing motility and dim- 
inishing pain. 

General Sedatives include the narcotics and anesthetics. Local Sedatives include Aconite, 
Opium, Ice, etc. Pulmonary Sedatives, as Hydrocyanic Acid, Veratrine and the nauseants 
and emetics. Spinal Sedatives, as Physostigma, Gelsemium, Potassium Bromide. Stomachic 
Sedatives include Arsenic, Bismuth, Silver Nitrate, Sodium Bicarbonate. Vascular Seda- 
tives, as Digitalis, Tobacco, Aconite, Veratrum, and the emetics. Nervous Sedatives, among 
which are Potassium Bromide, Tobacco, Lobelia, and the group of spinal depressants. 

Sialogogues (olaXov, saliva, ayoj, I carry off), — are agents which increase 
the secretion and flow of saliva and buccal mucus, either by reflex action from 
the local irritation produced when anything is taken into the mouth, or by 
stimulating the glands during their elimination. The principal sialogogues 
are divided into two groups, the first or topical sialogogues acting by reflex 
stimulation; the second, general sialogogues, acting through their systemic 
influence on the glands or their secretory nerves; and include the following- 
named substances: 

Topical Sialogogues. General Sialogogues: 

Acids and Alkalies. Pilocarpus (Jaborandi). 

Ether, Chloroform, etc. Muscarine. 

Mustard. Ginger. Physostigma. 

Pyrethrum. Mezereon. Mercurials. 

Tobacco. Cubebs. Iodine compounds. 

Capsicum. Rhubarb. Antimonials. 

Horse-radish. Tobacco. Ipecacuanha. 



CLASSIFICATION OF MEDICINES. 45 

Agents which diminish salivary secretion are termed Antisialics. The prin- 
cipal member of this group is Atropine, which paralyzes the terminals of the 
nerves of secretion. Physostigma counteracts this paralysis, but in large doses 
acts also as an antisialic by lessening the blood supply to the glands. Opium 
diminishes the reflex excitability of the reflex centre and also lessens the secre- 
tion directly. Others acting locally are — 

Borax. Soda. Lithia. 

Potassium Chlorate. Lime. Magnesia. 

Insipid or nauseous articles of food or medicine. 

Smell is one of the senses which is increased by Strychnine. It is decreased 
by all cerebral depressants and by those agents which produce changes in the 
nasal mucous membrane, as Potassium Iodide. 

The cerebral centre for this faculty is probably situated either at the tip of the temporal 
lobe, or in the limbic lobe, and the terminal branches of the olfactory nerve are distributed 
upon the mucous lining of the upper portion of the nasal fossae. Strychnine probably stimu- 
lates the former, and all drugs acting upon the latter region have more or less effect upon the 
power of distinguishing smells. 

Stimulant (stimulus, a goad), — is a term which is used in various senses 
when applied to medicinal agents. Alcoholic preparations, which are true 
narcotics, are commonly termed "stimulants," and the same expression is em- 
ployed to designate any agent which excites even briefly the organic action of 
any part of the system. All excessive stimulation reacts into depression, and 
most of the agents which stimulate the nerve centres at first will soon depress 
and finally paralyze them. In many cases the action is one of progressive stimu- 
lation primarily and progressive paralysis afterwards, affecting the centres in 
the inverse order of their development, the highest or latest developed centres 
being affected first, the lowest or oldest ones last. These laws are well ex- 
emplified in the action of Alcohol upon the nervous system. [Compare the 
article entitled Alcohol in Part I.] 

Diffusible Stimulants are those which have a prompt but transient effect on the general 
system, such as Alcohol, Ammonia, Camphor. Spinal Stimulants exalt the functions of the 
cord, as Strychnine, Picrotoxin, Ergot, Atropine, Phosphorus. Cardiac Stimulants increase 
the action of the heart, as Alcohol, Adrenalin, Strychnine, Atropine, and Morphine in small 
doses; also Squill, Convallaria, Cimicifuga and Digitalis, which slow but strengthen the car- 
diac action. Respiratory Stimulants directly stimulate the respiratory centre, as Ammonia, 
Strychnine, Apomorphine, Belladonna. Vascular Stimulants, as Alcohol, Chloroform, Ether 
(all three in very small quantities), Adrenalin, Ammonia, Strychnine, Digitalis, and Squill, 
acting on the vaso-motor centre; and the Nitrites, Belladonna, Electricity, Volatile Oils, acting 
3 local dilators of the vascular system. Cerebral Stimulants, as Alcohol, Opium, Belladonna, 
Caffeine, Cocaine, Cannabis, Chloroform, Ether, Tobacco. Renal Stimulants, as the diuretic 

ip. Stomachic Stimulants, as the Aromatics, Volatile Oils, Vegetable Bitters, Mineral 
Acids. Nux Vomica, Mustard, Capsicum. Hepatic Stimulants, as Nitro-muriatic and Nitric 
cids. and the cholagogue purgatives Podophyllum, Jalap, Leptandra, Euonymin, Iridin. 
Intestinal Stimulants, as Mercurials, Elaterium, Colocynth, Jalap, Scammony, Podophyllum, 
which affect the glandular apparatus, — and Belladonna, Physostigma, Nux Vomica, Rhu- 
barb, Senna, Aloes, Frangula, Cascara, which chiefly affect the muscular fibres and the intes- 
tinal nerves. Cutaneous Stimulants, as the diaphoretic group, and the rubefacients Mustard, 
cum, Turpentine, Ammonia, 

Local Stimulants increase common sensibility to the extent of producing pain, chiefly by 
direct action upon the end-organs of the sensory nerves in the skin, though some act probably 



46 CLASSIFICATION OF MEDICINES. 

by stimulating the local circulation, as in inflammation. The principal members of this sub- 
division are — 

Faradism. Chloroform. Volatile Oils. 

Heat. Phenol. Acrid Essential Oils. 

Cold. Creosote. Metallic Salts. 

Alcohol. Mineral Acids. Veratrine (at first). 

Ether. Ammonia. Cantharis (at first). 

Stomachics or Gastric Tonics are agents which increase the appetite and 
promote gastric digestion. They include a number of substances, dietetic 
and medicinal, some acting by stimulating the production of gastric juice, others 
by stimulating the local circulation, and several by exciting the activity of the 
nervo-muscular apparatus of the stomach. The first indication is met by the 
use of dilute alkaline solutions before meals, — the second by administering 
any of the pungent carminatives, as the Aromatic Oils, Pepper, Mustard, etc., 
or by Alcohol and Ether in small doses, or by the Aromatic Bitters, as Gentian, 
Orange, or the simple bitters, as Calumba; — while the third desideratum is 
secured by the use of such agents as Nux Vomica, Hydrastis, Arsenic, the di- 
lute mineral acids and the volatile oils. 

Adjuvants to digestion are the digestion-ferments, Pepsin, Ingluvin, Papain, and also 
dilute HC1 acid; all of which may be used to supplement the gastric juice when sufficient in 
quantity or quality. The juice of the Pineapple contains a very active digestive principle, 
and may be employed as an aid to digestion with excellent results. Pepsin acts in acid media, 
and is only applicable to gastric indigestion; Pancreatin acts in alkaline media, is destroyed by 
acids, and is only applicable to intestinal indigestion; while Papain exercises its proteolytic 
power in either acid, alkaline or neutral solutions, and is equally applicable to either gastric or 
intestinal indigestion. 

Styptics and Hemostatics (otu<j>u>, I contract, at^a, blood, ot&occ, a stand- 
ing), — are agents which arrest bleeding; Styptics being those which are applied 
locally, and Hemostatics those which are administered internally. Some of the 
former act mechanically, by promoting the formation of a clot in the mouths 
of the bleeding vessels; others cause the vessels themselves to contract, thereby 
checking the flow of blood. The principal members of this class are the follow- 
ing named: — 

Styptics. Hemostatics. 

Acids. Ferric Sulphate. Adrenalin. 

Alum. - Lead Acetate. Gelatin. 

Antipyrine. Silver Nitrate. Cotarnine. 

Collodion. Zinc Sulphate. Hydrastinine. 

Gelatin. Spider's Web. Ergot. Digitalis. 

Adrenalin. Cold (locally.) Gallic Acid. Matico. 

Cotarnine. Cauterization. Lead Acetate. 

Hydrastinine. Dilute Sulphuric Acid. 

Tannic Acid. Ipecacuanha. 

Vegetable Astringents. Hamamelis. 

Matico. Oil of Turpentine. 

Ferric Chloride. Heat (locally). 

Taste is not much affected by drugs except as each drug makes its own 
peculiar impression on the nerves of taste, and may overcome that of another 
agent. Smell has much to do with taste in many instances, the expedient of 
holding the nose while swallowing castor oil being familiar to every one. 



CLASSIFJ('\ii.«\ or \nnici\is. 47 

The "after-taste" of drugs is often different to their original taste; thus Hitters are said 
to leave a sweet after-taste, and the same is claimed for Quinine if given in acid solution so 
as to be entirely dissolved, and if washed out of the mouth with water immediately after swal- 
lowing. Substances which are excreted from the system in the saliva (as Iodides i leave a very 
persistent aftcr-tastc. 

Urinary Acidifiers include the Acid « Sodium Phosphate, Benzoic and 
Salicylic Acids and several of their salts, Vegetable Acids in excess, Urotropin, 
and Salol; also excess of proteids, sugar and starch in the food, and certain 
wines and spirits. The mineral acids have little or no influence on the acidity 
of the urine, being excreted as neutral sulphates, chlorides, phosphates, etc. 

Benzoic Acid and its salts are among the very few agents by. which morbid alkalinity of 
the urine can certainly he neutralized, though this is denied by some clinicians. Salol is 
much quicker in its action on the urine than is Ammonium Bcnzoate; as ordinarily in a day or 
so, under its administration, the urine in chronic cystitis loses its alkalinity and foul odor, and 
becomes clear (Dr. Mansel Sympson). Potassium Bitarlrale, being an acid salt, will in most 

s acidify an alkaline urine. Acid Sodium Phosphate is one of the most efficient agents 
for this purpose (Hutchinson). Urotropin is a reliable agent to render an alkaline urine acid. 

Urinary Alkalinizers include the alkalies, particularly Potassium and 
Lithium Salts, but excepting Ammonia, which is broken up in the organism. 
Sodium salts, being partly excreted by the bile and the bronchial mucus, and 
partly locked up in the system as the neutral chloride, while sodium urate is 
insoluble, are not so efficient in this regard as are other alkalies. Fruits, milk 
and fish also act in the same manner by means of the salts which they convey 
into the economy, and a strictly vegetable diet plays an important part towards 
the same end. 

Urinary Sedatives and Astringents, when administered internally, act 
in a sedative manner upon the whole extent of the urinary tract through the 
medium of the urine, which, being charged with them, brings them into contact 
with the genito-urinary mucous membrane. Some of them may be applied 
locally as far as the urethral and vesical mucous surfaces, the portion above the 
latter being inaccessible to direct local medication. 

Instances of the application of these agents are the use of Potassium and Lithium Salts 
to diminish the acidity of the secretion, — Cubebs, Copaiba, and Sanlal Oil as antiseptics and 
astringents, — and urethral injections of Alum, Acetates of Zinc and Lead, Boric Acid, Chloral 
and Zinc Chloride, etc., for a simple purpose. Copaiba is one of the most efficient agents for 
rendering the urine antiseptic, and should be more employed in cystitis and urethritis than it 
is. Oil of Eucalyptus is nearly as efficient, and Stigmata Maidis (Corn Silk), in tincture, is 
well thought of for its general alterative influence on the urinary tract. 

Uterine Depressants lower the activity of the nervo-muscular apparatus which 
controls the uterine contractions. The most important of these agents are — 

Opium. Chloral. Tobacco. 

Bromides. Chloroform. Copper Sulphate. 

Cannabis. Tartar Emetic. Emetics. 

Viburnum Prunifolium. Piscidia Erythrina. 

Uterine Stimulants — See Oxytocics. 



48 CLASSIFICATION OF MEDICINES. 

Uterine Tonics and Alteratives, are medicines which are considered to 
have such specific influence over the uterus. Authorities differ very much regard- 
ing the action and use of these agents, but those named in the following lists 
are generally believed to have considerable value in uterine therapeutics, viz. — 

Uterine Tonics. Uterine Alteratives. 

Potassium Bromide. Pulsatilla. Iodine. Glycerin. 

Potassium Chlorate. Cimicifuga. Iodoform. Hydrastis. 

Helonias Dioica. Savin. Iodized Phenol. Galvanism. 

Astringents (locally). Silver Nitrate. 

Those in the first list, except Astringents, are used internally; those in the second list 
are employed as topical applications to the uterine cavity or cervix. 

Vascular Contractors increase the contractile power of the vessels, lessen- 
ing the circulation therein and raising the blood-pressure; hence they are used 
to check hemorrhage and cut short inflammations. The principal agents in- 
cluded in this group are — 

Adrenal Extract. Atropine (small doses). Iron. Camphor. 

Adrenalin. Opium (small doses). Sulphuric Acid. 

Antipyrine. Cocaine. Barium Salts. 

Cotarnine. Ergot. Lead Salts. 

Hydrastinine Digitalis. Silver Salts. 

Strychnine. Squill. Zinc Salts. 

Hamamelis. Strophanthus. Cold (locally). 

These agents act upon the local vaso-motor mechanism in the walls of the vessels, Ham- 
amelis affecting the venous system especially. Cold is one of the most powerful agents of 
this class, and is also a cardiac sedative. Adrenal Extract produces an enormous rise of the 
blood-pressure, due to its extraordinary contractile power over the muscular fibres in the walls 
of the arterioles. Adrenalin is said to be 625 times more powerful in this respect than the 
extract. Digitalis, Squill, and Strophanthus, in small doses contract the vessels, but in large 
doses dilate them. 

Vascular Dilators produce dilatation of the peripheral vessels, and in- 
crease the rapidity of the circulation, thus equalizing the blood-pressure and 
relieving internal congestions. The most useful are Alcohol and Ether, as they 
stimulate the action of the heart simultaneously with the vascular relaxation. 
The chief members of this group are — 

Alcohol. Ether. Belladonna. \ Chloral. 

Nitrous Ether. Stramonium. Vat last. Chloroform 

Nitroglycerin. Hyoscyamus. j Ammonium Acetate. 

Amy! Nitrite. Opium (full doses). Tartar Emetic. 

Potassium Nitrite. Ipecacuanha. Hydrocyanic Acid. 

Sodium Nitrite. Dover's Powder. Aconite (?). 

Erythrol Tetranitrate. Thyroid Extract. Heat (at first) . 

The dilating action of Amyl Nitrate and other Nitrites is due either to weakening of the 
muscular walls of the arterioles or to paralysis of the vaso-motor terminals therein. Alcohol, 
Ether and Opium probably depress the vaso-motor centre. Aconite does not affect the vaso- 
motor centre or the vaso-motor nerves, hence the lessened arterial tension induced by it is due 
to its depressant action on the heart alone (Ringer). Atropine and the drugs containing it 
or its congeners act on the vessels differently in different doses, and at different stages in its 
action. 

The Vascular Dilators are often called Vascular Stimulants or stimulants of the circula- 
tion; but there is this difficulty of speaking of stimulants or sedatives of the circulation, that 
if both the heart and the vessels are stimulated at the same time, the action of the one tends 
to counteract that of the other. On the other hand, a drug which weakens the heart may 
increase the circulation by dilating the vessels, thus acting as a vascularstimulant (Brunton). 



1'I.ASSll U'ATION OF MKIMCINIS. 49 

Vesical Sedatives arc substances which lessen irritability of the bladder, 
relieving pain anil decreasing the desire to micturate. Opium, Belladonna, 

Hyoscyamus, Stigmata Maidis, Cannabis, lessen the irritability of the nerves; 
Calcium Carbonate relieves that clue to the presence of calculi; mucilaginous 

drinks, such as Barley water or Linseed tea, also astringents like Buchu, CJva 
I'rsi, Pareira, diminish the irritation due to chronic cystitis; and antiseptics, as 
Copaiba and Cubebs, act in like manner, being carried by the urine to the bladder. 

Vesical Tonics increase the contractile power of the muscular fibres in the 
wall of the bladder. By strengthening the detrusor they prevent retention of 
urine and by stimulating the sphincter they prevent incontinence. The most 
important members of this group are Cantharides, Belladonna, Strychnine 
and Potassium Bromide by internal administration, Silver Nitrate locally, and 
the use of a urethral bougie. 

Cantharides stimulates the sphincter vesicas by rendering the urine irritant thereto; 
Strychnine, by increasing the irritability of the nerve-centre which governs it. Potassium 
Bromide lessens reflex susceptibility from the bladder, so that the detrusor is less frequently 
called into action. Belladonna probably decreases the sensibility of the bladder to changes 
of pressure within it. Silver Nitrate, locally applied to the neck, acts in the same manner 
as the passing of a urethral bougie, namely, — by altering the direction of reflex action (Brun- 
ton). 

Visions are caused by several drugs, the action of which is probably ex- 
erted on the sight-centres in the cerebrum rather than on the eye itself. The 
delirium and hallucinations produced by Alcohol are familiar examples, — the 
objects raised thereby being usually animals, as snakes, toads, and dogs. Sodium 
Salicylate in some persons produces very disagreeable visions. The Bromides, 
if taken in continued large doses may, during the typhoid condition which 
follows, cause visions of such intense character that they are often impressed 
permanently on a brain which, at the time, was utterly unconscious of all its 
real surroundings. Digitalis may produce subjective sensations of the con- 
tinued presence of light, and Cannabis Indica, among the many curious effects 
produced by its ingestion in large doses, frequently gives origin to similar dis- 
turbances of the visual function, of an indefinite and varied but usually pleasant 
character. 



: 



ADMINISTRATION OF MEDICINES. 



ADMINISTRATION OF MEDICINES. 



Medicines may be introduced into the circulation by various routes, in- 
cluding the mouth, the stomach, the rectum, the respiratory tract, the veins 
and arteries, the subcutaneous cellular tissue, and the integument. 

The Mouth is the usual receptacle for medicines intended for the stomach, 
but may itself be employed for the introduction of minute quantities of power- 
ful agents. A drop of the tincture of Aconite placed on the tongue is quickly 
absorbed, and soon manifests that fact by its symptoms. Many of the small 
tablets used for hypodermic administration, if placed under the tongue, are 
readily conveyed into the system, and used in this way form a very convenient 
means of medication with alkaloids and other active principles. 

The Stomach is the most convenient organ for the absorption of medi- 
cines and the one most frequently employed. After being swallowed, the 
remedies find their way into the current of the circulation through the walls 
of the gastro-intestinal blood-vessels and the lacteals. When the stomach is 
empty and its mucous membrane healthy, crystalloidal substances in solution 
pass rapidly through the walls of its vessels. Colloidal Substances (fats, albumin, 
gum, gelatin, etc.) require to be digested and emulsified before they can be ab- 
sorbed. Iodine and Iodides should be given on an empty stomach, so that 
they may diffuse rapidly into the blood; if administered during digestion, the 
acid gastric juice and the starch of the food will alter their chemical consti- 
tution and weaken their action. Acids should be given, as a rule, on an empty 
stomach, especially when they are intended to check the secretion of the acid 
of the gastric juice. Alkalies, of which Sodium Bicarbonate may be taken as 
the type, are given after meals to neutralize excessive acidity, and before meals 
to stimulate the acid gastric secretions. Silver Oxide and Silver Nitrate should 
be administered after the digestive process is ended; if given during digestion, 
chemical reactions destroy or impair their special attributes and defeat the 
object for which they were prescribed. Metallic Salts (especially corrosive sub- 
limate), also Tannin and pure Alcohol, impair the digestive power of the active 
principle of the gastric juice, and should be given by the stomach only during 
its period of inactivity. Malt Extracts, Cod-liver Oil, Phosphates, etc., should 
be administered with or directly after food, so that they may enter the blood 
with the products of digestion. Bismuth should be given on an empty stomach, 
it being usually employed for its local sedative action on the gastric mucous 
membrane. Potassium Permanganate should be given after meals; on an empty 
stomach it would irritate the mucous membrane and might possibly produce 
ulceration thereof. Arsenic and other irritant and dangerous drugs (the salts 
of copper, zinc and iron), should be given directly after food, except where 
local conditions require their administration in very small doses on an empty 






ADMINISTRATION OK MKDICINl'.S. 51 

stomach. Morphine should only be given by hypodermic injection when the 
patient is lying down, unless he is previously habituated to its use. Pilocarpine, 
administered to produce sweating, should be given when the patient is in bed 
in a warm room. Ammonium Acetate acts as a diaphoretic when (he recipient 
tS warm in bed, but as a diuretic when the patient is in a cold atmosphere. 
Sulphonal should be given two or three hours before its hypnotic action is de- 
sired, as it is very slowly absorbed. 

Under some circumstances it becomes necessary to introduce medicines directly into the 
Stomach, as in eases of the patient's inability to swallow, through narcotic poisoning or other 
causes. The stomach-pump or the stomach-tube may thin be employed to convey both food 
and medicine to that organ. In obstruction of the esophagus, as from stricture or malignant 
disease thereof, it may become necessary to make an opening through the abdominal wall 
and the wall of the stomach itself. Nasal feeding, by the use of a small catheter with a hard 
rubber funnel inserted into its end is a very efficient method of conveying liquids into the 
stomach. The eye end of the catheter is oiled and passed gently along the floor of the nose 
and down the pharynx; the fluid being then poured into the funnel. This method is particu- 
larly serviceable in cases of acute tonsillitis or other painful affections of the mouth or palate, 
also after excision of the tongue, when swallowing is to be avoided as much as possible. In 
many cases, especially insane ones, the patient will so constrict the muscles of the throat as 
to force the catheter into the mouth; but if it is withdrawn until nearly out of the pharynx, 
the presence of the fluid as it drops down will excite swallowing, and the patient may be fed as 
well as if the tube were in the esophagus. 

The Rectum will absorb many substances applied in the form of enemata 
or suppositories. Those most suited to this route are the salts of the alka- 
loids in solution, especially those of Morphine, Atropine and Strychnine, the 
latter being absorbed more rapidly by the rectum than by the stomach. Acid 
solutions, if not too frequently repeated, are well administered by this channel. 
Nutritive enemata must be small, not exceeding three or four fluid ounces, or 
they will not be retained. They become necessary in many cases, especially 
in cases of gastric ulcer, in order to afford rest to the stomach. It is often found 
advantageous to have the food predigested before being administered by the 
rectum, for which purpose Pancreatin is used. [Compare the articles entitled 
Injectioxes and Suppositoria in Part II and Enemata in Part III.] 

The Respiratory Tract admits of the rapid absorption of medicinal sub- 
stances through its extensive blood-supply. The inhalation of vapors or atom- 
ized fluids, the insufflation of powders into the nares, fauces, larynx, etc., and 
the use of a medicated nasal douche, are methods whereby this channel may 
be utilized. [Compare the article entitled Inhalationes, in Part IT] 

The Veins are only used as a route of medication in emergencies, when 
the other channels are not available, and where immediate action is necessary 
to the preservation of life, the operation being a highly dangerous one. The 
injection intravenously of Saline Solutions in the collapse of cholera, diabetic 
coma, etc., Blood or Milk as a last resort in excessive hemorrhage, epilepsy, 
uremia, the collapse of cholera, and a solution of Ammonia for the bites of ven- 
omous reptiles, in Hydrocyanic-acid poisoning, opium-narcosis, and chloroform- 
asphyxia, are instances admitted in practice. 

Arterial Transfusion has also been performed successfully in a number of cases, and 
is considered safer than venous transfusion when a large quantity of fluid has to be introduced 



52 ADMINISTRATION OF MEDICINES. 

into the circulation. A special apparatus is employed for these purposes, known as Aveling's 
transfusion syringe, but the ordinary Dieulafoy's aspirator slightly modified may be used with 
safety and convenience. The danger of the operation lies in the liability of introducing air 
into the circulation, an occurrence which may cause instant death in the human subject. 

The Hypodermic Method is the introduction of medicines into the or- 
ganism by injecting them into the subcutaneous areolar tissue, from which 
they are quickly absorbed by the lymphatic and capillary vessels. The great 
advantage of this method is the absolute certainty as to the quantity of drug 
actively affecting the organism, a very essential question when using small 
quantities, as when powerful alkaloids are employed. Another advantage is 
the avoidance of reaction between the drug and the contents of the stomach, 
which may destroy the activity of the former, or seriously change its character. 
In the presence of a chill or other condition of impaired peripheral circula- 
tion, hypodermic injections cannot be expected to act with any degree of speed 
or certainty, and in the presence of dropsy they are useless because the drug 
lies in the fluid contained in the subcutaneous tissues until, as the result of pur- 
gation, increased circulation, or diuresis, absorption of the dropsical fluid occurs. 

The medicine must be in solution, and the latter should be of neutral reac- 
tion and freshly prepared; the usual menstruum being distilled water, though 
filtered spring water will answer just as well, and much better than distilled 
water which has been standing several days and frequently exposed to the air. 
The solution is to be injected beneath the skin, not into it, by a hypodermic 
syringe, care being taken to avoid puncturing a vein. The most suitable locali- 
ties for the injection are the external aspect of the arms and thighs, the ab- 
domen, the back, and the calves of the legs. On the external aspect of the thigh, 
just in front of the great trochanter, there is an area of some two inches square, 
over which the insertion of a fine hypodermic needle is not felt, so barren is the 
skin of sensitive nerve filaments in that region. A few years ago the sight of a 
hypodermic syringe in a physician's hand suggested an injection of morphine 
to the patient and to the patient's friends, and many a physician has acquired 
the reputation of giving morphine on every possible occasion because he ad- 
ministered drugs by the hypodermic method. It is therefore well to inform 
the patient that another drug is being so administered when such is the fact. 
In this age of toxin and antitoxin treatment the hypodermic syringe has become 
a necessity, as many of these agents are inert when given by the stomach. When- 
ever such preparations are employed their injection must be administered under 
strict aseptic conditions, applied to the syringe and needle as well as to the site 
of the operation, and the contents of the syringe should be discharged very 
slowly into the tissues beneath the skin, giving time for the fluid to diffuse itself 
without rupturing the connective tissue. 

The classic practice of pinching up a fold of the integument before inserting the hypo- 
dermic needle is entirely wrong both in theory and in practice. It is never done by persons 
who habitually use this instrument on themselves, and they are admittedly the most expert 
of all operators in this line. It increases the liability to local soreness, and often produces 
bruises and ecchymoses which might be avoided by following the method described below. 

After nearly filling the syringe with the solution to be used, the needle, if separate, should, 



ADMINISTRATION OF MEDICINES. 53 

be screwed on tightly; and with the instrument held in a vertical position, point uppermost, 
the excess of solution over the amount required should be ejected, thus expelling on bubbli 

ami tilling the needle itself. \ site having been selected, where there is no danger of pene- 
trating a vein or artery, the needle should In- quickly inserted at a right angle with the sur- 
face, mik\ earried on for fully one-half its length into the subcutaneous tissue, except when a 
solution of Cocaine is to he injected for the production of local cutaneous anesthesia, in which 
case it is injected into the skin itself. The syringe should be held steadily, not moved around, 
so as to avoid injuring the tissue. The piston should be pressed down slowly, and when the 
injection has been delivered the needle should be quickly withdrawn, and no attention paid 
to the few drops of solution which may follow it. The very finest needles should alone be 
used, except in cases where the patient is struggling and liable to break the needle off by his 
movements. The point of the needle should be perfect and its surface highly polished. It 
is far better to use a new needle every day than to risk one's reputation for skill on a blunt- 
pointed and rough-surfaced instrument. The writer buys Green's short and finest needles by 
the dozen and uses a new one on every patient. He has injected a strychnine solution in this 
manner on some 300 patients during three years, three or four times daily in the same upper 
arm for a month in each case, without having produced any more serious results than a hyper- 
eniic zone around some punctures in a very few instances. If the solutions are freshly pre- 
pared with clean water, the needles sharp, clean and bright, and the injections delivered 
beneath the skin and not into it, there is no danger of producing abscesses or even indurations 
with the agents ordinarily employed in this manner. After using the syringe force out all 
liquid, and wipe the needle-point dry between the fingers, before returning it to the case; 
the sebaceous matter on the fingers will keep it free from rust. Avoid puncturing a vein; 
if you do so, watch the patient and prepare an injection containing gr. T Jj, of Atropine Sulphate, 
to administer if dangerous symptoms arise. Never, except under special circumstances, ad- 
minister the Salts of Morphine or Atropine hypodermically to children less than 15 years of 
age. 

Acetanilide, in minute proportion, added to aqueous solutions for hypodermic use, is said 
to preserve them from decomposition more efficiently than any other agent hitherto employed 
for that purpose, but Phenol, a drop or two to the fluid ounce, is generally effective in this 
respect . 

Compressed Tablets for hypodermic use are prepared by the prominent manufac- 
turers, and are furnished in glass tubes containing from 20 to 25 tablets each. The writer 
prefers those which are very small, entirely free from foreign material, sufficiently soluble, 
and put up in short tubes which can be carried in cases to fit the vest pocket. The tablets 
may be readily dissolved in a teaspoon at the bedside, or in the syringe itself if the instrument 
has a screw-hole large enough to admit the tablet before screwing on the needle. A regular 
line of Hypodermic Tablets includes the agents named in the following list, though many 
others are prepared by the manufacturing chemists. 

List of Hypodermic Tablets. 

Aconitine, (crystals) gr. r J- 7 . Morphine Sulphate, gr. J, }, J, £. 

Apomorphine Hydrochloride, gr. T \y. Morphine & Atropine, No. 1. 
Atropine Sulphate, gr. *&*, T i ffl tV- Morphine Sulph., gr. i- 

Caffeine, gr. i. A;T Atropine Sulph., gr. ^ 

r* • tt j" u, -j 11 Morphine & Atropine, No. 2. 

Cocaine Hydrochloride, gr. \ \. Morphine Sulph., gr. \. 

Lonnne Hydrobromide, gr. f. Atropine Sulph., gr. ^ n . 

Colchicine, gr. 5 V. Nitroglycerin, gr. zfor, T hs, A- 

Corrosive Sub. and Urea, gr. ^5. Physostigmine Sulphate, gr. T ^. 

Digitalin (soluble), gr. j^-q. Picrotoxin, gr. Jj- 

Duboisine Hydrochloride, gr. T ^ 5 . Pilocarpine Hydrochloride, gr. J. 

Ergotin, gr. \. Sodium Arsenate, gr. y 1 ^. 

Gelsemine Hydrochloride, gr. Jj. Sparteine Sulphate, gr. $■$. 

Hyoscine Hydrobromide, gr. T J 5 , 3*5. Strychnine Nitrate, gr. T ^j, -fa, ? V 

Hyoscyamine, gr. jfo, ^. Strychnine Sulphate, gr. T £ T , 5 V> t\>> 5*0 • 
[For Formulae for Hypodermic Solutions, see Appendix.] 

Parenchymatous Injection is the delivery of a medicine deeply into the tissues, either 
to affect a muscle itself or to locally influence some important nerve-trunk. The principal 
agents used in this manner are Strychnine for palsied muscles, Chloroform for sciatic and 
other neuralgias, Salts of Cocaine for local anesthesia, and Phenol for deep-seated inflamma- 
tions. 

The Integument is an active absorbent of crystalloidal substances when 
its epidermis or cuticle is removed, and many substances may be made to pass 



54 ADMINISTRATION OF MEDICINES. 

through the latter and produce their characteristic effects on the system. By 
this route there are four methods of introducing medicaments into the circu- 
lation — the Endermic, Enepidermic and Epidermic Methods, and Inoculation. 
The Endermic Method obviates the difficulty of absorption through the cuticle 
by removing the latter with a blister, and then powdering the medicament over 
the surface of the denuded derma. Before the introduction of the hypodermic 
method this procedure was quite common, but it is rarely employed now, as 
it is both painful and unpopular. 

An ordinary Cantharides-plaster, followed by a poultice to raise the blister, may be em- 
ployed; but a quicker method is to place upon the skin a piece of lint soaked in Stronger 
Water of Ammonia, covering it with a watch-glass or a piece of oiled silk to prevent evapora- 
tion. The blister raises rapidly and should be removed with scissors and the medicine in 
powder is then placed on the raw surface. Morphine, Atropine, Quinine, and Strychnine 
are the agents generally used in this manner. 

The Enepidermic Method consists in placing the medicine in simple con- 
tact with the epidermis, no friction being used to hasten its penetration. Chloro- 
form and oleic acid solutions of the alkaloids pass by osmosis in this manner 
with comparative ease, but aqueous solutions act very slowly, and alcoholic 
ones with great difficulty if at all. Drugs are readily absorbed from the sur- 
face of hot, moist poultices, a fact to be remembered in directing such appli- 
cations for children, as narcotic poisoning may follow the liberal use of opium 
in this manner. A good belladonna plaster will cause dilatation of the pupils 
and may produce the characteristic rash all over the body. 

The Epidermic Method or Inunction consists in the use of friction to pro- 
mote the passage of the medicament between the cells of the epidermis. Mer- 
curial ointment, cod-liver oil, and other fats, oleates, etc., are rubbed into the 
skin of the armpits, the popliteal space, and other parts of the body, for their 
local and systemic effects. Oil inunctions are an excellent method of introduc- 
ing fatty substances into children and persons who cannot take oils by the 
stomach. The inunction of castor oil will produce a purgative effect. 

Inoculation is the introduction of medicinal agents through the scraped or 
punctured skin by an operation which is similar to that employed for vaccina- 
tion. 






DOSAGE OF MEDICINES. 55 

DOSAGE OF MEDICINES. 



The Doses given throughout this book are for adults; for children the fol 
lowing rule (Young's) will be found the most convenient. Add 12 to the age 
and divide by the age, to get the denominator of a fraction, the numerator of 
which is 1. Thus, for a child two years old, ~^ = 7, and the dose is one- 
seventh of that for an adult. Of powerful narcotics scarcely more than one 
half of this proportion should be used. Of mild cathartics, two or even three 
times the proportion may be employed. 

For Hypodermic Injection, the dose should be two-thirds or three-fourths of that used 
by the mouth; by rectum five-fourths of the same. Strychnine acts more actively when given 
per rectum than by the stomach. 

Children bear Opiates badly: — but on the other hand they stand comparatively large 
doses of several other drugs; such being Arsenic, Belladonna, Ipecacuanha, Calomel and 
other preparations of Mercury, also Squill, Rhubarb, and several other purgatives. Pilocar- 
pine has very little effect on children, though it readily induces perspiration and salivation in 
adults. 

Conditions which modify the action of medicines, and therefore affect 
their dosage, are — age, body-weight, temperament and idiosyncrasy, drug- 
habits, intervals between doses, time of administration, condition of the stom- 
ach, temperature of the body, cumulative drug-action, mode and form of drug- 
administration, disease, climate, race, etc. 

The Dosage of Medicines is the weakest part of the therapeutic arma- 
ment, the flaw in our weapons which may be the cause of their failure at any 
moment, perhaps the most critical one for a life. If the accumulated rubbish 
of ages, which has been called therapeutic knowledge, is ever to be given scienti- 
fic shape, or placed in process of becoming a science, the question of dosage 
must form one of the principal corner-stones in the foundation. Drugs have 
widely differing actions on the human organism in health and in disease, ac- 
cording as they are administered in different doses, in different menstrua, and 
during different conditions of the subject's health. This difference, when be- 
tween extremes of dosage, is often so wide as to separate actions directly 
contrary to each other, the action of the very large dose opposing that of the 
very small one: — a truth hidden by one set of dogmatists under their former 
doctrine (now rule) of similars, and avoided by the great mass of the medical 
profession, through dread of the bogy-name irregular. 

The U. S. Pharmacopoeia now gives an average approximate dose for adults of each drug 
and preparation intended for internal administration, but disclaims any intention to have 
them regarded as obligatory. In the British Pharmacopoeia a minimum and maximum 
dose is stated for all the more important medicines, the quantities being intended to represent 
the average range in ordinary cases, for adults. In the preface to that work it is however 
distinctly stated that these doses "are not authoritatively enjoined," and that "the prac- 
titioner must rely on his own judgment and act on his own responsibility in graduating the 

-> of any therapeutic agents which he may wish to administer to his patients." As a 
matter of fact, most British practitioners ignore the doses given in their pharmacopoeia, or at 



. 



56 DOSAGE OF MEDICINES. 

best consider them as mere indications. The German Pharmacopoeia has appended to it a 
table giving the maximum single dose and the maximum daily dose for a number of drugs 
and preparations, but they arc of little value in practice except to catch an unwary physician ' 
in a legal proceeding for mal-pra< til e. 

In the following pages an effort has been made, whenever possible, to indi- 
cate the different doses of active agents for different purposes, and the proper 
intervals for repetition in certain cases, as determined by the accumulated ex- 
perience of clinicians, which is the only safe guide in this respect at present. 
The average doses of official drugs and preparations are given in brackets, 
preceded by the contraction av., thus— [av. gr. xxx.] These should be memor- 
ized by the student, and the following rules will be found useful for that purpose. 

Average Adult Doses of Official Preparations. 

Acids (dilute), njxxx;- — except Hydrochloric and Nitro-hydrochloric, njxv; and Hydro- 
cyanic, tTEJss. 

Alkalies, — Solution of Potassium Hydroxide (Liquor Potassae), tiJtxv. Carbonates, 
gr. xv, except that of Magnesium, gr. xlv; of Lithium, gr. vijss; of Ammonium, gr. iv. Po- 
tassium Bicarbonate, gr. xxx; Sodium Bicarbonate, gr. xv. Sodium Borate, gr. vijss. 

Alkaloids and their Salts, — form several groups: (1) Aconitine, gr. T ^: (2) those 
from plants of the Solanacea, including Atropine, Hyoscine, etc.; also including Colchicine, 
g r - riF : (3) Strychnine and Physostigmine, gr. -^- 5 : (4) those fiom Opium gr. \, except 
Codeine, gr. ss; Narcotine (unofficial) gr. iij; and Apomorphine, as an expectorant gr. ^, 
as an emetic gr. T \: (5) those from Cinchona, gr. iv: (6) Pelletierine, gr. iv; Piperine, gr. iij; 
Caffeine, gr. j; Cocaine and Hydrastinine, gr. ss; Hydrastine, Sparteine and Pilocarpine, 
gr. \; Veratrine, gr. fa. 

Extracts vary from gr. J to gr. xv, as follows: — Physostigma, gr. \; Belladonna, Cannabis 
Indica, Digitalis, Scopola, Stramonium, gr. \; Nux Vomica, gr. \; Colocynth, Opium, gr. ss; 
Colchicum, Hyoscyamus, Quassia, gr. j; Aloes, Euonymus, gr. ij; Cimicifuga, Ergot, Gentian, 
Leptandra, Rhamnus (Cascara), Rhubarb, Sumbul, gr. iv; Colocynth compound, Kra- 
meria, gr. vijss; Glycyrrhiza, Hematoxylon, Taraxacum, gr. xv. Extract of Malt, 3iv. 

Fluidextracts vary from ttjj to 3ij; 25 have an average dose of ttjxv, and 27 have 
itjxxx. Of the rest, those of Aconite, Belladonna Root, Cannabis Indica, Capsicum, Digitalis, 
Gelsemium, Ipecac, Nux Vomica, Scopola, Staphisagria, Stramonium, have an average dose 
of njj; Phytolacca, Sanguinaria, Squill, Veratrum, tijjss; Colchicum Seed, Conium, Hyos- 
cyamus, Quillaja, njiij; Convallaria, Euonymus, Lobelia, Lupulin, Podophyllum, Quassia, 
rnjviij ; Matico, Pareira, Spigelia, 3j; Taraxacum, Triticum, 5ij; that of Mezereum is not 
given internally. 

Glucosides. Ammoniated Glycyrrhizin, gr. iv; Salicin, gr. xv; Strophanthin, gr. ^\^. 

Infusions. Digitalis, 3ij; Wild Cherry, 3ij; Senna, the Compound Infusion, oiv. 

Mixtures. Chalk 3iv; Compound Iron Mixture oij; Rhubarb and Soda oj; Com- 
pound Glycyrrhiza 3ij. 

Oils, Fixed. Cotton Seed Oil, Codliver Oil, Castor Oil, 3iv; Expressed Oil of Almond, 
Linseed Oil, Olive Oil, oj- Lard Oil and Oil of Theobroma are only used externally. 

Oils, Volatile, njiij: — except that of Mustard. njj; Bitter Almond, njss; Cinnamon, 
Savin, Croton, itjjj; Cajuput, Copaiba, Cubeb, Eucalyptus, Santal, TTRviij; Betula, Erigeron, 
Gaultheria, Turpentine, ttoxv. Ethereal Oil is not used internally. 

Oleoresins. Ginger, Pepper, gr. ss; Lupulin, gr. iij; Capsicum, gr. vijss; Aspidium, 
gr. xxx. 

Pills ij; — except those of Opium, Phosphorus, and the Pills of Podophyllum, Bella- 
donna and Capsicum, pill j. 

Powders form two classes: (1) those given in grains, Acetanilide Compound, Ipecac 
and Opium, Compound Morphine, gr. vijss; Aromatic Powder, gr. xv; (2) those given in 
doses of half a drachm or more, Compound Chalk, Compound jalap, Compound Rhubarb, 
3ss; Compound Glycyrrhiza 5j- 



DOSAGI OB MEDICINES. 57 

Resins. Podophyllum, gr. } as a purgative, gr, ,'„ as a laxative. Jalap, gr. ij; Scam 
mony, gr. iij. 

Spirits r>s-, except that of Nitroglycerin, itRj; Bitter Almond, nt>viij; Ammonia, 
Camphor, nj xv ; Ether, Anise, ,~>j; Compound Juniper, 7>ij. Spiritus Frumenti (Whisky) 
and Spiritus Vini Gallici (Brandy), according to the amount of alcohol desired to be admin 

1st, 'led. 

Syrups 5j or more,— except that of Ferrous Iodide, rgjxvj [pecac as an expectorant, 
new . as an emetic T>iv; Squill and Compound Syrup of Squill, ngxxx; Lime njjxxx. 

Tinctures 5j, — except that of Iodine, itgjss; Belladonna Leaves, Cantharides, iirv ; 
Capsicum, Iron Chloride, ("iclsemium, Ipecac and Opium, Opium, Stramonium, Strophan 
thus, njviij; Aconite, Cannabis Indica, Nux Vomica, \\{[x; Arnica, Asafetida, Benzoin, Digi- 
talis, Hyoscyamus, Lobelia (as an expectorant), Myrrh, Physostigma, Sanguinaria, Squill, 
Veratrum, ituxv; Aloes, Alois and Myrrh, Benzoin (compound), Cinchona (compound), 
Cinnamon, Colchicum Seed, Guaiac (ammoniatcd), Lactucarium, Lavender (compound), 
Quassia, Rhubarb (aromatic), Tolu, Valerian (ammoniated), Ginger, njjxxx; Camphorated 
Tincture of Opium (Paregoric) oij. The tinctures of Calendula, Lemon, Pyrethrum, (,)uil- 
laja, and Vanilla, arc not assigned any dose. 

Waters 5ss, — except Ammonia, tnj.xv; Bitter Almond, Hydrogen Dioxide, oj; Orange 
Flower (stronger), Camphor, Creosote, Hamamclis, Rose (stronger), oij . 

Wines 5ij. — except Opium, njryiij; Antimony, Ipecac, njxv; Colchicum Seed, njjxxx; 
Coca, 5iv. White Wine and Red Wine are not assigned any dose, but are prescribed accord- 
ing to the amount of alcohol desired to be given. 

Vinegars, are only two, — that of Opium, njlviij, and that of Squill, njjxv. 



PART I. 

MATERIA MED1CA AND THERAPEUTICS. 



i 



ABRUS, Jequirity (Unofficial), — is the seed of Abrus precatorius, the 
Wild Licorice, a plant of the nat. ord. Leguminosse, indigenous in India, but 
growing wild in most tropical countries. The seeds are small, hard, of a bright 
scarlet color, and contain some fixed oil, Abric Acid, and two proteid poisons, 
a paraglobulin and an albumose, the latter of which is named Abrin. The 
root, leaves and branches contain sugar and a principle which closely resembles 
glycyrrhizin. 

Preparation. 

Infusum Abri, Infusion of Jequirity (Unofficial), — prepared by macerating three pow- 
dered seeds in Bss of cold water for twelve hours, adding oss of boiling water, and filtering 
when cold. It should be used while fresh, as after two or three days it is worthless, andjs 
found in a short time swarming with bacteria. Another formula contains gr. ix to the o, 
with gr. iv of Boric Acid to prevent decomposition. 

Physiological Action and Therapeutics. 

Jequirity seeds, when moistened with water, become highly poisonous. If 
applied to the conjunctiva, a severe inflammation is set up, with edema and 
false membrane, ulceration of the cornea, and extension to the lids, face, neck, 
and submaxillary glands. Inserted into a wound in cattle, they cause death 
in a few hours. Sidney Martin has shown that the proteid poisons contained 
in Jequirity seeds are almost identical in their physiological and toxic proper- 
ties with the similar principles found in snake venom, although less powerful. 

Jequirity is used for the purpose of producing a purulent or croupous con- 
junctivitis, by which to destroy old granulations (trachoma) and pannus. A 
mild infusion is applied to the eye two or three times a day for two days, fol- 
lowed by weak solutions of Alum or Borax, and repeated after three weeks 
if necessary. An emulsion of the seeds in water is a useful application to un- 
healthy ulcers and lupus. 

ABSINTHIUM, Wormwood (Unofficial), — the leaves and tops of Artemisia Ab- 
sinthium, a perennial garden herb of the nat. ord. Composite, indigenous in Europe, but 
cultivated in the United States. It contains a volatile oil and a bitter principle, Absinlhiv. 
Dose, gr. xx-xl, in infusion. 

Absinthe, the French liqueur, is an alcoholic solution of the oil, containing also extracts 
of Anise, Marjoram and Angelica. Its continued use produces various nervous symptoms, 
morning nausea and vomiting, also a tendency to epileptiform convulsions. 

'58 



\i \. 1 \ \« I I AMI HUM. 



59 



The bitter constituent of Absinthium is stimulant i<> the >lii-,isti\ .■ orgi ms, bul the oil is a 
narcotic poison. It increases the cardiac anion, ami produces tremor, tupor, epileptiform 
convulsions, involuntary evacuations, ami stertorous breathing, h is hut little used in mi 
dne, onlj as a stomachic tonic in dyspepsia. 



ACACIA, Gum Arabic, -is a gummy exudation from Acacia Senegal, a 
small tree of the nut. ord. Leguminosse, indigenous in Africa. It occurs in 
spheroidal tears of various sizes, breaking with a glassy, somewhat iridescent 

fracture; insoluble in alcohol, but soluble in water, forming a thick and mucil- 
aginous liquid. It consists of Arabia or Arabic Arid, C 12 H 23 O u , combined with 
calcium, potassium and magnesium. 

Preparations. 

Mucilago Acaciae, Mucilage oj Acacia, — has of Acacia 34, Lime Water 33, Water to 
too parts. It should not bo prescribed with tinctures or spirits except in very small quantity. 
Hose. 5ij-vj [av. oiv] 

Syrupus Acaciae. Syrup oj Acacia, — has of Acacia 10 per cent. Should be freshly 
made. Dose, indefinite. 

Acacia enters into the composition of Mistura Amygdalae, Mistura Glycyrrhizae Com- 
posita, Pulvis Cretae Compositus, Trochisci Cubeboe, and Trochisci Glycyrrhizas et Opii. 

Incompatibles. 

Incompatible with Acacia are: Acids (mineral), Alcohol, Ammonia, Ant. et Potas. 
Tartrate, Borax (unless syrup or glycerin are present), Ether, Ferric Salts (unless excess of 
acid ;s present), Lead Subacetate (but not the acetate), Lead-water, Mercuric Chloride (con- 
centrated solution), Ammonium Oxalate (concentrated solution), Potassium Tartrate and 
Bitartrate, Silicates, SyTup of Squill, Tincture of Guaiac (blue color), Tinctures (alcoholic 
and ethereal). 

Gum Arabic has no activity except the negative one of a demulcent, and is 
chiefly used in coughs, sore throats, catarrhal inflammation of the stomach and 
intestines, and irritant poisoning. It is much employed in pharmacy to suspend 
insoluble powders in mixtures, for which purpose the mucilage is generally used. 



ACETANTLIDUM, Acetanilide, Antifebrin, C 8 H 9 NO — is a synthetic 
compound obtained by the interaction of aniline and glacial acetic acid. Chem- 
ically it is Phenyl-acetamide, the radicle phenyl, C 8 H 5 , being substituted for one 
atom of hydrogen in Acetamide, a base obtained by heating ethyl acetate with 
strong water of ammonia, or by distilling ammonium acetate. The trade name 
Anlijebrin is copyrighted, and should be dropped from professional usage. 

Acetanilide occurs in colorless, inodorous, glistening, lamellar crystals, of 
slightly pungent taste, soluble in 200 of cold water, 18 of boiling water, 4 of 
alcohol, freely in ether and in chloroform. Dose, gr. j-iij (B. P.); average dose, 
gr. iv (U. S. P.). Death has occurred from 5 grains, and recovery has taken 
place after a drachm. 

Pulvis Acetanilidi Compositus, Compound Acetanilide Powder, — has of Acetanilide 70, 
Caffeine 10, Sodium Bicarbonate 20. Dose, gr. v-x [av. gr. vijss]. 

As an antipyretic gr. iij of Acetanilide may be repeated every half hour until the tempera- 
ture falls, the patient being watched for cyanosis or symptoms of collapse. As an analgesic, 
gr. vij of Acetanilide will usually be sufficient in cases to which the drug is applicable. 



60 ,\( ETANILIDUM. 

Unofficial Derivatives and Allied Compounds. 

Agathin, Salkyl-aldchydr-a-methyl-phenyl-hydrazone, — is a synthetic compound, which 
has been used extensively in Europe as an anti-neuralgic and anti-rheumatic remedy. Dose, 
gr. v-x, two or three times a day, but from 5ss to ojss must be given before any effect is pro- 
duced. 

Ammonol, Ammoniated Phenylacetamide, — a proprietary antipyretic and analgesic, 
claimed to possess unusual stimulating and expectorant properties due to the loosely com- 
bined Ammonia in its composition. Beringer concludes thatit is merely an admixture of 
Acetanilide 2 parts, Sodium Bicarbonate 1 and Ammonium Carbonate 1, with a minute 
quantity of the dye Metanil-vellow. A similar mixture is used at the Philadelphia Hospital 
under the name Ammoniated Acetanilide, which consist of Acetanilide 2% grains, Sodium 
Bicarbonate, \\ grains, Ammonium Carbonate, 1 grain; this for a minimum dose. Dose, 
of Ammonol or Ammonol Salicylate, gr. v-xx. 

Analgen, — a Chinolin derivative; was re-formed by inserting benzoyl instead of the 
acetyl radicle, and re-christened Quinalgen. (See next page.) 

Analgesine, — a proprietary preparation, consisting of Acetanilide 60, Ammonium 
Chloride 20, Citrated Caffeine 10, Sodium Bicarbonate 10. Dose, gr. v-xv. 

Anilpyrin, — is a condensation product of Acetanilide 1, and Antipyrine 2 parts, and is 
more soluble in water and less toxic than acetanilide. Dose, gr. v-viij, thrice daily. 

Antikamnia, — is a proprietary preparation widely advertised as an antipyretic and 
analgesic. Analyses of several samples have been made by different chemists, all of which 
agree in finding the chief ingredients to be Acetanilide and Sodium Bicarbonate in varying 
proportions. By some observers Caffeine was detected, also Tartaric Acid, etc. The 
preparation is formulated by the latest analysis as a mixture of Acetanilide 70, Sodium Bi- 
carbonate 20, and Caffeine 10 per cent. Dose, gr. v-xv, in powder or tablets. 

Antikol, — contains Acetanilide 75, Sodium Bicarbonate 17^, Tartaric Acid 7£*per cent. 
(Squibb). Dose, gr. v-xv. Another "Antikol" is advertised by its manufacturer to consist 
of Acetanilide, Quinine Bisulphate, Sodium Bicarbonate, and Caffeine Citrate, the latter 
in the proportion of 10 per cent. Antilupin is a similar preparation. 

Antinervin, Salbromalide (Salicylbromalide), — is a mixture of Acetanilide 2, with 1 part 
each of Salicylic Acid and Ammonium Bromide. It was used with satisfaction as an analgesic 
and antipyretic during the epidemic of influenza in England in 1891, and has been of benefit 
in acute rheumatism, and in abnormal excitement of the nervous system, either against 
neuralgia or as a general nerve sedative. The best way to prescribe it is as an extempora- 
neous mixture, containing the proper proportions of its ingredients, viz. — Acetanilide 50, 
Salicylic Acid 25, and Ammonium Bromide 25 per cent., mixed secundem artem, and admin- 
istered in doses of gr. v-xv every two hours until relief is obtained. 

Benzanilid is obtained by the action of benzoyl chloride on anilin, is soluble in alcohol, 
insoluble in water, and is used as an antipyretic for children, in doses of gr. jss-viij, according 
to age. 

Euphorin, Phenyl-iirethane, — is antipyretic, antirheumatic and analgesic, in doses of 
gr. ij-viij; and may be used as an antiseptic dusting powder for ulcers and skin diseases. 

Exalgin, Methyl-acetanilide, — is a crystalline compound allied to Acetanilide, occurring 
in acicular needles, readily soluble in dilute alcohol, less so in warm water, with difficulty 
in cold water. Dose, gr. j-v, in wine, or other dilute alcoholic mixture. Alcohol oss, and 
Water oj form a permanent solution with gr. xvj of Exalgin. Its name, derived from e$, out 
of, aXyoc, pain, denotes its principal therapeutic action. In overdose it is highly dangerous, 
having produced symptoms resembling those of angina pectoris, also toxic effects resembling 
those of carbolic acid, with delirium, dyspnea, cyanosis, and renal disturbances. It has been 
used with most excellent results in neuralgias; also in chorea. In the latter affection daily 
doses of 3 grains were sufficient. 

Exodyne is a mixture of Acetanilide 90, Sodium Salicylate 5, and Sodium Bicarbonate 
5. The name (from e£, out oj, oduvi), pain) sufficiently states its claims to medicinal virtue. 
Dose, gr. iij-x. 

Febrinol, Methyl-para-acet-phenetidin, — so called by its proprietors, is a mixture of 
Acetanilide and other inert substances, advertised at one-half the price of similar coal-tar 
preparations. 






Al'l IWII Il'l M. Ol 

Malakin, Saticyl-para-phtnetidin, is .1 combination ol Phenacetin and Salicylii Vcid, 
.irul is described under S vi icjnum, in this book. 

Migranin, is .1 double Citrate of Antipyrine ;uul Caffeine, and is described under 
ANTIPYRINA, ill this hook. 

Neurodin, Acetyl-para-oxy-phenyl-urethane,—axi analgesic, antineuralgic and antirheu- 
matic remedy. Its antipyretic action is too sudden for it to be used as .1 general anti- 
pyretic. Its anion is uncertain and much inferior to that of phenacetin or antipyrine (Li ppi). 

Dose, gr. v-xxv, hut ,5jss has been taken in 24 hours without ill effects. 

Phenacetin, Methacetin and Phenocoll, — an- closely allied to Acetanilide, both 
chemically and medicinally, and an- described under the title At etphi \ ktidinum. 

Phenatol, — contains Acetanilide, Sodium Carbonate, Bicarbonate, Chloride, and Sul- 
phate, also Caffeine. Dose. gr. v-x. 

Phenolid, — is a mixture o\ Acetanilide 58, and Sodium Salicylate 43, and competes with 
the above asa panacea. Dose, gr. v-.w. 

Pyretine, — contains Acetanilide, Caffeine, Sodium Bicarbonate and Chalk, in varying 
proportions. Dose, gr. v-x. 

Quinalgen, — is a re-formed and re-named variety of the preparation named Analgen, 
and is described under the title Chinolinum. 

Salfene and Kaputin are Acetanilide mixtures, the latter being simply powdered Acetani- 
lide colored with some indifferent substance. 

Thermodin, Acetyl-para-ethoxy-phenyl-methane, — is closely allied to Neurodin (see 
above), which it resembles in all respects except its smaller dose, gr. v-x. 

Incompatibles. 

Incompatible with Acetanilide are : Amyl Nitrite, Bromine and alkaline Bromides, Hydrated 
Chloral, Iodides of alkalies, Nitrites, Phenol, Piperazin, Potassium Hydroxide, Pyrocatcchin, 
Resorcin, Sodium Hydroxide, Spirit of Nitrous Ether, Thymol. With Euphorin are: Anti- 
pyrine, Borneol, Bromal Hydrate, Camphor, Hydrated Chloral, Exalgin, Menthol, Phenol, 
Pyrocatechin, Resorcin, Salol, Thvmol, Urethane. With. Exalgin are: Bromal Hydrate and 
the others named under Euphorin, also Euphorin, Naphthol, Pyrogallol, Salicylic Acid. 

Physiological Action. 
Acetanilide is a typical member of the antipyretic group of the aromatic 
ies, commonly called coal-tar derivatives. Its principal action in medicinal 
doses is antipyretic and analgesic. On the normal temperature it has little 
effect, but it lowers the temperature in fever by central action on the heat-reg- 
ulating centre, decreasing heat production and to a less degree increasing heat 
dissipation. It depresses the heart and the respiration, contracts the arterioles 
by direct action on their muscular coat, raising the blood-pressure and acting 
a hemostatic. It lowers the reflex function of the spinal cord, depresses 
the sensory nervous system, and is strongly analgesic, is mildly diaphoretic 
and diuretic, and promotes the excretion of urea and uric acid. A toxic dose 
is powerfully depressant to the heart, respiration, and blood-pressure, causes 
profuse sweating, vomiting, cyanosis, chills, convulsions, coma, and paralysis 
of the motor nerves and the muscles, death occurring by failure of the respira- 
tion. Large doses are injurious to the blood, disintegrating its red corpuscles, 
changing the hemoglobin to methemoglobin, and arresting the movements of 
the leucocytes. The heart, liver and kidneys of animals poisoned thereby are 
found in a state of acute fatty degeneration. Skin eruptions of erythematous 
or urticarial type are frequently produced by it, and it often causes cyanosis 



62 ACETAMLIDUM. 



> 



without other toxic symptoms, probably due to the liberation of anilin in the 
blood-current. Collapse may be produced in some susceptible persons by an 
ordinary medicinal dose. When given in solution it is absorbed within half an 
hour, and it is completely eliminated in about 24 hours. 

Acetanilide is the principal constituent of the so-called "headache pow- 
ders" which are sold in drug-stores without prescription to any applicant, and 
have caused serious toxic effects in many cases. In one instance, investigated 
by the coroner of Pittsburgh, a single dose of such a preparation was followed 
by death within 45 minutes. An acetanilide habit is occasionally observed among 
the victims of this commerce, the subjects presenting blue mucous membranes, 
a weak and irregular heart, albuminuria, and edema of the feet and ankles, 
together with the moral depravity characteristic of morphine maniacs. 

Locally applied, Acetanilide is feebly irritant, dessicant, hemostatic, some- 
what analgesic and antiseptic, but not germicidal. Toxic symptoms have been 
produced by its external use on extensive burns and other wounded surfaces 
of large extent. 

In its actions as an antipyretic, an analgesic, and a cardiac depressant, Ace- 
tanilide has many analogues among the coal-tar derivatives, the most important 
being Antipyrine, Chinolin, and Phenacetin (Acetphenetidin), which are described 
elsewhere in this volume. It is probably the most toxic of those in general 
use, Antipyrine, Phenacetin and Lactophenin following it in the order stated 
as to liability to cause collapse. Compared with the action of Antipyrine, the 
effect of Acetanilide on the body-temperature is manifested more slowly (1 hour 
against J hour), but lasts a longer time (6 against 2 hours). It is markedly 
diuretic, and somewhat diaphoretic; is a cerebral, muscular and vaso-motor 
stimulant, and leaves no ill after-effects; — while Antipyrine is powerfully diaph- 
oretic, a cerebral sedative, and produces great depression. Furthermore, Ace- 
tanilide frequently produces nearly the same degree of reduction of body- 
temperature as Antipyrine, with the ingestion of only one-fourth the dose; and, 
like the latter agent, it has little or no effect on the normal temperature, but 
its continued use begets tolerance of its action. Its antipyretic effect is how- 
ever less reliable than that of Antipyrine, and corresponds in degree and in dura- 
tion to the size of the dose. 

Therapeutics. 
Acetanilide is chiefly used to reduce pyrexia and to relieve pain. With the 
former object it has been extensively employed in phthisis, scarlet fever, and 
the other exanthemata, also in acute rheumatism, bronchitis, influenza, and 
typhoid fever. In the latter affection it is too depressant for ordinary use, and 
its continued administration has seemed in several cases to increase the liability 
to periostitis of the ribs, gangrene of the tissues, and other serious sequelae, 
depending probably on impairment of the blood. The antipvretics should be 
used with great caution, if at all, in fever cases presenting exhaustion or asthenia, 
especially when accompanied by anemia. The opinion that fever is the ex- 






U'l [Till \l I IDINl \i. 

ponent of a defensive action by the organism against toxins, is gaining ground 
in professional esteem, and tends to restrict the use of antipyretic drugs to cases 
of hyperpyrexia only, and even in such the cold hath is preferred by many 
prominent clinicians. The toxic effects of Acetanilide and its congeners are 
probably due to the liberation in the blood of anilin, which is oxidized into 
paramidophenol. This change occurring more rapidly from Acetanilide than 
from the phenetidin compounds, the latter are safer and have largely replaced 
it in therapeutics. 

As an analgesic Acetanilide is efficiently palliative in headaches and neuralgia, 
in the pains of locomotor ataxia and those of rheumatic origin, as in sciatica 
and lumbago. It has been successfully used in epilepsy, to prevent the seizures 
by modifying reflex excitability. In all cases overdosing should be avoided, 
both as to quantity and repetition, especially in persons who are strangers to 
the prescriber, on account of the susceptibility to the poisonous action of the 
drug which is possessed by many individuals. 

Acetanilide is employed as a dry dressing, for its antiseptic and analgesic 
qualities, in the treatment of chancroids, ulcers, burns, wounds, and other 
breaches of tissue of small extent, often in mixture with an equal part of boric 
acid. It frequently proves irritant to tender tissue, exciting sharp and burning 
pain, instead of the analgesia usually ascribed to it. Added in minute propor- 
tion to solutions of salts of the alkaloids for hypodermic use it effectually pre- 
vents their decomposition. 

ACETPHENETIDINUM, Acetphenetidin, (Phenacetin), C 10 H 13 NO 2) — is a 
phenol derivative (acetparaphenetidin), the product of the acetylization of para- 
amidophenetol. It occurs in white, glistening, crystalline scales, or fine, crys- 
talline powder, odorless and tasteless, soluble in 70 parts of boiling water, in 
12 of alcohol, nearly insoluble in water. Dose, gr. v-x, [av. gr. vijss], in pow- 
der, tablets or cachets, hourly or every two hours, but larger doses, gr. xv-xx, 
are frequently administered for analgesis, up to a maximum of gj in 24 hours. 

Unofficial Analogues. 
Citrophen, Phenetidin Citrate, — a white, crystalline powder of acidulous taste, soluble 
in about 40 of water, and used as an antipyretic and antineuralgic. Dose, gr. viij-xv. 

Lactophenin, Laclyl-para-phenetidin, — is another phenetidin derivative, containing a 
lactic acid constituent instead of the acetic acid one of phenacetin. Its action is antipyretic, 
analgesic, and hypnotic, and it has been recommended as a substitute for phenacetin on 
account of its greater solubility. It has been used with especial benefit in abdominal typhus 
(Jaksch); also in acute rheumatism, chorea and locomotor ataxia (Von Roth). Dose, gr. 
viij-xv or more, up to 5jss daily, in wafers. 

Malakin, Salicyl-para-phenetidin, — is described under Salicinum. 

Methacetin, Oxy-methyl-acetanilide, — derives its name from its analogy to Phenacetin, 
from which it differs only in containing a methyl group in place of an ethyl one. It occurs as 
lustrous, scaly, colorless, odorless crystals; soluble in 12 of hot water, in alcohol, chloroform, 
glycerin and fatty oils; scarcely soluble in cold water. Methacetin was introduced as an 
antipyretic for children and feeble persons, and promised at one time to supersede phenacetin. 
It is well borne, and no malaise, tinnitus, cardiac weakness or exanthem follow its ingestion; 
but it often gives rise to a violent and exhausting perspiration. Its advantages, over all the 



64 ACETPHENETIDINUM. 

Other antipyretics of its class, are its lack of toxic properties and its comparatively ready solu- 
bility in water, being five times more soluble than its rival, phenacelin. Dose, gr. iij-v, or 
more. 

Phenocoll Hydrochloride, — is another synthetical antipyretic, closely allied to Phenace- 
tin, both chemically and medicinally, and distinguished by its comparatively free solubility. 
It is produced by the interaction of Phenetidin and Glycocoll (amido-acetic acid), and occurs 
as a white, micro-crystalline powder, soluble in about 16 of water, therein forming a neutral 
solution. Dose, gr. v-xx, 3 or 4 times a day. 

Thermol, Acetyl-salkyl-phcnetidin, — occurs in white, odorless, almost tasteless needles, 
soluble in alcohol, nearly insoluble in water. It is said to be free from phenyl or aniline con- 
stituents and to be devoid of toxic action on the blood or the heart. It is antipyretic, anti- 
septic, and analgesic, and has been used in typhoid fever, pneumonia, influenza, rheumatism, 
neuralgia, gout, dysmenorrhea, and nervous headache. Dose, gr. ij-xv. 

Incompatibles, 
Incompatible with A cet phenetidin are: Acids (strong), Alkalies (strong), Chloral Hydrate, 
Oxidizers, Piperazin, Phenol, Pyrocatechin, Salicylic Acid. With Phenocoll Hydrochloride 
are: Alum, Benzoates, Chloral Hydrate, Cinchona decoction or compound tincture, Mercuric 
Chloride, Nitric Acid, Nitro-hydrochloric Acid, Piperazin; Potassium Acetate, Bicarbonate, 
Bromide, Citrate, and Sulphate. With Methacetin are: Bromal Hydrate, Chloral Hydrate, 
Phenol, Pyrocatechin, Resorcin. 

Physiological Action and Therapeutics. 

The physiological action of Acetphenetidin is similar to that of Acetanilide. 
It is one of the safest of the new synthetical antipyretics, yet in sufficiently large 
doses it is as poisonous as any of its analogues. In one case 22^ grains, taken 
by a woman within six hours, produced collapse with marked lividity, great 
dyspnea and restlessness, cold perspiration, and slightly dilated pupils; in an- 
other case 120 grains were taken in twelve hours without the production of any 
symptoms (Wood). A toxic dose causes vomiting, cyanosis, chocolate-colored 
urine, yellow discoloration of the body, leucocytosis, and death by respiratory 
paralysis. In medicinal doses it depresses the heart slightly, and does not 
affect the blood or the respiration. It acts more gradually than other anti- 
pyretics, its maximum effect being reached in three or four hours. It reduces 
fever by lessening heat production and causes perspiration without producing 
collapse. It is also analgesic and hypnotic, relieving pain and inducing sleep. 
It has been administered with benefit, in 2-grain doses with \ grain of citrated 
caffeine at short intervals, for migraine; also in epidemic influenza, both as a 
prophylactic and as a remedy. As an antipyretic it is extensively employed 
in phthisis, peritonitis, polyarthritis, endocarditis, typhus and typhoid fevers; 
and as an analgesic in vaso-motor neuroses, for the lancinating pains of loco- 
motor ataxia, also in neuralgia and hemicrania. It is highly praised in whoop- 
ing-cough, rheumatic and other fevers, and though slower in action than anti- 
pyrine or acetanilide it is deemed fully as efficient in reducing pyrexia, while 
usually free from the depressant after-effects of the latter agents. It is strongly 
commended as a local antiseptic dressing. 

Phenocoll Hydrochloride is powerfully antipyretic, acting by causing a great 
diminution of heat production, without affecting heat dissipation. It is alsG 
analgesic and antirheumatic, and is believed to increase nitrogenous elimina- 






Venn w \ci i n i if, 6j 

tion. It is rapidly absorbed and quickly eliminated, imparting a brown o 
to the urine. In medicinal doses it has no effect on the circulation, and rarelj 

causes gastrointestinal irritation or other disagreeable symptoms, bill a very 
large dose depresses the heart and lowers the blood pressure. It has no injurious 
effect on the blood corpuscles, and it is one of the safest and most efficient mem 
hers of its elass. It has been u^v<\ with satisfaction as an antipyretic in hcitiY, 
malarial, typhoid and other fevers, also as an analgesic in acute and clmmu 
rheumatism, gout, epidemic influenza and neuralgia. 

Citrophen is readily soluble in carbonated water, making a pleasant, acidul- 
ous drink. It has been used with benefit as an analgesic in migraine, lumbago, 
neuralgia, sciatica, and the pains of neurasthenia and chronic morphinism, also 
in pertussis and influenza. 

ACIDUM ACETICUM, Acetic Acid,— is a liquid composed of 36 per 

cent, of absolute Acetic Acid, HC 2 H 3 2 , and 64 per cent, of water. It is a clear, 

colorless liquid, of a distinctly vinegar odor, a purely acid taste, and a strongly 

acid reaction; miscible in all proportions with water or alcohol, and wholly 

volatilized by heat. It is prepared from wood by destructive distillation and 

purification. Acetic Acid is also official in two other degrees of concentration, 

viz. — 

Acidum Aceticum Glaciale, Glacial Acetic Acid, HC 2 H 3 2 , — is nearly or quite abso- 
lute Acetic Acid, solid below 59° F., above that temperature a colorless liquid. Is strongly 
escharotic and onlv used locally. 

Acidum Aceticum Dilutum, Diluted Acetic Acid, — consist of Acetic Acid 10, Distilled 
Water 50 parts, contains 6 per cent, of absolute Acetic Acid, and has an sp. gr. of 1.009. It ls 
used in the preparation of the two official Aceta (Vinegars). Dose, Ttjlxv-oij [av. njxxx.] 

Acetum, Vinegar ((Unofficial), — is an impure dilute acetic acid, formed by the action of 
a ferment on a dilute alcoholic liquid, the alcohol being oxidized thereby. 

Acetonum, Acetone (D imethyl-ketone) C 3 H c O, — a colorless, mobile and volatile liquid, 
miscible with water, alcohol, etc. It is an excellent solvent for resins, gums, camphor, fats 
and gun-cotton, and is employed in the manufacture of some oleoresins and of sulphonmethane 
(sulphonal). 

Acetates of Ammonium (solution), Iron (solution), Lead, Morphine, Potassium, So- 
dium, and Zinc, are official. The Mineral Acids are incompatible with them. 

Physiological Action and Therapeutics. 
Acetic Acid, like the other vegetable acids, in concentrated form is escharotic 
nd produces gastro-enteritis if swallowed. In dilute form it acts as a refrig- 
erant, diminishing thirst and allaying restlessness. It forms salts in the stom- 
ach, thus enters the blood, and is there oxidized, producing carbonic acid and 
thereby increasing the acidity of the urine. It is also diuretic. Long used, 
it causes emaciation and poverty of the blood, producing a general scorbutic 
condition. It is hemostatic and anthelmintic, and the vapor inhaled causes 
reflex contraction of the vessels and raises the blood-pressure. Investigations 
into its germicidal powers have given it high rank among germ-destroyers, a 
solution containing 7 per cent, proving destructive to many pathogenic bacteria. 
6 



66 ACIDUM BORICUM. 



, 



The glacial acid is used as a caustic in many skin affections, as warts, con- 
dylomata, etc., and to destroy the parasite in ringworm and pityriasis. It has 
been employed locally in carcinoma, with the view of dissolving the supposed 
cancer-cells. The dilute acid is used locally in superficial inflammations of 
the skin, and may be sponged over the body to check perspiration and reduce 
the surface temperature in fevers. It is often administered internally to reduce 
obesity, which it does only by impairing digestion. Locally, it may be em- 
ployed to arrest slight hemorrhages, as epistaxis; and it is occasionally used by 
enema for the destruction of ascarides. It is highly praised by Squibb as a 
solvent for the active principles of drugs, which it extracts completely, so that 
it may be substituted for alcohol in the preparation of both fluid and solid ex- 
tracts. 

Vinegar was the popular antiseptic during the plague in London in 1666, 
and Acetic Acid in alcoholic solution, v\,xx in giij, is still employed on dressings 
after operation and for the disinfection of suture materials, as an efficient pre- 
ventive of infection. 

Acidum Trichloraceticum, Trichloracetic Acid, HC 2 C1 3 2 , — a substitution product 
from Acetic Acid, but usually prepared by the action of Nitric Acid on Chloral Hydrate in the 
presence of sunlight. It occurs in colorless, deliquescent crystals, which are readily soluble 
in water and in alcohol. A powerful antiseptic and caustic, it is used in 2 per cent, solution as 
a dressing for wounds, and as a lotion and spra3' in acute coryza. It is used by dentists as an 
application to the gums in pyorrhea alveolaris, and internally in doses of gr. ss-j well diluted, 
for the gastric catarrh and summer diarrhea of children. It is a test for albumin in urine. 
Dose, gr. ij-v, well diluted. 



ACIDUM BORICUM, Boric Acid, Boracic Acid, H 3 B0 3 ,— is a weak 
•acid occurring in transparent, colorless, six-sided plates, of unctuous touch, 
odorless, of a cooling and slightly bitter taste, soluble in 25 of water, in 15 of 
alcohol and in 10 of glycerin. Its aqueous solubility is increased by the addi- 
tion of hydrochloric acid or borax. It is produced from Borax by the action 
of sulphuric acid; also by the purification of the native acid. Dose, gr. v-xv. 
[av. gr. vijss.] There are two official Borates, viz. — 

Sodii Boras, Sodium Borate (Borax), Na 2 B 4 7 + ioH 2 0, — colorless, transparent prisms, 
of cooling and sweetish, afterwards alkaline taste, and alkaline reaction, soluble in 16 of water 
at 59° F., and in 0.5 of boiling water; insoluble in alcohol. Occurs native in ancient lake 
beds in Death Valley region, California, and various other parts of the world. Dose, gr. v- 
x.xx, [av. gr. vijss.] 

Glyceryl Borate, Boroglycerin, — official in the following preparation, — 

Glyceritum Boroglycerini, Clycerile 0) Boroglycerin, — prepared by heating together 
Boric Acid 310 and Glycerin 460, until reduced to 500 grammes, then adding an equal weight 
of Glycerin. 

Liquor Antisepticus, Antiseptic Solution, — contains of Boric Acid 2, Benzoic Acid 0.1, 
Thymol 0.1, Eucalyptol 0.025, Oil 0I Peppermint 0.05, Oil of Gaultheria 0.025, Oil of Thyme 
0.01, Alcohol 25, Purified Talc 2, Water to 100. Dose, 3ss-ij, [av. oj.] 

Unguentum Acidi Borici, Ointment oj Boric Acid, — has of Boric Acid 10, Paraffin 10, 
White. Petrolatum 80. 

Incompatible with Boric Acid are; Alkaline Hydrates, Earths and Carbonates. Incom- 
patible with Borates are: Mineral Acids, Alkaloidal Salts, Metallic Salts. 



\ciiu M BORICTJM. 67 

I nofficiai Preparations. 

Borine,- is a proprietary antiseptic preparation, advertised to be "composed of the 
active constituents of Benzoin, Wintergreen, Meadowsweet, Golden Rod, Witch Hazel, 
combined with the stearoptenes of Wild Thyme, Eucalyptus, Peppermint, and Boracic Acid." 
What the stearopten of Boracic Acid is the advertisers do not say. It is intended chiefly for 
external use. diluted, 1 part to 1-4 of water; but may be used internally in doses of aj-ij. 

Boroglyceridum, Boroglyceride, — is a solid chemical compound, prepared by heating 
together Boric Acid and Glycerin. It is soluble in water, but is generally used in solution 
with glycerin, as the above official glycerite. It combines readily with Chrysarobin, Phenol, 
Atropine and Morphine, and is used as a local application in eye diseases and skin 
affections. 

Borolyptol, — is a proprietary preparation intended for use as an antiseptic, both inter- 
nally and locally. It is said to be composed of Aceto-boro-glyceride 5 per cent., Formalde- 
hyde J per cent., together with the active antiseptic constituents of Pinus pumilio, Eucalyptus, 
Myrrh, Storax, and Benzoin. Dose, 5j-ij> as an intestinal antiseptic. 

Euthymol and Euphormol are similar preparations, advertised as containing Boric 
Vid. Thymol, Menthol, Oil of Eucalyptus, etc. 

Magnesii Boro-citras, Magnesium Borocitrate, — prepared extemporaneously thus: 
15. Magnesii Carbonatis 5j, Acidi Citrici oij, Sodii Biborat. 5ij, Aquae Bullientis 5viij. 
A tablespoonful two or three times daily as a solvent of uric acid. 

Potassii Tartra-boras, Potassium Tartraborate, — is a better solvent of uric acid than 
the Magnesium salt, and is soluble in 2 parts of cold water. Prepared by heating together 
Boracic Acid 1, Potassii Bitartras 4, Water 10 parts. Dose, gr. xx, largely diluted with water 
three or four times a day. 

Sodium Tetraborate, — is obtained by heating together equal parts of Boric Acid, Borax 
and Water. The resulting compound is neutral, and is supposed to be a salt. It was intro- 
duced to furnish a more soluble form of Boric Acid, and may be used wherever the latter 
is indicated, but it has the disadvantage of forming hard crusts upon dressings, which irritate 
abraded surfaces. 

It has long been known that the addition of Borax to Boric Acid in aqueous solution 
greatly increases the solubility of the acid. 

Listerine, — is a proprietary preparation, advertised to be "'the essential antiseptic con- 
stituent of Thyme, F.ucalyptus, Baptisia, Gaultheria and Mentha Arvensis, in combination. 
Each fluid-drachm also contains two grains of refined and purified Benzoboracic Acid," — 
whatever that may be. It is chiefly intended for external use, but may be given internally, 
in doses of 3j three or more times a day (as indicated), either full strength, or diluted with 
water, or in combination with other drugs. 

Physiological Action and Therapeutics. 

Boric Acid is feebly germicidal, but in dilute solution (1 in 143) it is anti- 
septic and stimulant, and has a soothing effect on mucous membranes. In con- 
centrated form it is decidedly irritant, but it is used as a dusting powder, also 
in lotion and ointment for ulcers, eczema, burns, scalds, pruritus ani, fetid 
perspirations, wounds, tinea tonsurans and tinea circinata. A saturated solu- 
tion has been highly recommended as an application in phlegmonous erysipelas, 
and solutions of gr. v-xx to the ounce are employed as disinfectant and soothing 
eye-washes in conjunctivitis. It has been found efficient as an internal remedy 
in cystitis with ammoniacal urine, and a saturated solution as a wash for the 
bladder has given great relief in the cystitis from spinal disease. Its physio- 
logical action is feeble, but poisonous doses have caused lowered temperature, 
depressed spirits, a feeble pulse, and an erythematous eruption with swelling, 
followed by exfoliation, and especially affecting the lower extremities. 

Sodium Borate has considerable antiseptic power, but is inefficient as a 
germicide. It aids the solution of boric and benzoic acids, and increases the 
contractile power of the uterus when given internally. It is used in solution 



/ 



68 ACIDUM J Ll'ORICL'M — ACIDUM GALLICUM. 

to remove the epidermis from the skin, and as a sedative lotion in acne, freckles, 
chloasma, leucorrhea and aphthae, also to allay itching in urticaria, psoriasis, 
impetigo, and in pruritus pudendi, scroti et ani. It has been used internally 
in amenorrhea, dysmenorrhea, puerperal fever, and puerperal convulsions, for 
its supposed specific action on the uterus; and has been found beneficial in 
epilepsy, though far inferior to potassium bromide in efficacy and far more 
dangerous in toxic effects. It is apparently of most service in cases where the 
bromides fail and in those in which the epilepsy is associated with gross organic 
disease. 

When administered in large doses Borax produces certain toxic symptoms 
to which the term Borism is applied. These include intestinal disturbance, 
nausea, vomiting and anorexia, also dryness of the skin, with redness and even 
inflammation of the mucous membranes. There is great general weakness, 
the hair is dry and falls out, and a cutaneous eruption occurs, which may as- 
sume the forms of seborrheic eczema, reddish patches which desquamate like 
psoriasis, or papules attended with much itching. In severe cases albumin may 
appear in the urine, and edema of the face and extremities may occur, so that 
whenever this drug is given in full doses, a careful watch should be kept upon 
the state of the urine (Fere). 

Boroglyceride in aqueous solution (i to 40), or as the official Glycerite, is an excellent 
antiseptic, and is used as a lotion in purulent ophthalmia and in the treatment of wounds, 
also as a local application to diphtheritic membranes. It is an efficient preservative of milk 
and food against putrefactive changes, and is entirely harmless. 

An elegant cosmetic cream may be made by dissolving Boric Acid in Glycerin, and then 
incorporating it with White Wax and Almond Oil. 

ACIDUM FLUORICUM, Fluoric Acid, HF (Unofficial),— is a strong escharotic, 
acting deeply and leaving a dry and painful slough. The dilute acid (1 in 200) is prepared 
by acting on fluor spar by Sulphuric Acid, the resulting gas being dissolved in water. Its 
dose is npxx-xxx, well diluted. 

Dilute Fluoric Acid has been successfully used as an internal remedy in goitre, and the 
gas has been inhaled with benefit in laryngeal diphtheria. 

Antitussin (Unofficial) is the trade name of an ointment, which contains Difluor-diphenyl 
5, Vaselin 10, and Lanolin 85 parts. It has been used with benefit in whooping-cough, by 
being rubbed into the skin of the chest, back, or abdomen, daily for a week, then every other 
day; but it may produce local ulceration at the point of application. 



ACIDUM GALLICUM, Gallic Acid, HC 7 H 5 5 .H 2 0— is an organic acid, 
occurring in long needles and triclinic prisms, having a slightly acid and astring- 
ent taste, soluble in 100 of water and in 5 of alcohol at 59 F., and in 3 of boil- 
ing water. It is prepared from Tannic Acid or from a paste of powdered galls 
(see Galla, page 69), by fermenting for six weeks, boiling and reboiling in 
water, filtering and crystallizing. According to some authorities, the tannic acid 
of the galls is split up into gallic acid and glucose by fermentation; according 
to others the glucose is an impurity and the tannic acid is simply converted 
into two parts of gallic acid, thus— HC H H 9 9 + H 2 = (HC 7 H 3 5 ) 2 . Dose, 
gr. v-xx, [av. gr. xv], in solution, pill or powder. 



ACIIH'U i. \l I.U'l'M. 



6 9 



Acidum Tannicum, Tannic Arid, (Tannin), M(',,l l„( >„, is a monobasic 
organic arid, occurring in light-yellowish scales, of strongly astringent taste 

and acid reaction, obtained from powdered galls (sec ('.alia below), by c\ 
posure for three days in a damp atmosphere, then macerating with ether, pros 
ing, and drying the liquid portion. It is soluble in 1 of water, in 0.6 of alcohol, 

;q° F., and in about 1 of glycerin with moderate heat; very soluble in boiling 
water and in boiling alcohol, almost insoluble in ether, chloroform, benzol or 
benzin. Dose, gr. j-xx, [av. gr. vijss] in wafer, pill or capsule. 

Quercus, White Oak, — is the bark of Quercus alba, the white-oak tree, 
nat. ord. Cupuliferae. It contains a variety of tannin named Quercitannic 

I, C2gH 24 )2 , also Pectin and a bitter principle named Qiiarin, but no gallic 
acid. The only official preparation is the liuidextract, the dose of which is 
m,v-xx, [av. ntxv]. A decoction (fikj to the pint) may be used in doses of §ss-j. 

Galla, Nutgall, — is an excresence on Quercus infectoria, nat. ord. Cupuli- 
ferae, caused by the punctures and deposited ova of the insect Cynips tinctoria. 
It occurs as hard, globular bodies, of blackish-gray color, tubcrculated on the 
surface. They contain Gallic Acid about 5 per cent., Tannic Acid 15 to 75 
per cent., and other unimportant constituents. Their sole value is as the source 
of these two substances, and they are rarely used in their own form medicinally. 
gr. v-x, [av. gr. vijss.] 

Vegetable Astringents contain some form of Tannic Acid, as Quercitannic Acid from 
Oak-bark, Rhatania-tannic Acid in Rhatany, etc. The official acid is Gallotannic Acid, 
being that produced from Galls. These astringents depend for their medicinal value upon the 
Gallic and Tannic Acids contained in them. Such are — 



Alnus, Alder Bark. 
Castanea, Chestnut. 
Catechu, Catechu. 
Diospyros, Persimmon. 
Galla, Nut Gall. 
Geranium, Cranesbill. 



Granatum, Pomegranate. 
Hamamelis, Witch Hazel. 
Haematoxylon, Logwood. 
Heuchera, Alum Root. 
Kino, Kino. 
Krameria, Rhatany. 



Myrica, Wax Myrtle. 
Nymphaea, Pond Lily. 
Quercus Alba, Oak Bark. 
Rosa Gallica, Red Rose. 
Rubus, Blackberry. 
Statice, Marsh Rosemary. 



Preparations. 

Unguentum Acidi Tannici, Ointment 0} Tannic Acid, — is a 20 per cent, ointment, 
made with Glycerin and Ointment. 

Trochisci Acidi Tannici, Troches of Tannic Acid, — each troche contains nearly one 
grain of Tannic Acid. 

Glyceritum Acidi Tannici, Glycerite of Tannic Acid, — has a strength of 1 part of Tannic 
Acid to 4 of Glycerin. 

Suppositoria Acidi Tannici, Suppositories of Tannic Acid (Unofficial), — have 1 part 
of Tannic Acid in 5 of Cacao Butter. 

Collodium Stypticum, Styptic Collodion, — has of Tannic Acid 20, Alcohol 5, Ether 
illodion to make 100 parts. 

Tinctura Gall*, Tincture of Nutgall, — strength 20 per cent. Dose, 5 ss— iij, [av. 3j-] 

Unguentum Galla?, Nutgall Ointment, — strength 20 per cent. 



Allied Substances and Derivatives. 

Gallobromol, Dibromogallic Acid, C 8 Br 2 (OH) 3 COOH, (Unofficial), — occurs in small 
white, needle-shaped crystals, soluble in 10 parts of lukewarm water. The solution gradu- 
ally darkens and after a few days becomes brown. Lepine states its internal action as similar 



70 ACIDUM GALLICUM. 

to that of potassium bromide. In i or 2 per cent, solutions it has been used with remarkable 
success as a local application in gonorrhea of all stages. It seems to readily destroy the gono- 
coccus. 

Pyrogallol, Pyrogallic Acid, Tri-hydroxy-benzene, C 6 H 3 (OH) 3> — is a triatomic phenol, 
obtained chiefly by the dry distillation of Gallic Acid. It occurs in light, white, shining 
lamina?, or fine needles, of bitter taste; soluble in water, alcohol and ether. Dose, gr. j-ij. 

Tannigen Diacityl-tannin (Unofficial), — is an acetic acid ester of tannin, prepared by 
the action of glacial acetic acid on tannic acid. It occurs as an odorless and tasteless powder, 
insoluble in cold water and dilute acids, but soluble in cold alcohol and in dilute solutions 
of soda, sodium phosphate and borax. It is said to pass through the stomach unchanged 
and to be gradually decomposed in the intestines, thus exerting an astringent effect upon 
the entire intestinal canal. Its uses have been those of an intestinal astringent. It appears 
to be absolutely innocuous. Dose, gr. iij-viij, up to 3ij daily. 

Tannalbin, Exsiccated Tannin Albuminate (Unofficial), — occurs as a light-brown, odor- 
less, and tasteless powder, containing 50 per cent, of Tannic Acid combined with egg-albumin, 
insoluble in water and in acid fluids. Dose, gr. xv-xxx, up to 3j or 3jss daily, as an intes- 
tinal astringent. 

Tannocol (Unofficial), — consists of equal parts of Tannic Acid and Gelatin, and occurs 
as a light-brown powder, without odor or taste. Dose, gr. vij-xv, 3 to 5 times a day, as an 
intestinal astringent. 

Tannoform, Methylene Di-tannin (Unofficial), — is a condensation product of Tannic 
Acid and Formaldehyde, and occurs as a bulky, odorless powder, insoluble in water, but sol- 
uble in alcohol or ether, also in alkalies. Dose, gr. iv-viij, as an intestinal astringent. 

Incompatibles. 

Incompatible with Gallic Acid are: Arsenic, Carbonates, Copper salts, Ferric salts, 
(unless excess of acid present), Gold salts, Lead Acetate, Iodine, Lime-water, Nitric Acid, 
Opium in solution, Potassium Permanganate, Silver salts, Sodium Bicarbonate, Tartar 
Emetic. 

Incompatible with Tannic Acid are: Albumin, Alkaloids, Amyl Nitrite, Antipyrine, 
Arsenic, Bromine, Calcium Chloride (concentrated solution), Chlorine, Chromic Trioxide, 
Ferric salts, Gelatin, Glucosides, Gluten, Hydrochloric Acid, Iodine, Iodoform, Lime-water, 
Nitric Acid, Permanganates, Piperazin; Salts of Antimony, Bismuth, Chromium, Copper, 
Gold, Lead, Mercury and Silver; Spirit of Nitrous Ether, Potassium Chlorate and other 
oxidizers, Potassium Dichromate, Sulphuric Acid. 

Physiologic Action and Therapeutics. 

Gallic Acid, and its congener Tannic Acid, are astringents, the former 
being the feebler of the two. They differ in that tannic acid coagulates albumin 
and gelatin, while gallic acid does not. According to some authorities the dif- 
ference between gallic and tannic acids is one of oxidation, according to others 
of hydration; the latter assuming tannic acid to be simply gallic acid anhydride. 
They constringe the muscular tissue in the walls of the minute vessels, thus 
checking secretion and hemorrhages and cutting short local inflammations. 
Except in enormous doses, they are harmless. Gallic Acid is preferred to tannic 
acid when an astringent action is desired upon remote parts, as the lungs, kid- 
neys, etc., which can only be reached through the circulation. In hematuria, 
distant passive hemorrhages, albuminuria, diabetes insipidus, bronchorrhea, 
night-sweats, chronic diarrhea, and chronic cystitis, it is a most useful internal 
remedy. 

Tannic Acid is a powerful astringent. It precipitates pepsin and coagu- 
lates albumin, impairs digestion, stops peristalsis, and causes constipation. 



ACint \i OALLICUM. 71 

A part of that taken into the stomach unites with the pepsin and albumin, while 
a part is converted into gallic and pyrogallic acids, and in these forms il is both 
absorbed and excreted. It is a crystalloidal body, hut combines with colloids, 
and is a valuable antidote in poisoning by the alkaloids and tartar emetic, with 
which it forms tannates which are nearly insoluble. Its continued use disorders 
digestion, irritates the mucous membranes, and produces emaciation. Injected 
into the veins it forms emboli and thus may cause death, but by the stomach 
it is non-toxic. Tannic Acid is a more powerful astringent than Gallic Acid, 
and hence it is preferred for local use and for astringent effect on the intestinal 
canal. It is well employed in hemorrhoids and hemorrhages from the lower 
bowel, in hematemesis, epistaxis, rectal ulcers or fissures, catarrhs and chronic 
affections of the mucous membranes, endocervicitis, conjunctivitis, dysentery 
and diarrheas, eczema, impetigo and other forms of skin-disease, otorrhea, 
bed-sores, prolapsus ani, and many other affections. 

Styptic Collodion is used to stanch the bleeding from an open wound, to 
unite and protect incised or lacerated wounds, and to cover and change the 
character of foul ulcers. 

Pyrogallic Acid has been absorbed from the surface with fatal results, pre- 
ceded by vomiting, diarrhea, rigors, fever, a black urine charged with globulin, 
and disintegration of the red blood-corpuscles. It has great affinity for oxygen, 
and may be used as an antiseptic and disinfectant in 1 to 3 per cent, solutions. 
Externally as an ointment, 1 to 8 of lard, it is used in chronic psoriasis, lupus, 
leprosy, and epithelioma. Internally it has been administered in 2 grain doses 
for internal hemorrhages. 

Tannalbin and Tannocoll are very similar in action and uses. They do 
not precipitate pepsin, coagulate albumin, or impair digestion. They pass 
through the stomach unchanged, and are resolved into their constituents by the 
alkaline secretions of the intestinal canal and the pancreatic juice, gradually 
setting free their tannin in the intestinal tract. They are free from irritant 
action on the stomach, and are valuable remedies in all forms of diarrhea in 
which astringents are indicated. 

Tannoform is siccative, antiseptic, deodorant, and astringent. In 20 to 
50 per cent, triturations with starch or talcum, it is used with benefit in many 
skin diseases, and for the night-sweats of phthisis. Internally it has given satis- 
faction in intestinal catarrh. 

Oak-bark is astringent and tonic, but is seldom used internally. Its actions 
and uses are those of Tannic Acid. A decoction is much used in country prac- 
tice as a cheap astringent application for injection in leucorrhea, prolapsus 
ani, and hemorrhoids, and as a gargle in faucial inflammation and prolapsed 
uvula. It has also been used as an injection into dropsical cysts, and as a lotion 
for flabby ulcers and suppurating wounds. The powdered bark as a poultice 
has proved an excellent application in gangrene, and in finely pulverized state 
it is a useful ingredient of tooth-powders. A concentrated fluid extract was 



72 ACIDUM HYDROCHLORICUM. 

used in the Heaton-Warren operation for the radical cure of hernia, by injec- 
tion into the tissues around the margin of the ring, with the object of exciting 
inflammation and occlusion of the opening. 

ACIDUM HYDROCHLORICUM, Hydrochloric Acid, Muriatic Acid,— 
i- a liquid composed of about 32 per cent, of absolute Hydrochloric Acid Gas, 
HC1, and 68 per cent, of water. It is colorless and fuming, of specific gravity 
1. 1 63, pungent odor, intensely acid reaction and taste, and is obtained by the 
action of sulphuric acid upon sodium chloride, the resulting gas being carried 
through water, which dissolves it. It is sometimes used as a caustic. Its union 
with basic substances forms salts, called Hydrochlorides. 

Acidum Hydrochloricum Dilutum, Diluted Hydrochloric Acid, — is a 10 per cent. 
solution by weight of the absolute acid in water. Dose, trjiij-xx, [av. itjxv]. 

Acidum Nitro-hydrochloricum, Nitro-hydrochloric Acid — is described under Acidum 

NlTRICUM. 

Incompatible with Hydrochloric Acid are: Alkalies, Bromates, Carbonates, Chlorates, 
Lead salts, Mercurous salts, Oxides, Permanganates, Silver salts, Tartar Emetic. 

Physiological Action of the Mineral Acids. 

The mineral acids, including hydrochloric, nitric, nitro-hydrochloric and 
sulphuric acids, resemble each other closely in their general action. These 
strong acids are escharotic, abstracting water from the tissues, combining with 
their albumin, and destroying the protoplasm. Sulphuric Acid has a strong 
affinity for water, completely decomposing the tissue, and is therefore the most 
powerfully escharotic. Nitric Acid does not readily redissolve the albumin 
precipitated by it, which thus forms a barrier against the deep action of the acid. 
Sulphuric Acid chars or carbonizes the tissues black, while Nitric and Hydro- 
chloric tan them yellow. 

Acute poisoning by the mineral acids has for its principal symptoms pain 
in the mouth, gullet, and epigastrium, violent vomiting, and rapid collapse 
characterized by cold perspiration, feeble pulse, and suppressed voice. After 
death the esophagus and stomach are found to be corroded, the lesions showing 
sloughs of black color after sulphuric acid, of yellow color after nitric or hydro- 
chloric acids. If death does not take place early, the internal organs show 
wide-spread degeneration of their protoplasm, and desquamative nephritis has 
been frequently observed. In cases of recovery prolonged illness from local 
organic changes is the usual result. 

In dilute preparations these acids produce a sour taste in the mouth and 
a sensation of roughness on the teeth. They stimulate the flow of saliva, bile, 
and the intestinal secretions, but decrease the production of the gastric juice; 
in accordance with the somewhat doubtful rule that acids in contact with the 
mouths of ducts from glands stimulate the action of those glands which pro- 
duce alkaline secretions, and check that of those producing acid secretions. 
Nitrohydrochloric Acid is an efficient cholagogue, a quality possessed also, 
but in less degree, by the others. Secretion generally is promoted by Nitric 



VCIIH'M HYDROCN VNICI VI. 73 

and Hydrochloric Acids, and is lessened by Sulphuric Acid, which is the most 
astringent oi the three. En small doses given before meals they aid digestion, 
by synergizing the action oi the pepsin, but if long continued they will impair 
digestion by lessening the production of the gastric secretions. Hydrochlori< 

Acid is the normal digestive acid of the stomach, existing in the gastric juice 
in the proportion of 0.2 per cent. These acids check fermentation and consti- 
pate the bowels, except Nitric Acid, which relaxes them. They render the urine 
slightly more acid than its normal reaction, but will not acidify an alkaline urine 
as the vegetable acids do. In the blood they exist as salts which are rapidly 
excreted by the kidneys. Phosphoric Acid is described under the title l'nos 
PHOR1 s. 

Therapeutics of the Mineral Acids. 

All the members of this group are useful in fevers, if well diluted, Hydro- 
chloric being usually preferred, especially in typhoid. In atonic dyspepsia, 
acidity of the stomach, and locally in ulcerations of the throat, Hydrochloric 

id is best used. Nitric is the acid generally preferred as a caustic, its action 
being effectual and superficial. As such it is applied undiluted to phagedenic 
ulcers and sloughs, warty growths, and to the cavity of the womb in chronic endo- 
metritis. Dilute Nitric Acid is used internally in oxaluria and lithemia, inter- 
mittent and remittent fevers, and aphonia of singers. Dilute Nitro-hydrochloric 
is more suitable for chronic hepatic disorders due to malaria; Sulphuric in 
hemorrhages, diarrheas, colliquative sweating, and as a prophylactic against 
lead-poisoning. Dilute Sulphuric Acid is used as an acid drink in fevers, and 
before meals in acidity of the stomach. It is very doubtful whether the latter 
has any special influence on the nervous or osseous systems. 

All these acids act injuriously on the teeth, by attacking the enamel. They 
should always be largely diluted, taken through a straw or glass tube, and the 
m >uth should be thoroughly rinsed at once with an alkaline wash. 

ACIDUM HiTDROCYATHCUM, Hydrocyanic Acid, Prussic Acid, HCN, 
— is a colorless, unstable, inflammable liquid, soluble in water and in alcohol, 
wry volatile, and so toxic that death has resulted from smelling it. It is never 
found outside the chemical laboratory, and is official only in the dilute form — 

Acidum Hydrocyanicum Dilutum, Diluted Hydrocyanic Acid, — a liquid 
composed of 2 per cent, by weight of absolute Hydrocyanic Acid, HCN, and 
98 per cent, of water. It is colorless, faintly acid, of peculiar odor, and is pre- 
pared by distilling solutions of potassium ferrocyanide and sulphuric acid to- 
gether, or extemporaneously by adding 6 grammes of silver cyanide to a solu- 
tion of 15.54 Cc. of diluted hydrochloric acid in 44.10 Cc. of distilled water, 
shaking together and pouring off the supernatant liquid, n^xl have proved fatal. 
I) ee, "ij-iij, [av. "ijss] of a recent preparation; as, even under the most favor- 
able conditions, it will decompose within a year. 



74 ACIDUM HVDROCYANICUM. 

Preparations containing Hydrocyanic Acid. 

Aqua Laurocerasi, Cherry-laurel Water (Unofficial), — is a water distilled from the fresh 
leaves of Primus laurocerasus, the common Laurel or Cherry Laurel, a small tree of the nat. 
ord. Roseaca, sub-order Amygdalea. The leaves contain a variable amount of Hydrocyanic 
Acid and a volatile oil. Dose, njiv-xxx, cautiously. 

Scheele's Dilute Hydrocyanic Acid (Unofficial), — is a 4 or 5 per cent, solution, and is 
highly dangerous even by inhalation. 

Amygdala Amara, Bitter Almond (see its title) and its essential oil; also various other 
members of the sub-order Amygdaleas, including the official Primus Virginiana, perhaps the 
unofficial Primus laurocerasus, and the leaves and kernel of the peach and cherry trees, 
contain a proximate principle Amygdalin, and a ferment Emulsin, which in the presence 
of water react on each other, forming Hydrocyanic Acid, a volatile oil, and glucose. C 20 H 27 
NO u (Amygdalin)— 2HjO = C 7 H e O (Oil of Bitter Almond) + HCN (Hydrocyanic Acid) 
+ 2C 6 H, 2 O e (Glucose). 

Hydrocyanic Acid exists ready formed to a considerable extent in the juice of the bitter ' 
cassava. 

Other Cyanogen Compounds. 

Potassii Cyanidum, Potassium Cyanide, KCN, — a white, opaque salt, of alkaline re- 
action, bitter-almond taste, and a peculiar odor when moist; soluble in 2 of water, sparingly 
soluble in alcohol. Dose, gr. fo \ [av. gr. ■]. Locally a solution of gr. j-v to the 5 is as 
strong as should be employed. 

Potassii Ferrocyanidum, Potassium Ferrocyanide, K 4 Fe(CN) e 3H 2 0, — large, lemon- 
yellow prisms or tablets, efflorescent, odorless, of sweetish taste and neutral reaction, soluble 
in 4 of water, insoluble in alcohol. Employed in pharmacy as a test solution, and in the 
preparation of Iron Ferrocyanide, Diluted Hydrocyanic Acid and Potassium and Silver 
Cyanides. Rarely used medicinally. Dose, gr. v-xv, [av. gr. vijss]. 

Incompatibles. 

Incompatible with Hydrocyanic Acid are: Acids (mineral), Antimony Oxides, Iron and 
Copper salts, Mercury Oxides, Silver Nitrate, Sulphides; with Cyanides are: Acids, Alkalies, 
Hydrated Chloral, Iodine; Lead, Mercurous, and Silver salts; Permanganates, Potassium 
Chlorate, Potassium Nitrate. Atropine is physiologically incompatible. 

Physiological Action. 
Hydrocyanic Acid is one of the most powerful and rapid poisons known, 
half a grain having proved fatal almost immediately. Its action on the or- 
ganism is one peculiar to itself, the inhalation of a strong preparation produc- 
ing rapid insensibility and almost immediate exhaustion; — -death from a full 
dose occurring by sudden paralysis of the heart, from a less but still a fatal 
dose, by paralysis of respiration. The symptoms are those of sudden and com- 
plete asphyxia, but some volitional movements may be made before death, 
unless the dose be very large. In cases in which the dose, though fatal, per- 
mitted of the observance of its effects, they were usually divisible into two 
marked stages, (1) dyspnea, slow and full pulse, giddiness, loss of muscular 
power; (2) vomiting, dilated pupils, unconsciousness, spasms, muscular rigid- 
ity, and cessation of the heart's action. In poisonous, but not fatal doses, the 
following effects have been observed: feeble pulse, dilated pupils, turgid and 
dusky face, insensibility, convulsions or rigidity, but no paralysis. Large 
medicinal doses may produce salivation, irritation of the throat, dizziness, buz- 
zing in the ears, headache, numbness, dusky countenance, staggering gait, 
sense of constriction in the chest, palpitation of the heart, a frequent or an 



\C11M \l HYDROCYANIC l\l. 75 

abnormally slow pulse, a souse of great weariness and drowsiness. Posl mor- 
tem examination usually shows dilated pupils, the eyes having a marked glassy 
lustre, the cadaveric rigidity very great. The blood, in eases which have beer 
rapidly fatal, may show the arterial color in both the arterial and the venous 
systems; but in slower eases it is dark and iluid, engorging both sides of the 
heart, the venous trunks, and the cerebral sinuses. The paralyzant action of 
the chug is chiefly exercised on the nerve-centres in the medulla; next on the 
peripheral afferent nerves, the spinal cord, the motor nerves, and finally on 
the muscular tissue. It stops the heart by irritation of the vagus-roots in the 
medulla, as well as by paralyzing the cardiac motor ganglia. It is said to form 
with hemoglobin a compound (cyan-hemoglobin), which does not readily give 
up oxygen. The odor of the acid is fragrant, resembling that of bitter almonds 
or peaches, and may be detected in the lungs shortly after death. The effects 
of a medicinal dose pass off in an hour at the farthest. 

Locally applied to the skin, Hydrocyanic Acid penetrates the epidermis 
and paralyzes the end-organs of the sensory nerves in the derma. It is rapidly 
absorbed from mucous surfaces. 

Potassium Cyanide has similar action, but in addition has some few peculiar 
to itself. Locally used it produces dermatitis, with an eczematous eruption, 
and if applied to an abraded surface freely may cause fatal effects. Internally 
it has proved fatal in doses of 3 to 5 grains, with all the symptoms of hydrocyanic 
acid poisoning, but its action is less rapid. In the stomach it is converted into 
hydrocyanic acid by the displacement of K by H in the presence of an acid. 
As the amount of acid in the stomach is small, this reaction proceeds gradually, 
and there is generally an interval of several minutes, up to 15 or 20, before the 
onset of toxic symptoms, which are much less violent than those from hydrocy- 
anic acid, and the tetanic convulsions of the latter agent may be entirely absent, 
but the result is no less fatal. This Cyanide is much used in photography, and 
many cases of poisoning by it have occurred in persons employed in that art. 

Therapeutics. 

Diluted Hydrocyanic Acid is used for its antispasmodic and sedative effects. 
In vomiting, whooping-cough, and coughs of spasmodic character, in asthma 
and other neuroses of the respiratory organs, in affections involving the pneu- 
mogastric nerve, vertigo and headache from stomachal derangements, gastralgia, 
painful dyspsia, and vomiting, it is very efficient as a palliative. In acute 
mania and melancholia it has been used with advantage; and in various skin 
diseases, accompanied by itching and tingling, its use as a lotion (Tr^xxx-^j ad 5J 
aquae rosse) to the unbroken surface, promptly relieves the pruritus and other 
distressing sensations. Being rapidly eliminated it requires frequent admin- 
istration for its effects to be of service. 

Potassium Cyanide in ointment (gr. v ad sj) is used to allay pruritus, and 
in solution (gr. iij-v ad sj) is applied locally with benefit in reflex headaches, 
and is used as a wash to remove nitrate of silver stains. It has been used in- 



76 ACIDUM LACTICUM — ACIDUM NITRICUM. 

ternally in doses of gr. j for acute articular rheumatism, but such employment 
of it is highly dangerous. In smaller doses (gr. \-\), it is a useful ingredient 
of cough mixtures, where opium or its alkaloids are not admissible. 

Potassium Ferrocyanide has been used in doses of 8 to 15 grains as an as- 
tringent and anodyne, but it is seldom employed in medicine. 

Cherry-laurel water has been extensively used as a flavoring agent, having 
a very agreeable taste. It is official in the British Pharmacopoeia, and is sup- 
posed to be a rather elegant mode of administering prussic acid; but the un- 
certainty of its strength is such that it should never be used internally, except 
in very small quantities. It has been employed as an anesthetic injection into 
the urethra prior to catheterization, and was formerly employed by ophthal- 
mologists as an eye-wash in painful affections of that organ. 

ACIDUM LACTICUM, Lactic Acid, — is a liquid composed of 75 per cent, by weight 
of absolute Lactic Acid, HC 3 H 6 3 , and 25 per cent, of water; nearly colorless, syrupy, odor- 
less, of acid taste and reaction, freely miscible with water, alcohol and ether, but nearly in- 
soluble in chloroform. It is produced by the lactic fermentation of sugar of milk or grape 
sugar, has a sp. gr. of 1.2 13, and is difficult to obtain pure. It enters into Syrupus Calci 
Lactophosphatis. Dose, ttjjxx— 3j; [av. Ttjxxx.], well diluted. 

Lactic Acid is found in the stomach as a product of the food, and combines with bases 
in the blood, forming lactates, which, being oxidized, are converted into carbonates. It aids 
digestion and promotes the appetite, but in large doses causes flatulence and much epigastric- 
pain. Injected into the peritoneal cavity of animals, it excites endocarditis, and given in 
diabetes it has produced acute rheumatism and rheumatic endocarditis. Hence its supposed 
causation of acute rheumatism when in excess and free in the blood. It dissolves false 
membranes and also calcium phosphate. Hypnotic properties have been ascribed to it. 

Lactic Acid is used with benefit in diabetes, atonic dyspepsia, oxaluria, and in the lithic 
and phosphatic diatheses, when due to imperfect digestion and assimilation. As a solvent 
of false membrane in diphtheria it is unquestionably of great sendee but painful. In chronic 
cystitis it arrests the ammoniacal decomposition in the urine. As the acid found in the shops 
is generally of poor quality, disappointment in its use may be expected. Albumin, milk, and 
oxidizers, are incompatible with Lactic Acid. 

ACIDUM NITRICUM, Nitric Acid,— is a liquid composed of 68 per 
cent, by weight of absolute Nitric Acid, HN0 3 , and 32 per cent, of water. It 
is colorless, fuming, very caustic and corrosive, of sp. gr. 1.414, strongly acid 
in reaction, and is obtained by the action of sulphuric acid on potassium nitrate. 
It is only used externally as a caustic. 

Preparations. 

Acidum Nitricum Dilutum, Diluted Nitric Acid, — has of the above 10 grammes in 58 
of Distilled Water, and contains 10 per cent, by weight of absolute Nitric Acid. Dose, 
njiij-xl, [av. ttjjxxx], well diluted. 

Acidum Nitrohydrochloricum, Nitre-hydrochloric Acid, {Nitromuriatic Acid, Aqua 
Regia) — a golden yellow, fuming, corrosive liquid, composed of Nitric Acid 18 vols., Hydro- 
chloric Acid 82 vols. Is wholly volatilized by heat, usually dissolves gold-leaf, and a drop 
added to test-solution of potassium iodide liberates Iodine in abundance. Dose, TTjjj— viij, 
[av. itjjiij], well diluted. 

Acidum Nitrohydrochloricum Dilutum, Diluted Nitrohydrochloric Acid, — consists 
of Nitric Acid 4, Hydrochloric Acid 18, Water 78 vols. Dose, ngv-xx, [av. t$xv], well diluted. 

Incompatibles. 

Incompatible with Nitric Acid are: Alcohol, Alkalies, Carbonates, Ferrous Sulphate, 
Lead Acetate, Oils (essential), Sulphides. 



\rn>i \i ci. i ii i \i. 



77 



Physiological Action \\i> Therapei rics. 
The action and uses of these agents arc described with those of the other 
mineral acids, under the title Acidum Hydrochloricum. Some special proper 

ties arc as follows: — 

Nitric Acid is an exceedingly powerful escharotic, but, as it coagulates and 
does not redissolve the albumin of the tissues, it forms a harrier to its own ex 
cessive action. The vapor may cause edema of the glottis, intense bronchitis, 
and death from suffocation. It is used for the destruction of chancres, warts, 
hemorrhoids, phagedenic ulcers, etc.; and internally in dilute form for bilious 
affections, as it is somewhat cholagogue in its action on the liver. It is excreted 
to a small extent as ammonia, slightly decreasing the acidity of the urine and 
lessening phosphatic deposits therein. It is one of the principal tests for deter- 
mining the presence of albuminuria. 

Xitrohydrochloric Acid is an efficient cholagogue, and is employed with 
benefit in jaundice, dyspepsia, and the so-called bilious condition; also in acid- 
it)' of the stomach and in frontal headache situated just above the eyebrows 
when unaccompanied by constipation. In hepatic disorders it may be used 
in dilute form as baths, or applied to the hepatic region on compresses. The 
official dilute acid is of little use therapeutically, as it rapidly deteriorates, and 
the same is true of the strong acid when old enough for the color to change to 
a lemon-yellow. The most efficient is the strong acid freshly prepared, which 
is of an orange-red color. This should be properly diluted when required for 
use, and should be constantly protected from light. 



ACIDUM OLEICUM, Oleic Acid, HC 18 H 33 2 ,— is one of the consti- 
tuent acids of oils and fats, obtained commercially as a secondary product 
in the manufacture of stearin candles. It is a yellowish, oily liquid, semi-solid 
at 40 F., odorless, tasteless, and of neutral reaction, insoluble in water but 
soluble in alcohol, chloroform, benzol, benzin, turpentine, and the fixed oils. 
It dissolves most of the metallic oxides and the uncombined alkaloids, forming 
the so-called Oleates, which, however, are not pure chemical compounds, but 
merely compounds of an oxide or an alkaloid, as the case may be, with oleic 
acid, dissolved in a great excess of the latter. Five of these are official, viz. — 

Oleatum Atropinae, Oleale of Atropine, — strength 2 per cent. 
Oleatum Cocainae, Oleale of Cocaine, — strength 5 per cent. 
Oleatum Hydrargyri, Oleale of Mercury, — strength 25 per cent. 
Oleatum Quininae, Oleale 0/ Quinine, — strength 25 per cent. 
Oleatum Veratrinae, Oleale 0} Veratrine, — strength 2 per cent. 

Unofficial Preparations. 

Oleates (Oleata) of Aconitine (2 per cent.), Morphine (10 per cent.), Morphine and 
Mercury (2 per cent, morphine and 20 per cent, mercuric oxide), Strychnine (2 per cent.), 
Arsenic (gr. xx of arsenic oleate to the o), Aluminum, Bismuth, Copper, Iron, Lead, Silver, 
etc., are prepared by the manufacturing pharmacists, and are to be obtained in the shops. 
Most of them answer to the description given above, but several are Oleo-palmitates, or 
double salts of Oleic and Palmitic Acids, being prepared from oils which yield the latter acid 
in considerable quantity. Drs. Shoemaker and Wolff, of Philadelphia, have introduced, 






78 Acrouii OXALICUM. 

under the above names, several solid or semi-solid preparations, which they claim to be 
chemically true oleates, salts having no excess of either their acid or basic radicles. They 
produced by the double decomposition of sodium oleates with solutions of neutral salts, 
the precipitates, trashed and dried, being the oleates required. These oleates are claimed 
to be more stable than the official oleic solutions, and having less oleic acid are much less 
i ostly. Many of them may be used as dusting powders, or mixed with oil or lard to form 
ointments. 

Oleic Acid is used only in making the oleates, which were introduced by 
Marshall as substitutes for ointments, being cleaner, more elegant, and more 
penetrating, but decidedly more irritating if applied with friction. Their medi- 
cinal properties depend upon the bases employed, hence their actions and uses 
will be described under the corresponding basic titles. As parasiticides, the 
Oleates of Copper and Mercury are most efficient, and in skin diseases generally 
these preparations are rapidly gaining favor. 



ACIDUM OXALICUM, Oxalic Acid, C 2 H 2 4 , (Unofficial),— is an organic 
acid which exists as oxalates in many plants, particularly rhubarb, spinach, 
and those of the genus Rumex, commonly called "sorrel." It may be prepared 
by the oxidation of sugar, starch, or many organic substances, by Nitric Acid, 
or by fusing sawdust with a mixture of potassa and soda. It occurs in small, 
colorless crystals, which are soluble in 10 of water and in 2\ of alcohol. Dose, 
gr. £-£, but the latter amount has caused serious respiratory depression. 

Acid Potassium Oxalate, Salt of Sorrel, Salt 0} Lemons (Unofficial), — is used in house- 
holds for removing ink and iron stains, cleaning brass, etc. It is nearly as toxic as the acid. 

Ferri Oxalas, Ferrous Oxalate (Unofficial), — a ferruginous salt, highly esteemed by 
Hayem. Dose, gr. j-iij. 

Ammonii Oxalas, Ammonium Oxalate, — is official as a test-solution for calcium salts. 
Cerii Oxalas, Cerium Oxalate, — is described under its own title. 

Incompatible with Oxalic Acid and the Oxalates are: Arsenates, Metallic Salts, except 
those of aluminum, chromium, and magnesium. 

Physiological Action and Therapeutics. 
Oxalic Acid derives its importance from its frequent use as a poison. It 
is largely used in the arts, for bleaching and dyeing, also in households for 
cleaning brass and removing ink and iron stains, and has often been mistaken 
for Epsom salts, which it resembles in appearance. It is a rapid and powerful 
poison, causing burning pain in the throat and abdomen, vomiting of acid, 
greenish or bloody mucus, a small and irregular pulse, collapse, stupor, some- 
times convulsions, and death from paralysis of the respiration. In some cases 
the nervous symptoms mask the gastric effects entirely, so that the patient may 
suddenly fall unconscious immediately after the ingestion of the poison. Death 
has occurred from 3j (Taylor), but recovery has occurred after 3iv (Murrell). 
It paralyzes the respiratory, vaso-motor, and other spinal motor centres, also 
the heart, which is arrested in systole. It is eliminated by the kidneys and pro- 
duces glycosuria; is emmenagogue and abortifacient, and a powerful germicide. 
It is probably a constant product of metabolism, traces of calcium oxalate being 



U'UUM si I nil kin \i \< ini M StJLPHUROSUM. 79 

found in normal urine, and occurs in excess (oxaluria) in thai of many hypo 
chondriac and gouty subjects. It has been used medicinally in the treatment 
of amenorrhea, as a sedative in acute cystitis, ami in connection with Potassium 
Permanganate for disinfecting the hands of the surgeon. 

ACIDUM SULPHURICUM, Sulphuric Acid, -is a strongly caustic and 
corrosive liquid, oily, inodorous, of strongly acid reaction, and is composed 

of not less than 92^ per cent, of absolute Sulphuric Acid, HjS0 4 and 7^ per cent. 
oi water. It is obtained from the combustion of Sulphur and its oxidation by 
nitrous fumes. Its specific gravity should not be below 1.835, an d '* > s misciblc 
in all proportions with water and alcohol, with evolution of heat. Being dibasic 
it forms both acid and normal salts (sulphates) with monad bases. It decom- 
poses many organic substances, extracting their H and O in the proportion to 
form water, and leaving the carbon behind. 

Acidum Sulphuricum Dilutum, Diluted Sulphuric Acid, — has of the strong acid 1 part 
to S} of distilled water, and contains 10 per cent, by weight, of absolute sulphuric acid. Dose, 
njv-xl, [av. m>xxx], well diluted. 

Acidum Sulphuricum Aromaticum, Aromatic Sulphuric Acid, Elixir of Vitriol, is 
Sulphuric Acid n per cent, by volume, 20 per cent, by weight, diluted with Alcohol and 
flavored with Cinnamon and Ginger. It is not an acid, but rather an ether formed by reac- 
tion between the acid and the alcohol. Dose, njv-xx, [av. ttrxv], well diluted. 

Incompatible with Sulphuric Acid are: Alcohol, Barium and Calcium salts. Hypophos- 
phorous Acid. Metals, Oils (essential); Lead, Mercurous, Silver and Strontium salts, Organic 
substances, Sulphides, Vegetable astringent infusions. 

The actions of Sulphuric Acid are described with those of the other mineral 
acids under the title Acidum Hydrochloricum. Its principal uses are those 
of an astringent and a hemostatic, though it is occasionally employed as a caustic. 
Internally it is used in lead-poisoning to form the insoluble sulphate of lead, 
also as a remote astringent in diarrhea, hemorrhoids, hemorrhages, night-sweats, 
and mucous discharges. In choleraic diarrhea and lead-poisoning it is gener- 
ally administered in combination with opium. The only hemorrhages in which 
it is efficient are those from mucous surfaces. It is excreted chiefly by the kid- 
neys, part escaping by the bowels as sulphates, part also by the skin. Like the 
other mineral acids, it does not increase the acidity of the urine to any con- 
siderable extent. 

ACIDUM SULPHUROSUM, Sulphurous Acid,— is a colorless liquid of 
sulphurous taste and highly acid reaction, composed of not less than 6 per 
cent., by weight, of Sulphur Dioxide, S0 2 , and 94 per cent, of water. It is 
prepared by heating Sulphuric Acid with charcoal and dissolving the evolved 
gas in distilled water. Dose, »H,v-3j, [av. "ixxx.] largely diluted with water. 
Its salts are the Sulphites and Hyposulphites. 

Sodii Sulphis, Sodium Sulphite, Na 2 S0 3 .7H 2 0, — colorless, transparent, monoclinic 
prisms, efflorescent in dry air, of cooling, saline, and sulphurous taste, and neutral or feebly 
alkaline reaction; soluble in 4 of water and in 0.9 of boiling water, very slightly soluble in 
alcohol. Dose, gr. v-xxx or even up to 5j> [av. gr. xv.] 



SO ACIDUM TARTARRTM. 

Sodii Bisulphis, .Sodium Bisulphite, NaHS0 3 , — o])aque prismatic crystals, of faint, 
sulphurous odor, a disagreeable taste, and acid reaction; soluble in 4 of water and in 
alcohol, in 2 of boiling water, and in 49 of boiling alcohol. By strong heat it is converted into 
sulphur and sulphate of sodium. Dose, gr. iij-.xx, [av. gr. vijss.] 

Sodii Thiosulphas, Sodium Thiosulphate, (Sodium Hyposulphite), Na 2 S 2 3 .5H 2 0, — 
large, colorless, monoclinic prisms or plates, efflorescent in dry air, of cooling and bitter 
and neutral or faintly alkaline reaction; soluble in 1.5 of water and in 0.5 of boiling water, 
which partly decomposes it; insoluble in alcohol. Dose, gr. v-xx, [av. gr. xv.] 

Incompatibles. 

Incompatible with Sodium Hyposulphite are Acids, Chromates and Permanganates in 
acid solution, Chlorates, Iodine, Nitrates, Oxidizers; Salts of Barium, Lead, Silver; Arsenic, 
Ferric and Mercurous salts. All oxidizers change the Sulphites into sulphates, and the min- 
eral Acids decompose them. 

Sulphurous Acid Gas (sulphur dioxide) is extensively used as a disinfectant, 
being the most powerful and convenient agent for this purpose. Sulphur is 
burned on a shovel or plate in the room to be fumigated, all outlets having 
been carefully closed. The gas is injurious to many fabrics, is irritant to the 
respiratory mucous membrane, and inhaled may cause dangerous inflamma- 
tion of the glottis. Sulphurous Acid has a powerful affinity for oxygen, is strongly 
disinfectant and deodorant, and very destructive to all plant and animal life. 
It is used as a spray or by a mop locally in many affections of the throat, and 
in diphtheria, stomatitis, aphthae, ulcers of the tonsils, syphilitic and tuberculous 
laryngitis, and chronic bronchitis, it may be thus applied with great benefit. 
Morbid fermentation in the stomach, with growth of penicillium and sarcina?, 
is quickly stopped by 5 to 60-minim doses in water, or by the sulphites in 20- 
grain doses. In parasitic skin diseases and foul wounds these agents are ex- 
tremely useful as local applications. 

The Sulphites and Hyposulphites are partly decomposed by the acid of 
the stomach, sulphurous acid being given off, and the balance being converted 
into sulphates act as purgatives, and are absorbed, undergoing elimination as 
sulphates by the kidneys and bowels. They were formerly supposed to enter 
the blood and tissues as sulphites, and to arrest morbid processes of the zymotic 
character, but both these assumptions have proven erroneous. The Sulphites 
were formerly used in zymotic and septic fevers as internal antiseptics on theo- 
retical grounds, but their supposed value has not been realized. 

ACIDUM TARTARICUM, Tartaric Acid, H 2 C 4 H 4 6 — is a dibasic organic acid, 
prepared from Potassium Bitartrate by neutralizing a solution thereof with chalk and cal- 
cium chloride, then decomposing the calcium tartrate thus formed by sulphuric acid, evapo- 
rating and purifying. It occurs in colorless, transparent prisms, which are odorless, of acid 
taste and reaction, and soluble in 0.8 of water and in 2% of alcohol at 50 F. Twenty grains 
exactly neutralize 27 of Potassium Bicarbonate, 22 of Sodium Bicarbonate, or 15^ of Am- 
monium Carbonate. Dose, gr. v-xx, [av. gr. vijss.] 

Tartaric Acid is an ingredient of the Effervescing Powder (see under Potassium). Six 
Tartrates and one Bitartrate (see Index) are official, and are described, with their actions and 
uses, under the titles of their respective bases. For Potassium Bitartrate see under Potassium . 
The Alkaline Cupri-c Tartrate Volumetric (Fehling's) Solution is described under the title 
Ferrum. 

Incompatible with Tartaric Acid are: Alkalies, Calcium salts, Carbonates, Lead salts, 
Lime-water, Mercury salts, Vegetable astringents. 



ACOM 11 \l. Si 

The actions and uses of Tartaric Acid arc similar to those of the other vegetable 
is described under \cidum \ceticum. It is chiefly employed in the preparation of effet 

vcsi ing " drinks and effen escing granulated sails. 

ACONITUM, Aconite,— is the dried tuberous root of Aconitum Napellus, 
the Monk's hood or Wolf's-bane, a perennial plant of the nat. ord. Ranunculaceae, 

found in mountainous regions of Europe, Asia and N. America. This plant 
has deep blue, helmet-shaped flowers, and leaves which have deeply cut, wedge 
shaped segments, exciting slowly when chewed a sensation of tingling in the 
tongue and lips. The root is conical and tapering, with a thick bark enclosing 
a seven rayed, star-shaped pith, odorless, taste sweetish at first, soon becom- 
ing acrid. A minute portion, cautiously chewed, causes prolonged tingling 
and numbness of the tongue and lips. Aconite contains the alkaloids Aconitine, 
C^H^NOn, Benzaconine, C^H^NO,!, and Aconine, C 22 H 35 N0 9 ; also. Aconitic 
Acid, gum, sugar, etc. Dose, gr. }-ij, fav. gr. j.] 

Aconitine may be considered an acetyl-benzaconine, as it is resolvable into benzaconine 
and acetic acid. Benzaconine may be resolved into aconine and benzoic acid. Aconine and 
Benzaconine are the principal constituents of the Napclline and Picraconitine of older writers 
(Cash and Dunstan). 

Other Aconites are: Aconitum Ferox, from India, yielding the alkaloid Psendaconiliuc, 
which is even more toxic than Aconitine; Aconitum Japonicum, from Japan and China, con- 
taining Japaconitine, which is identical with Aconitine; Aconitum Lycoctonum, the alkaloid 
of which is called Lycoctonine. The plant Delphinium Staphisagria contains an alkaloid 
named Delphinine, which acts similarly to Aconitine, but less powerfully. 

Official Preparations. 
Fluidextractum Aconiti, Fluidextract of Aconite, — an alcoholic preparation of which 
each drop represents nearly one grain of the powdered drug. Dose, HE^-ij, [av. Tnjj .] 

Tinctura Aconiti, Tincture of Aconite, — has of Aconite 10, Alcohol and Water to ioo. 
Dose, trgj-xv, [av. njfx.] 

Tinctures of Aconite-root vary greatly in strength. In Fleming's Tincture 70 parts 
of aconite are used in preparing 100 of the tincture, in that of the B. P. 5, in the French 20, 
the German 10, while the Linimentum Aconiti (B. P.) is really a very strong tincture, of the 
strength of 1 to 1 J. Probably the best and safest preparation for ordinary use is a 10 per cent, 
tincture, of which the maximum single dose for an adult is stated in the P. Ger. at nji.x, and 
the maximum daily dose at tTJJxxxv. 

The best rule for the administration of Aconite is to give minim doses of the official 
tincture every 15 minutes until the desired effect is produced. 

Aconitina, Aconitine, C^H^NO^, — is a w r hite, prismatic powder, readily soluble in 
alcohol or chloroform, nearly insoluble in water. It is difficult to obtain it of constant strength, 
some samples being nearly inert, others extremely active. As it occurs commercially it is a 
mixture of several alkaloids, and should not be used internally in practical medicine (Wood). 
The Aconitine Crystalisee of Duquesnel is a nitrate of aconitine, and is probably the most active 
preparation on the market (Squibb). Dose, gr. -j^o - ut^j [ av - g r - t<jo]> but the amorphous 
Aconitine may be administered in doses of gr. sV^jV (Merck) . 

Unofficial Preparations. 

Oleatum Aconitinae, Oleale of Aconitine, — is a 2 per cent, solution in Oleic Acid, for 
external use. Duquesnel's crystals will not dissolve in Oleic Acid (Squibb). 

Napellina, Xapelline, — contains Benzaconine and Aconine, and has been used in doses of 
gr. k-l. It has been studied by Laborde, who claims for it most valuable hypnotic properties, 
and proposes to use it as a substitute for opium and chloral. 

St. Jacob's Oil (a patent medicine), — is a weak Aconite Liniment, which also contains 
Ether, Alcohol, Turpentine, red coloring matter and water (Squibb). It contains Turpentine 
(82 per cent.), Aconite, Ether, Alcohol, Carbolic Acid, Capsicum and a small quantity of 
Origanum (Murrell). 

7 



82 ACONITUM. 

Incotnpalibles. 

Incompatible with Aconite are: Acids, Alkalies, or Water (hot). Atropine, Digitalis 
Morphine, Scoparin, and Strychnine, are physiologically incompatible with Aconitine. 

Physiological Action. 

The taste of Aconite is bitter, acrid and pungent. Soon after the inges- 
tion of even a small quantity, a sensation of numbness and persistent tingling 
are felt in the tongue and lips. Full medicinal doses cause a sense of constric- 
tion in the fauces, irritation of the gastro-intestinal mucous membrane with 
increased secretion; sometimes nausea and vomiting, and severe pains in the 
joints and muscles; always more or less salivation, diaphoresis and diuresis; 
reduced respiratory power, cardiac rate and force; lowered arterial tension 
and temperature. 

A lethal dose produces great muscular weakness, dim sight, dilated (some- 
times contracted) pupils; shallow, irregular, and labored respiration, slow and 
weak pulse, cold surface, clammy sweat, great anxiety, numbness and tingling 
in the extremities, lowered body-temperature (2 to 3 F.), abolished sensation, 
impaired reflexes and motility, and finally death from paralysis of the heart 
and respiration, with or without convulsions, consciousness being preserved 
until near the end, when C0 2 narcosis sets in. In two recorded cases, edema 
of the entire body resulted from eating the leaves of the growing plant. 

Aconite is rapidly absorbed and the active principle is destroyed by oxida- 
tion, so that its medicinal effects do not last long and it may be administered 
in small doses at frequent intervals. The effects of a full dose continue for 
three or four hours. Applied externally it paralyzes the sensory nerves of the 
part, and causes its characteristic numbness and tingling. 

The action of Aconite is due to its chief constituent, Aconitine, which is 
the most powerful alkaloid known, and fatal to man in the dose of gr. -%■$. Its 
dominant action is depressant to the peripheral nerve terminations, especially 
those of the sensory nerves, but stimulant to the vagus roots, slowing and steady- 
ing the action of the heart and lowering the blood-pressure. It slows the respi- 
ration, relieves pain, lowers the body temperature, is mildly diaphoretic and 
feebly diuretic. In overdose it paralyzes both the motor and sensory nerves — 
the sensory being affected first and from the periphery inward, while the motor 
nerves are affected from the centres outwardly. It stimulates at first but soon 
relaxes the inhibitory apparatus of the heart, and paralyzes finally the vagus 
ends, the cardiac muscle and its contained ganglia, the respiratory centres, 
and the spinal cord in all its functions — sensory, reflex and motor; but does not 
affect the cerebrum. 

The primary stimulation which the drug produces upon the vagus centre 
in the medulla slows the heart-rate at first; but its depressant action upon the 
motor cardiac centres and the vagus end-organs in the heart is soon mani- 
fested, and finally the vagus centre shares in the increasing paralysis, which 
affects the vaso-motor centre as well as the cardiac nervous apparatus. The 



\l'p\l II \l. 



83 



heart-rate becomes very rapid near the end, from paralysis of the vagus term 

inals in its structure. Death is due generally to paralysis of the respiratory 
centre, sometimes to cardiac failure. 

Benzaconine may be resolved into aconine and benzoic acid. It is only 
.'„th as toxic as Aconitine, depresses the motor nerves, the vaso-motor centre, 
and the cardiac muscle, but does not paralyze the sensory nerves. It stimu 
lates the vagus, causing slowing of the pulse, and affects the cerebrum, causing 
a semi-comatose condition. 

Aconine is a feeble agent, being 2000 times less toxic than aconitine. In 
quantity it has a paralyzant action on the motor nerve terminations like that 
of Curare, does not affect the vaso-motor centre, but stimulates the vagus roots 
and strengthens the ventricular systole. 

Therapeutics. 

Aconite was well known to the ancients, by whom it was regarded as the 
most virulent of all poisons. It was introduced into medicine by Baron Storck, 
of Vienna, in 1762, and its pharmacology and therapeutics were the subject 
of an essay by Fleming in 1844, for which he was awarded a gold medal by the 
University of Edinburgh. 

Aconite antagonizes the fever process, and rightly used is therefore one of 
the most valuable drugs we possess. It has well been called the "therapeutic 
lancet," and is certainly responsible to a great extent for the disuse of venesec- 
tion. Its power over the circulation, respiration and transpiration renders it 
of the greatest value in all affections characterized by a high, resisting pulse, 
a dry, hot skin, and elevated body-temperature. The chief indication for its 
use is vascular excitement in sthenic subjects; it is contra-indicated when there 
is adynamia, weak action of the heart, cardiac degeneration or dilatation, and 
gastro-intestinal irritation or inflammation. Aconite is not a remedy for use 
in continued fevers, and its prolonged administration is not indicated except 
under very exceptional circumstances. Even in the inflammatory and febrile 
conditions for which it is usefully employed it will be found of greatest value 
in their early and sthenic stages, its later use being often injurious. 

Aconite is very efficient in acute affections of the bronchial mucous mem- 
brane, in coryza, tonsillitis and asthma due to exposure, also in both catarrhal 
and spasmodic croup. One of the best methods of "breaking up a cold" is 
to administer small doses of the tincture at frequent intervals for several hours, 
followed by 10 grains of Dover's powder at bedtime. As a febrifuge and seda- 
tive it is useful in simple and catarrhal fever, also in scarlatina, measles and 
erysipelas. In the early stage of acute inflammations of serous membranes, 
as meningitis, pleurisy and pericarditis, it has great power for good, but its 
employment in these affections should be restricted to the period before the stage 
of effusion. In acute peritonitis it is a valuable adjunct to Opium in cases 
presenting the sthenic characteristics which indicate its employment. In the 



> 



> 



84 ADEPS. 

early stage of pneumonia its sedative influence upon the respiration may be 
utilized with benefit, but it should not be used beyond the time when the heart 
begins to undergo much strain. In acute articular and muscular rheumatism 
it is frequently of great service, and if used from the beginning of the attack 
in rheumatic fever it will generally prevent the cardiac complications which are 
so dreaded in that disease. 

Aconite has proved very efficient in neuralgia, especially if the attack is 
accompanied by high vascular excitement, also when the branches of the fifth 
nerve are affected. Aconitine has proved remarkably efficient in trigeminal 
neuralgia of obstinate character, but it is a doubtful and dangerous agent for 
internal use, on account of its variable purity and composition, and its great 
toxicity. Aconite gives satisfaction in the treatment of cardiac affections char- 
acterized by overaction or hypertrophy and absence of dilatation or valvular 
lesions, particularly in exophthalmos, nervous palpitation, and tobacco heart. 
Even when valvular disease is present it may be cautiously used in extreme 
hypertrophy to control the forcible cardiac action. 

When diarrhea or dysentery follows a chill and can be ascribed to cold and 
exposure, the patient having high fever and cutting pains in the abdomen, Aconite 
will be found a very serviceable remedy. In sudden suppression of menstrua- 
tion following a chill, getting the feet wet, or similar evidences of exposure, 
this agent is efficient in removing the discomfort and causing the reappearance 
of the flow. In congestive dysmenorrhea it frequently gives marked relief. 
In the early stage of gonorrhea drop doses of the tincture, given hourly until 
some physiological effect is produced, will lessen the severity of the inflammatory 
symptoms and prevent chordee. In the so-called urethral fever it is highly 
recommended, and a drop or two of the tincture given immediately after the 
passage of a urethral sound will prevent the chill which often succeeds that 
operation. 

Externally, Aconite is used with benefit as a local anodyne in superficial 
neuralgias, herpes zoster, pruritus and chilblain. For the relief of vague, wan- 
dering pains in the limbs, liniments containing this tincture will prove more 
effective than those of any other form. For odontalgia the tincture may be 
rubbed on the gum in the vicinity of the aching tooth, or it may be introduced 
upon a pledget of cotton into a dental cavity. Any preparation containing 
this drug should be used with great caution upon an abraded cutaneous surface, 
as it is rapidly absorbed by the unprotected derma. 

Aconite is best administered in small doses of the tincture well diluted and 
frequently repeated. Doses of n^| to \ every 15 minutes give better results 
than larger ones at longer intervals. 

ADEPS, Lard, — is the prepared internal fat of the abdomen of the hog, 
Sus scrofa, purified by washing, melting and straining. It occurs as a soft, 
white, unctuous solid, of bland taste and neutral reaction, entirely soluble in 



API PS. 85 

ether, benzin, and bisulphide of carbon; composed of 38 per rent, of stearin 
and margarin, and 62 per tent, of olein. Lard forms 50 per cent, of (Yratum, 
and So per cent, of Unguentum, and enters into the composition of several "I 
the official cerates. Fats are formed of the principles Stearin, Margarin, and 
()/(•;/?, which are salts of stearic, margaric, and oleic acids, with the common 
base glycerin, and contain also odorous and coloring principles. 

The action of the Oils and Fats is described under MT.ORRHD 1 OLEUM. Lard 
is only used as an ingredient of ointments and cerates. Lard Oil has been pro- 
posed as an inferior substitute for Cod liver oil in cases where the taste of the 
latter is particularly offensive. 

Preparations. 

Adeps Benzoinatus, Benzoinated Lard, — has 2 per cent, of Benzoin in powder, incor- 
porated by stirring. 

Oleum Adipis, Lard Oil, — is a fixed oil expressed from lard at a low temperature. 

Official Derivative and Analogues. 

Acidum Stearicum, Stearic Acid, — is an organic acid, usually obtained from the more 
fats, chiefly tallow. In its impure, commercial form, it occurs as a hard, white, glossy 

Solid, odorless, and tasteless, permanent in the air; insoluble in water, soluble in 45 of alcohol, 
in ether. It is used as a substitute for wax, and is an ingredient of the Suppositoria 
erini. Stearates of Atropine, Morphine, Cocaine, Copper, Mercury and Zinc are on the 

market, that of Zinc being the only official one, and the most generally used. [See under Zin- 

cr\;.j 

Adeps Lanae, Wool-fat, — is the purified fat of the wool of sheep, freed from water. It 
is insoluble in, but miscible with, large quantities of water, sparingly soluble in alcohol. 

Adeps .Lanas Hydrosus, Hydrous Wool-jat (Lanolin), — is the purified fat of the wool of 
sheep, mixed with not more than 30 per cent, of water. A yellowish-white, ointment-like 

5, having a faint, peculiar odor; insoluble in water, but miscible with twice its weight 
thereof. 

Under the name Lanolin this substance was in use for several years before it became offi- 
cial. It is a cholesterin fat, and a verv old medicament, having been mentioned by Ovid, 
Herodotus, Pliny and Aristophanes; yet the process of obtaining it from the suds from the 
washings of sheep's wool is patented in this country by Liebrich. It differs from all other 
fatty substances chiefly in resisting saponification and the action of water, having no tendency 
to become rancid; and readily passes through the integument, carrying with it any medica- 
ment with which it is charged. It is a perfectly neutral base, and therefore not liable to de- 
compose any ordinary substance. The difficulty about its use has been its very disagreeable 
Sbeepy smell, but recent samples seem in great measure to be devoid of this objectionable 
quality. It is particularly useful in chronic skin diseases where there is infiltration, and 
where a penetrative action is desired for medicaments locally applied. In a few cases of 
acute and subacute eczema it has proved irritating, but as a rule it is perfectly bland. Where 
a >implc protective action alone is desired it is inferior to Lard, Vaselin or Cold Cream. 

Cetaceum, Spermaceti, — is a peculiar, concrete, fatty substance obtained from the head 
of the sperm whale. It occurs in white, pearly masses, which are odorless, of bland taste and 
neutral reaction, becoming rancid in the air, soluble in ether, chloroform, carbon disulphide 
and boiling alcohol. It is a constituent of — 

Unguentum Cetacei, Spermaceti Ointment (B. P.), — has of Spermaceti 20, White Wax 
S, Almond Oil 72, Benzoin 2. The last-named ingredient renders the ointment irritating, 
and should be omitted when a perfectly bland application is required. 

Unguentum Aquas Rosae, Ointment oj Rose Water, {Cold Cream), — contains Spermaceti, 
Almond Oil, Rose Water, etc. [See under Rosa.] 

Spermaceti consists of Cetin (Cetyl Palmitate) with several other fats in small quanti- 
ties. Its action is solely that of an emollient, and it is rarely used internally, though an alco- 
holic preparation was once a regular prescription for coughs, bronchial irritation, and for a 

ntly delivered woman. A Cerate is employed as a bland ointment for blisters, abrasions 
and ulcers, but it is too stiff for easy application, and the Ointment is preferred in practice. 



86 ADONIS. 

The latter on lint to broken blisters from walking affords great relief, and may be smeared on 
the feet to prevent injury from a rough tramp over broken ground. 

Sevum Praeparatum, Prepared Siiet, — is the internal fat of the abdomen of Ovis Aries 
(the Sheep), purified by melting and straining. It should be kept in well-closed vessels and 
not used after it has become rancid, as it will on exposure to air. It is a white, smooth, solid 
fat, of bland taste and neutral reaction, insoluble in water or cold alcohol, soluble in 44 of boil- 
ing alcohol, 60 of ether, and slowly in 2 of benzin. It consists chiefly of Stearin, but also has 
Palmitin and Olein, and is a constituent of Unguentum Hydrargyri. It is a harder fat thaD 
lard and more liable to turn rancid. It is used in ointments and liniments to give them greater 
consistency, but may be applied alone as a dressing to ulcers. In physiological action and 
therapeutics it follows the other oils and fats. [See under Morrhtle Oleum and Oliwe 
Oleum.] 

ADONIS (Unofficial), — is the plant Adonis vernalis, the Pheasant's Eve 
or False Hellebore, a perennial herb of the nat. ord. Ranunculaceas, which 
grows wild in Europe and Asia. It contains Aconitic Acid, also the toxic glu- 
coside Adonidin, which is the active principle and is found in small quantity 
in all parts of the plant. 

Preparations. 

Tinctura Adonis, Tincture oj Adonis (Unofficial), — Dose, oss-ij. 

Infusion Adonis, Infusion of Adonis (Unofficial), — has from 4 to 8 parts of the plant in 
200 of water. Dose, oss every 4 to 6 hours. 

Adonidinum, Adonidin (Unofficial), — a canary -yellow, hygroscopic powder, of intensely 
bitter taste and neutral reaction, soluble in water and in alcohol. Dose, gr. J, every 3 or 4 
hours (Durand). 

Physiological Action and Therapeutics. 

Adonis, when fresh, has acrid, irritant and vesicant properties, which dis- 
appear when the plant is dried. It affects the heart in the same manner as 
Digitalis, but more promptly, slowing, regulating and strengthening the beats 
and raising the blood-pressure in the arteries. In consequence of the latter 
action it is a diuretic and removes edema and dropsy. It also slows and deepens 
the respiration, and relieves dyspnea. In toxic dose it paralyzes the terminals 
of the vagus, excites the accelerator apparatus of the heart, and finally causes 
paralysis of the cardiac motor nerves. It is rapidly eliminated and does not 
accumulate in the system. Adonidin has similar action, which is almost ex- 
actly like that of digitalin, but stronger, and about ten times as powerful as 
that of digitoxin (Brunton). In large doses it causes either vomiting or diar- 
rhea (Huchard). 

In Russia this plant is a household remedy for cardiac and renal dropsy, 
and in Siberia it is used as an abortifacient. It is useful in cases of uncom- 
pensated heart disease, in which, by reason of arrhythmia and feeble cardiac 
energy, grave circulatory disorders exist, especially dyspnea and dropsy. It 
is recommended in functional irregularity of the heart and in palpitation with- 
out any cardiac lesion (Da Costa). It acts more promptly than digitalis and 
may be administered for months without cumulative effect (Durand), hence 
it is preferred to digitalis in those cases of mitral or aortic regurgitation in which 
the latter drug is not well tolerated. In general it is less certainly beneficial in 
valvular disease than digitalis, and should only be used when the latter fails 



ETHER. 87 

Nothnagel). In connection with the bromides this drug has been successfully 
used in epilepsy. 

iETHER, Ether, Ethyl Oxide (C 2 H 5 ),0,— in its absolute form is not offi- 
cial, the strongest preparation containing 4 per cent, of alcohol and some water. 
Considered as a generic term an ether is analogous to a salt as an alcohol is to 
a metallic hydrate. The particular ether officially so named is Ethyl Oxide, 
prepared from ethylic alcohol (ethyl hydrate), by a dehydrating agent with the 
aid of heat, and then purified by various processes. The agent used is sul- 
phuric acid, hence this ether is improperly called sulphuric ether, but the acid 
simply dehydrates the alcohol and remains in the retort, becoming constant Iv 
more diluted by the abstraction of water from the alcohol. Consequently 
H.O is the difference between Alcohol and Ether. (C 2 H„0) 2 — H 2 = (C 2 - 
Hj) a O. The official ethers are the two first named in the following list. 

JEther, Ether, — is a volatile and inflammable liquid, composed of about 
per cent, of absolute ether (ethyl oxide), and about 4 per cent, of alcohol 
containing a little water. Its sp. gr. is 0.725 to 0.728 at 59 F. It is the prepa- 
ration employed for anesthetic use, and is generally called Sulphuric Ether, 
a term which properly belongs to ethyl sulphate, C,H 10 SO 4 . The dose of Ether 
for internal administration is tti^x-xxx [av. n\,xv.] in syrup; hypodermically 
for heart failure, n\,x-xx. The best preparation for use in prescriptions is the 
spirit, which mixes readily with water. 

Water dissolves a tenth of its volume of Ether, and reciprocally Ether takes up about 
the same proportion of water. It is colorless, of a strong and characteristic odor, hot and 
pungent in taste. It evaporates speedily in the open air, with the production of considerable 
cold. When good, it evaporates from the hand, without leaving a disagreeable odor. It 
boils at about the temperature of the body, and its vapor is very heavy and very inflammable. 
It dissolves Hydrargyrum Bichloride, Hydrargyrum Iodidum Rubrum, Iodine and Bromine 
freely; Sulphur and Phosphorus sparingly. It is also a solvent of the fixed and volatile oils, 
many resins and balsams, caoutchouc, and most of the organic vegetable alkaloids. It does 
not dissolve Potash or Soda, in which respect it differs from Alcohol. 

.flither Aceticus, Acetic Ether (Ethyl Acetate), C 2 H 5 C,H 3 0, — is an inflam- 
mable liquid, transparent and colorless, of ethereal and acetous odor, soluble 
in alcohol, ether, chloroform, and in 8 of water. It is composed of about 90 
per cent, by weight of Ethyl Acetate, and about 10 per cent, of alcohol contain- 
ing a little water. Dose, Hx-xxx, [av. ni_xv.] 

>Ether Nitrosus, Nitrous Ether, (Ethyl Nitrite), C,H 5 N0 2 , — is official in 
the form of the Spirit (see next page). 

Hydrobromic Ether, Ethyl Bromide, C 2 H 3 Br (Unofficial), — is not inflam- 
mable. Dose, internally and hypodermically, nrx-,3ss. 

Hydriodic Ether, Ethyl Iodide, C 2 H 5 I (Unofficial), — is a colorless liquid, 
non-inflammable, and insoluble in water. Dose, inhaled, ntxv. 

For the Chlorinated Ethers see under Chloroform. 

Preparations. 
Oleum iEthereum, Ethereal Oil,— is a-volatile liquid, consisting of equal volumes of 
heavy Oil of Wine and Ether. Used to prepare the Spt. /Etheris Comp. As it occurs in 
commerce it is usually a worthless preparation. 



»8 .ETHER. 

Spiritus jEtheris, Spirit of Ether, — has of Ether one-third, Alcohol two-thirds. Dose, 
nHx-Sij, [av. oj.] 

Spiritus -5itheris Compositus, Compound Spirit oj Ether (Hoffmann's Anodyne), — 
has of Ether 32$ per cent., Alcohol 65, Ethereal Oil 2 J. Dose, njv-oij, [av. oj] 

Spiritus jEtheris Nitrosi, Spirit of Nitrous Ether, Sweet Spirit of Nitre, — is an alcoholic 
solution of Ethyl Nitrite, C,H 5 N0 2 , containing not less than 4 per cent, of the latter. It 
turns acid with age, and should not be kept long. It is a constituent of Mist. Glycyrrhizae 
Co. (3 percent.). Dose, njjx-Sij, [av. njxxx.] 

Incompatibles. 

Incompatible with Ether are: Bromine, Chromic Trioxide; with Acetic Ether Alkalies, 
Chlorine Water, Chromic Trioxide, Water; with Ethyl Bromide Alkalies, Water of Ammonia; 
with the Spirit of Nitrous Ether Acacia, Acetanilide, Alkalies, Antipyrine, Carbonates, Ferrous 
Sulphate, Gelatin, Guaiac tincture, Iodides, Morphine, Tannic and Gallic Acids, Piperazin, 
Thymol, Uva Ursi preparations. 

Analogues. 

Chloroformum, Chloroform, and the Chlorinated Ethers, are described under the title 
Chxoroformum. 

Pental, Tri-methyl-clhylene, C 5 H I0 (Unofficial), — is a colorless liquid, highly inflam- 
mable, insoluble in water, but miscible in all proportions with alcohol, ether and chloro- 
form. Sp. gr. 0.678. It is obtained by heating amylene hydrate in the presence of acids. 

Pental is an efficient anesthetic, equal to Nitrous Oxide in its rapidity of action and 
safety, but superior thereto in its more prolonged action and having no unpleasant after- 
effects. Under it there is seldom any stage of exhilaration, and consciousness is sufficiently 
retained to enable response to commands, even when insensibility to pain is reached. It does 
not lose its effect by repeated inhalations. Compared with Chloroform, it acts more promptly, 
and has no evil after-effects; with Ethyl Bromide, it is somewhat slower in action but more 
lasting in effect, and can be prolonged as may be necessary; with Nitrous Oxide, it can be 
continued for a longer time, is more safe, and free from after-effects of unpleasant character. 

Anesthetic Mixtures. 

Nussbaum's has — Ether 3 parts, Chloroform 1, Alcohol 1. 

Vienna General Hospital uses — Ether 9, Chloroform 30, Alcohol 9. 

The Vienna Mixture, — Ether 3, Chloroform 1. 

A. C. E. Mixture, — recommended by the Medico-chirurgical Society of London in 1864, 
consists of Alcohol 1, Chloroform 2, and Ether 3 parts. 

M. S. Mixture, — has of Ether 56J, Chloroform 43^ parts by volume, and is said to be a 
true molecular solution, containing neither of its ingredients free. 

Meyer's Mixture, Anesthol, — has of the M. S. mixture (above) 83, Ethyl Chloride 17 parts 
by volume, and boils ot 104 F. Dr. Meyer considers it a great improvement on the Schleich 
solutions, causing but slight general disturbance, no struggling, infrequent vomiting, rapid 
recovery, and no disturbance of the lungs or kidneys. 

Schleich' s Solutions — are three in number, and are made up'by volume and not by weight, 
as follows: (No. 1), Ether 6, Chloroform 1^, Benzin (Petroleum Ether) J. (No. 2), Ether 
5, Chloroform ij, Benzin J. (No. 3), Ether 2§, Chloroform 1, Benzin £; or Ether 80 Cc, 
Chloroform 30 Cc, Benzin 15 Cc. The latter is adapted to major operations and has a boil- 
ing point of 107. 4 F. 

Physiological Action of Ether. 

Ether is anodyne, antispasmodic, diaphoretic and anthelmintic; a cardiac 
and cerebral stimulant, an anesthetic, and a narcotic poison. Given internally, 
it is a most powerful stimulant of secretion, acting especially on the secretions 
of the stomach, salivary glands and pancreas. On the cerebrum and the motor 
and sensory nerves its action is similar to that of alcohol, but more prompt 
and less protracted. It is eliminated rapidly, chiefly by the lungs. Externally 
it is a powerful refrigerant and local anesthetic; also rubefacient when rubbed 
into the skin. 

Ether when inhaled produces at first faucial irritation, a sense of stran- 



ETHER. 8g 

gulation and cough; then a stage of excitement (cerebral intoxication), in which 
the face is flushed and the respiration and pulse are accelerated. A tetanic 
convulsive stage generally follows, the fate being cya nosed, the muscles rigid, 
and the respiration stertorous. This soon subsides, and complete insensibility 
is established, the muscles being then relaxed, the reflexes abolished, and the 
cerebral functions suspended, the lower centres in the medulla carrying on 
the processes of respiration and circulation. If the inhalation he continued, 
these also become paralyzed, death usually resulting from slow paralysis of res- 
piration, the heart pulsating long after breathing has ceased. If the inhalation 
be discontinued before the lower centres are affected, the patient gradually 
emerges from the condition of insensibility, and, as the narcosis subsides, vomit- 
ing is usually experienced. 

Or. Brunton found that in a hot climate Ether will decompose within a few hours, and 
hence, during his investigations for the Hyderabad Chloroform Committee, he found it im- 
possible to obtain pure ether. This may account for the preference for Chloroform as an 
anesthetic which is so universal in the Southern States. 

Ether is less irritant than Chloroform to the mucous membranes when 
swallowed, but its vapor is more irritant to the air-passages. The one grave 
danger following its administration is the subsequent development of a broncho- 
pneumonia, more rarely a lobar pneumonia. Acute mania has followed its 
inhalation for anesthesia, but only in a few cases. Ether is a cardiac and vaso- 
motor stimulant and raises the blood-pressure; Chloroform is a cardiac and 
vaso-motor depressant and lowers the blood-pressure. Ether has been often 
administered with safety in cases of organic heart disease. It does not clot the 
blood. Its vapor is very inflammable, less pleasant to inhale than that of Chloro- 
form, is slower in action, has a longer stage of excitement, and a less profound 
narcosis, and causes a greater degree of vomiting. It is much less dangerous 
than Chloroform, death from the inhalation of Ether occurring slowly and usually 
by paralysis of respiration — from Chloroform, it is almost always sudden, and 
is generally believed to occur by paralysis of the heart. Ether has undoubtedly 
been the direct cause of a number of deaths, besides several which occurred 
some hours after the termination of its anesthesia; but the sudden deaths pro- 
duced by it have nearly all occurred in patients who had some lung disease or 
some enervating lesion, as intestinal obstruction, tumor of the brain, cancer 
or kidney disease. When bronchitis or renal disease exists Ether is positively 
dangerous. The mortality of ether-anesthesia is about i in 10,000 cases. 

Modes of Dying in Anesthesia. 

(1.) From sudden paralysis of the cardiac ganglia, early in the inhalation, by reflex ac- 
tion proceeding from some peripheral injury before complete anesthesia is produced. Thus, 
in the extraction of teeth, a small quantity of Chloroform having been administered, the 
heart is enfeebled, and the action of the cerebral hemispheres suspended, but not that of 
the basal or medullar}' ganglia. If at this stage the 5th nerve be irritated, by the intimate 
relation of its nucleus with that of the pneumogastric reflex inhibition may be transmitted 
over the latter, arresting the cardiac ganglia. The stage of incomplete anesthesia is always 
a dangerous one in which to perform any operation around the distribution of the 5th nerve. 



go 



.■ETHER. 



(2.) In the stage of rigidity, from tetanic fixation of the respiratory muscles, the blood 
bucking up on the venous side, and arresting the heart's action, respiration ceasing before 
the cardiac action is stopped. 

(3.) In the stage of complete relaxation, by paralysis of respiration; or by paralysis of the 
tongue, causing obstructed respiration. 

(4.) In the same stage, by paralysis of the motor ganglia of the heart. 

(5.) From depression of the functions by chloroform narcosis, and from shock, — and may 
occur in the anesthetic state, or afterwards. 

Contraindications for Anesthesia are: fatty degeneration or dilatation of 
the heart, renal and pulmonary disease, fainting fits, enlarged tonsils, cerebral 
tumor, diabetes mellitus and chronic alcoholism — particularly the first and last 
named. 

Dangerous Symptoms should be met by withdrawing the vapor and invert- 
ing the patient head downward, drawing the tongue forward and applying a 
cold douche to the face and chest. Atropine hypodermically is an agent of great 
value in combating the cardiac failure. Artificial Respiration and faradization 
of the respiratory muscles if breathing ceases. Strychnine, hypodermically, as 
a cardiac and respiratory stimulant, has many advocates, and has done good 
service, especially in chloroform narcosis. Amyl Nitrite by inhalation, or 
Ammonia, hypodermically. Heat to the body and limbs. 

Physiological Action of Other Ethers. 

Hydriodic Ether is an antispasmodic and a general stimulant; also an an- 
esthetic if inhaled for a sufficiently long time. Its use as a medicinal agent 
is chiefly to bring the system rapidly under the influence of Iodine. It increases 
appetite, stimulates the action of the heart, gives vivacity to the general feelings 
and activity to the intellect. 

Ethyl Bromide has a pleasant odor, produces but little irritation of the 
air-passages, has very brief stages of excitement and rigidity, and but a short 
stage of insensibility, with prompt awakening and little of the mental confusion 
and excitement consequent on the use of the other anesthetics. It is not inflam- 
mable, acts quickly, and is a good local anesthetic. Its action in other respects 
corresponds with that of Ether. 

Nitrous Ether is a mild diaphoretic, a diffusible stimulant, a carminative, 
and an efficient diuretic. On the blood it acts similarly to Amyl Nitrite, di- 
minishing oxygenation, relaxing the peripheral vessels, accelerating the heart's 
action, and lowering arterial tension. Relaxing the renal and cutaneous 
sels, it is diuretic and diaphoretic. 

Acetic Ether has a pleasant odor and taste, forming agreeable combina- 
tions with other carminatives as a stimulant and antispasmodic. 

Comparative Safety of Anesthetics. 

A comparison of these agents in respect to their safety has been made by Dr. Richardson, 
who considers Methyl ic Ether to be the safest of all, and the others as follows: 

Safe are — Ethyl Bromide, Ethyl Chloride, Ether, Ethene (defiant gas), Ethene Chloride, 
Methyl Bromide, Methyl Chloride, Methene Chloride, Methane (marsh gas), Nitrous Oxide. 

Of doubtful value are — Amylene, Amyl Chloride, Butyl Chloride, Benzene (benzol), 



ETHER. (,i 

Carbon Disulphide, Carbon Dioxide, Carbon Tetrachloride, Methyl Alcohol, Meth 
Spirit of Turpentine. 

Dangerous are — Amy] Hydride, Butyl Hydride, Carbon Monoxide, Ethyl Hydride. 
Chloroform and Ethene bichloride are considered useful, hut requiring care. 

TllKRAl'KUTK'S. 

When diluted with alcohol Ether mixes readily with water, and may be 
administered internally with advantage in indigestion of fats, and to aid the 
digestion of cod liver oil. It is given in hysteria to relieve the paroxysm and 
flatulence, and in hepatic colic from calculi, Ether with Turpentine (I)urande's 
solvent remedy), which acts only as an anodyne and antispasmodic, is con- 
sidered valuable by some authorities. Subcutaneously Ether is used in the 
algid stage of cholera, sudden cardiac depression, neuralgia, and in the ady- 
namia of hemorrhage, pneumonia and the eruptive fevers. Local anesthesia 
by the Ether spray affords great relief in neuralgia of superficial nerves, lum- 
bago, chorea, and spinal irritation. In minor surgical operations this is a val- 
uable method. 

As a General Anesthetic the vapor of Ether is less prompt in action than 
that of Chloroform, but is equally efficient and much safer. It should be in- 
haled in as concentrated a form as possible, and will then produce insensibility 
in from 5 to 10 minutes. It is the safest and most reliable anesthetic for major 
operations requiring complete relaxation and the expenditure of considerable 
time, and being the least depressant of all anesthetics should be preferred when 
shock is liable to be a prominent feature of the case. If a light be in the room 
it should be high above the patient, a grate-fire or gas-stove in the vicinity is 
very dangerous. [Compare the article on Chloroform.] Besides its surgical 
uses ether-anesthesia is employed in neuralgia, cancer, tetanus, chorea, colic, 
delirium, puerperal mania and convulsions, infantile convulsions, hystero-epilepsy, 
epileptic seizures, laryngismus stridulus, whooping-cough and asthma. The un- 
pleasant after-effects may be greatly modified if not entirely prevented by the 
previous administration of Morphine, gr. ■£-£, and Atropine, gr. tt$, subcuta- 
neously. It is contraindicated in cases of asthma, chronic bronchitis, advanced 
pulmonary tuberculosis, and marked arterio-sclerosis. 

Schleich's Method is based upon the theory that the safest general anesthetic is one which 
has a maximum evaporation point slightly above the body-temperature of the patient, 
so that its elimination by the lungs during each act of expiration may be nearly, but not quite, 
as much as its absorption during the previous act of inspiration. Such an anesthetic is ob- 
tained by mixing Ether, Chloroform and Benzin in various proportions, the result giving 
true chemical solutions (mixtures according to some chemists), the evaporation points of 
which may be varied at the will of the anesthetist and adapted to the patient's body-tempera- 
ture at the time of administration. Experience has however disproved the claims made for 
these solutions, cases of deep cyanosis, excessive vomiting, broncho-pneumonia, albuminuria, 
and alarming conditions of the respiration and circulation having frequently occurred under 
their use. 

Hewitts Method, which is preferred in England, is to administer nitrous oxide gas first 
and follow with ether in a closed inhaler. This method is rapid and safe, the preliminary 
choking sensation of ether is avoided, and unconsciousness is quickly produced. 

Ethyl Bromide had a short period of popularity as an anesthetic, but fell 
into disrepute after a few cases of death under its influence, which were prob- 
ably not due to the agent used (Levis' and Sims' cases). Its action is less pro- 



g2 AGARICUS ALBUS — AGARICUS MCSCARIUS. 

longed than that of Ether, but it has many advantages, being non-inflammable, 
acting rapidly in small quantity, and being comparatively free from ill effects. 
It may be used as a primary inhalation before the use of ether, a method of 
inducing anesthesia which has given good results in many cases, being free from 
bronchial irritation, requiring less ether to maintain the effect than when ether 
is given alone, having less intoxication and muscular excitement, less tendency 
to vomiting, and a more rapid return to consciousness. It is considered an 
excellent anesthetic in obstetrics and gynecology, its inhalation has proved 
useful in hysteria, epilepsy, chorea and other spasmodic disorders; and it has 
been employed subcutaneously in place of Ether in the treatment of spasmodic 
affections such as whooping-cough and chorea. 

The Compound Spirit of Ether is an admirable agent in gastralgia, colic, 
flatulence, and syncope, also in the various paroxysms of hysteria. In com- 
bination with the camphorated tincture of opium it is often remarkably efficient 
in checking the simple diarrhea of hot weather. 

Spirit of Nitrous Ether is used as a diaphoretic, a diuretic and a carmina- 
tive; also in expectorant mixtures, as an antipyretic in febrile affections, and 
to relieve pain in angina pectoris, dysmenorrhea and asthma. When its diuretic 
effect is desired it should be administered in iced water, and the patient should 
be lightly covered: but when its diaphoretic action is required, it should be 
preceded by a hot drink, and the patient should be well covered. 

Hydriodic Ether may be obtained in glass capsules containing five minims 
each, and is used by inhalation in chronic pulmonary disorders, cardiac dyspnea, 
spasmodic affections of the bronchi and larynx, asthma, and catarrhal laryngitis. 
It is not employed as an anesthetic. 

AGARICUS ALBUS, White or Purging Agaric (Unofficial), — is the fungus Polyporus 
officinalis, which grows upon the European larch. It occurs in large, white, spongy pieces; 
and contains Agaricic or Laricic Acid, also from 40 to 70 per cent, of resins. The term 
Agaricin was formerly appled to the impure Agaricic Acid containing about 3 per cent, of 
Agaricol, which is physiologically inert. 

The taste of Purging Agaric is first sweetish, then becoming very acrid and bitter. The 
powder inhaled causes violent sneezing, and taken internally in full doses it produces watery 
stools. Small doses check diarrhea and dysentery, and diminish the secretions of the bronchi 
and mammae. 

Agaricus Albus was formerly employed as a drastic purgative, in doses of gr. xxx to oj- 
It has been used with much success, in 15-grain doses of the powder, or 3 grains of the alco- 
holic extract, to check the night-sweats of phthisis. Agaricic Acid has proved very valuable 
in checking persistent sweating from any cause, especially that occurring after influenza. 
The dose is gr. yV to \; it should not be given hypodermicaily. 

AGARICUS CHIRURGORUM, Surgeons' Agaric (Unofficial),— is the interior 
portion of the fungus Polyporus jomenlarius, which grows on the trunks of beeches, birches, 
and oaks in Europe. It is prepared for use by boiling in weak lye and beating with mallets, 
and then occurs in light, thin, yellowish-brown pieces, soft and pliable, without odor or taste. 
It is almost pure cellulose. It was formerly used as a mechanical hemostatic, and for the 
purpose of moxa. When soaked in a strong solution of the Nitrate or Chlorate of Potassium 
and dried, it is very inflammable, and is called Spunk. 

AGARICUS MUSCARIUS, Amanita Muscaria, Fly-Agaric (Unofficial),- 
is a poisonous mushroom, of disagreeable odor and burning acrid taste, used 



ULANTHTJS. 93 

iii infusion with milk for poisoning flies, and by the Tartars as an intoxicant. 
It contains an actively toxic alkaloid, Muscarine, CjH^NO,, of syrupy con 
sistence, odorless and tasteless, soluble in water and alcohol, and readily dis 
solved out by water and dilute acetic acid, so that a doubtful mushroom may 
be easily rendered innocuous. Muscarine is produced synthetically by the 
oxidation of choline, but it is doubtful whether the article so prepared is as active 
as the natural alkaloid. 

Muscarines Nitras, Muscarine Nitrate (Unofficial), -a viscid, yellowish-brown liquid. 
Dose, gr. ,,',,-,',•, (Merck); gr. ', i (Ringer). It may be used hypodennically. 

Incompatible physiologically with Muscarine are Atropine, Digitalis, Physostigmine. 

Vine exactly opposes it, and vice versa; no example of physiological antagonism being so 
complete in all particulars. 

Physiological Action and Therapeutics. 

Agaricus acts as an intoxicant to the cerebrum, producing more vertigo 
and delirium than Alcohol, followed by profound sopor with lowered reflexes, 
perhaps coma and death. The action of Muscarine is very like that of Pilo- 
carpine and almost completely opposed to that of Atropine. It is a powerful 
respiratory and cardiac depressant, paralyzing the respiratory centre and ar- 
resting the heart in diastole by depressing the motor ganglia while stimulating 
its inhibitory apparatus. It lowers the arterial tension, produces profound 
salivation, lachrymation and sweating, contracts the pulmonary vessels, causing 
intense dyspnea, and increases the intestinal, hepatic and pancreatic secretions, 
but markedly diminishes the renal. It disturbs the gastro-intestinal tract, 
causing tetanic intestinal contractions, severe colic, vomiting and purging. 
It produces spasm of the accommodation and contraction of the pupil when 
u'iven internally, but dilates the pupil widely when locally applied. [Gelse- 
mium does so also.] Under its action the body-temperature is decidedly reduced, 
and the excretion of waste-products is lessened. It is eliminated unchanged 
by the kidneys. 

Muscarine has been as yet little used in medicine, but it will probably prove 
to be a valuable drug. It has been employed, with marked benefit, for the night- 
sweats of phthisis, given in doses of 5 minims of a one per cent, solution, hypo- 
dermically. It is of value in inflammation characterized by copious exudation, 
especially eye-inflammations, catarrhal jaundice, recent hemorrhoids, acute 
bronchitis, pulmonary hemorrhage, incipient pulmonary congestion, diabetes 
of both forms, and in constipation due to intestinal torpor and deficient secre- 
tion, accompanied by a torpid liver and difficult digestion of fats. In the lat- 
ter affection it should be given in small doses, gr. ^, thrice daily. A tincture 

Vgaricus has been found beneficial in ataxic typhus, chorea and chilblain. 

AILANTHUS, Tree of Heaven (Unofficial), — is the bark of Ailanthus glandulosa, a 
well-known shade tree, of the nat. ord. Simarubaceae, indigenous to China, but cultivated 
elsewhere. It contains an oleo-resin and a volatile oil, on which its properties probably de- 
pend. Dose, gr. x-5j. 

Fluidextractum Ailanthus, Fluidextract of Ailanthus (Unofficial), — Dose, njx-5j- 



94 ALBUMIN AND ALBUMINOIDS. 

Tinctura Ailanthus, Tincture of Ailanthus (Unofficial), — Dose, nsx-3ij. 

Ailanthus is a decided nauseant, and a drastic purgative, causing also vertigo, weakness, 
cold sweats, dull headache, pains in the back, numbness and tingling in the limbs. It para- 
lyzes the cerebrum and spinal cord of animals, impairment of motility beginning in their 
liind extremities. The cardiac action, at first increased, soon slows, the pulse becoming 
small and weak, and the respiration depressed, death occurring from paralysis of respiration. 
It is a good teniafuge. _ 

Ailanthus is used against tapeworm, a decoction of the fresh bark (5j to oiv), or the 
oleo-resin in drachm doses, being very efficient. It has been well employed in malignant 
scarlatina, with dark and partial eruption, insensibility, delirium and other cerebral symp- 
toms. 

ALBUMIN AND ALBUMINOIDS.— Albumin (albumen) is the typical 
member of a group of organic proximate principles which have the same gen- 
eral chemical composition but very different physical properties, and are called 
albuminoids, proteids, or nitrogenous principles. They all contain N, together 
with C, O, H, and Sulphur. The chief members of the group are Albumin, 
Fibrin and Casein, often termed the histogenetic bodies, because they are essen- 
tial to the building up of the animal organism. They are each resolved by 
caustic potassa and heat into Protein, which may then be thrown down by acetic 
acid. The albuminoids are originally formed in the vegetable kingdom, occur- 
ring in all parts of plants but especially in their seeds. When eaten by animals 
they undergo digestion into soluble compounds (peptones), which pass into the 
blood and are retransformed into serum-albumin before being built into the 
tissues. Albumin is the most important member of the group, as it forms the 
principal portion of all animal tissues, varying from i part per iooo in the cere- 
brospinal fluid to 383 per 1000 in the crystalline lens. The composition of 
its molecule is very complex and varies widely within certain limits in different 
organs and conditions, but C 72 22 H 112 N 18 S is given as its approximate formula. 

Albumin is amorphous, soluble in water, coagulated by heat, and occurs in three native 
forms, viz. — (1) Serum-albumin, which is yellow, elastic, transparent, soluble in water 
but precipitated by alcohol and by strong acids, and coagulated by heat at 104 F. (2) Egg- 
albumin, differs from the first by precipitating when shaken with ether, and in other respects. 
It is soluble in water and coagulated by heat. (3) Plant-albumin, occurs in nearly all vege- 
table juices and especially in the seeds of plants. It is coagulated by heat and strongly re- 
sembles egg-albumin. 

Incompatible with Albumin are: Acetic Acid (with heat), Alcohol, Alum, Ammonium 
Sulphate, Camphor, Coniine, Collodion, Copper Sulphate, Ether, Ferric Chloride, Heat, 
Hydrogen Peroxide, Lactic Acid, Mercuric Chloride, Metallic Salts, Metaphosphoric Acid, 
Mineral Acids, Phenol, Picric Acid, Tannic Acid, Thymol, Volatile Oils. 

Gelatinum, Gelatin — is a derivative of the proteids ossein and collagen, 
and is obtained from bones, tendons, cartilage, skin, and other fibrous animal 
structures, by prolonged boiling in water. It swells up in cold water, is soluble 
in boiling water, and its aqueous solution solidifies (gelatinizes) on cooling. 
Its composition is similar to that of albumin but it does not yield protein. Gelatin 
is the basis of soup, beef-tea, and other preparations made from meat with boil- 
ing water. 

Gelatinum Glycerinatum, Glycerinated Gelatin, — is composed of equal parts of Gelatin 
and Glycerin. 

Ichthyocolla, Isinglass, (Unofficial), — the swimming-bladder of several species of stur- 



Aim \u\ \\i> \i Bl \ii\oips. OS 

neon, occurs in horny, semi-transparent sheets, iridescent, soluble in 'i ol boiling water, and 
forms on cooling .1 transparent jelly. Ii is the purest form of Gelatin known. 

Emplastrum Ichthyocollse, Isinglass Plaster, Court Plaster, (Unofficial),— consists of 
Isinglass to, Glycerin i, Alcohol i-\ Water and Tincture of Benzoin, spread on taffeta and 
allowed to dry. 

Incompatible with Gelatin are: Alcohol, Alumnol, Chlorine water. Ferric salts, For- 
maldehyde, Mercuric Chloride, Metaphosphoric Acid, Picric Acid, Platinum Chloride, 
Potassium Ferrocyanide, Tannic Acid, Tartar Emetic. 

Chondrus, {Irish Moss, Carragheen) — is a sea-weed, Chondrus crispus, 

dried and bleached. It contains mucilage 55I, water 19, mineral matter 14, 

albuminoids o£, and cellulose 2 per cent. A jelly may be prepared by boiling 

. in a quart of water for an hour, then straining and adding 3 oz. of sugar 

while hot. The dose is indefinite, [av. ,,iv.] 

Irish moss is horny, translucent, pale yellowish-white, of sea-weed odor, and mucilag- 
inous saline taste. It swells in cold water but does not dissolve. On boiling with 30 parts 
of water for 10 minutes it yields a solution which gelatinizes on cooling. It is a demulcent 
and nutrient of some slight value in bronchial and catarrhal affections; but as it contains no 
Starch it is not as valuable as Iceland Moss (Cetraria) as a food for the sick. [See under 
the title Amyi.cm.] Another member of the Algae is the Fucus Vesiculosus, which is described 
under its own title. 

Unofficial Analogues 0} Albumin. 

Fibrin is the proteid which causes the clotting of plasma, lymph, and the 

blood when shed. It does not exist in the living, circulating blood, but is formed 

by the mutual action of fibrinogen, fibrino-plastin and fibrin-ferment, which 

arise as products of the breaking up of white blood-corpuscles. In normal 

blood it occurs to the extent of 0.2 per cent., is increased in inflammation and 

diminished in hemophiles. 

Fibrin has the same general composition as albumin but contains more O and S. Its 
ial characteristic is its power of spontaneous coagulation. It is insoluble in water and 
in ether, and is changed into syntonin (acid-albumin) by dilute hydrochloric acid. 

Casein is the proteid contained in milk. Its composition is the same as 
that of albumin, but it differs therefrom in not being coagulated by heat and 
by being thrown down by organic acids which do not precipitate albumin. 
It is. by some authorities, supposed to be a combination of albumin and potash. 

Gluten is a nitrogenous constituent of the seeds of wheat and other cereals, 
the former containing it in the proportion of from 8 to 15 per cent. It is made 
up of a number of albuminous principles which differ but slightly from each 
other, the chief ones being gluten-fibrin, gluten-casein, gliadin and mucedin. 

Unofficial Albuminous Preparations. 

Albumen Ovi, Egg-albumen, — the liquid white of the egg of the domestic 

hen, was official in the B. P. It contains 12 per cent, of albumin, with 3 of mucus 

and salts, and 85 of water. 

Many writers use the spelling albumen for the name of the proximate principle albumin. 
Others distinguish between the white of egg (albumen) and its chief constituent (albumin). 

Vitellus, Yolk 0} Egg, — is the yolk (or yelk) of the hen's egg, and occurs 
5 a viscid, reddish-yellow, opaque liquid, of bland taste and alkaline reaction, 



96 ALBUMIN AND ALBUMINOIDS. 

coagulated by heat and by alcohol. It may be regarded as a dense emulsion 
of oil suspended in water by means of albumin. It contains, in ioo parts, vitel- 
lin 16 to 18, cholesterin 0.4, lecithin 7, fat 21 to 31, also salts, etc., and from 
48 to 55 of water. Vilellin is described as a mixture of albumin and casein 
(Fowne), or as a proteid related to casein mixed with about one-fourth of al- 
bumin (Nat. Disp.). 

Glyceritum Vitelli, Glycerite oj Yolk oj Egg, Glyconin (Unofficial), — consists of Yitellus 
i.5, Glycerin 55, rubbed together until thoroughly mixed. 

Beef, among meats, has the highest nutritive value. The average of many 
analyses shows its composition to be as follows: In 100 parts, total albumin- 
oids 2of, fat 2f, extractives i£, salts x\, water 73^, also a minute quantity of 
creatin. 

Extracts of Meat prepared by boiling down the flesh of animals, as Liebig's Extract, 
are stimulants, not nutrients, as they contain practically none of the nutritious (albuminous) 
constituents of meat but only the salts and flavoring matter (E. Smith). 

Meat-juices, prepared by a cold process of extraction and partial digestion, are claimed 
to retain the fibrin, gelatin and coagulable albumin. Many such are on the market, under 
the trade-names Bovinine, Bovril, etc. 

Chittenden, by analyses of various meat extracts, has shown that they possess very little 
nutritive value as compared with fresh lean beef. In most of them the fat is less than 1 per 
cent., and the total amount of available proteid is far below 1 per cent. Some are even less 
nutritious than ordinary beef-tea. 

Beef Peptonoids is the trade-name of a powdered preparation which is claimed to con- 
sist of the nutritive constituents of beef with milk and wheat gluten, partially peptonized and 
containing 95 per cent, of nutritious material. Liquid Peptonoids is intended to represent 
the same combination in liquid form, all the constituents being entirely digested and ready 
for assimilation. Panopepton is a similar preparation. 

Sanose is a food preparation which is claimed to contain 100 per cent, of albuminous 
material, of which 80 is casein and 20 is albumose. 

Somatose is a dry powder, which is said to contain nearly 90 per cent, of albumoses, 80 
grains corresponding in nutrient value to about 1 \ ounces of fresh beef. 

Milk contains all the elements necessary for the growth and nutrition of 
animal tissues in the most digestible form. Its chief albuminoid constituent 
is Casein, but it also contains fat, sugar, salts and water, which vary in pro- 
portion according to the animal and its food. Cow's Milk, of sp. gr. 1.030, 
averages, in 100 parts, of albuminoids 4, fat 4, sugar 5, salts £, and water 86£. 
Goal's Milk is very near to that of the cow in composition, but Asses' Milk 
has much less of casein and salts, very little fat, and more sugar and water. 
Woman's Milk contains about the same proportion of casein as asses' milk, 
more fat than cow's milk, more sugar than the others, and less salts than any 
except asses' milk. 

Buttermilk contains, in 100 parts, casein 4J, sugar 2\, fat \, salts \, lactic acid \, and 
water 92. 

Condensed Milk is prepared by adding refined sugar and an alkali to fresh cow's milk, 
then evaporating the mixture in vacuum pans until it has a thick, semifluid consistency. 
Desiccated Milk occurs in the form of a dry powder, and is highly esteemed in the armies of 
Europe. 



u i;r\n\ \\i> \i BUMINOIDS. 97 

Peptonized Milk is prepared by adding to fresh cow's milk one-third pari of water, 

in which, after boiling and cooling, there is dissolved n pinch of Sodium Bicarbonate, and 

3ij of Liquor Pancreaticus is added to each pint. The mixture is then allowed to 

stand in a warm place for an hour, when ii is ready for use. Peplogenic Mill,- Powder, 

tuning the requisite proportions of the alkali and the pancreatic ferment, may be obtained 
in tin' drugstores and will prove satisfactory. 

Cheese is obtained from the milk of animals, especiallj the cow, by coagulating the 
in by means of rennet or an acid, and after separation submitting it to pressure. It con 
tains, in 100 parts, albuminoids (casein, etc.) 28 to 45, fat 6 to 30, salts a to 5, and water 36 to 
u; the proportions of each varying according to the quality of the milk used. 

Kumyss, Koomiss, — is an effervescing fermented liquor originally prepared 
by the Tartars from mare's milk, but now imitated with cow's milk by adding 
sugar of milk, fermenting in open tanks, skimming off the casein and butter, 
then bottling during active fermentation. Its successful preparation depends 
on its undergoing slow fermentation for 5 to 10 days in a cold room, at 40 F. 
If the temperature be higher than 50 the fermentation will be of the acetous 
variety, and will result in sour milk with heavy curd, feeble effervescence and 
repulsive taste. 

Wolff's Formula, for its preparation in small quantity, is as follows: — Dissolve 3ss 
(a tablespoonful) of grape sugar in oiv of water. Dissolve gr. xx (a teaspoonful) of Fleisch- 
mann's compressed yeast or well washed and pressed out brewer's yeast in 5ij of cow's milk. 
Mix the two solutions in a quart champagne bottle, and fill it within two inches of the top 
with good cow's milk. Cork well, secure the cork with wire, keep it in a cellar or ice chest, 
maintaining a temperature of 50 F. or less, and agitate twice daily. In three or four days 
it is ready for use, but should not be kept longer than four or five days. Draw it with a cham- 
pagne tap. 

Kumysgen is a powder containing the elements necessary for the preparation of Kumyss, 
for which a special bottle and tap are also furnished by the manufacturers. It is a very con- 
venient manner of making this preparation, and the product tastes just as well as that made 
in the ordinary way. Whether it acts as well dietetically remains to be ascertained. 

Kefir is the name of a fermented drink prepared from the milk of a cow or mare by the 
addition of a mushroom-like ferment found near the snow-line in the Caucasian Mountains. 
It is used by the natives of the Asiatic plains as a remedy for struma, anemia, lung and stomach 
diseases. Kefir is richer in albuminoids than Kumyss, is less alcoholic and less acid. 

The following table shows the average composition of Milk, Kumyss and Kefir: — 

Cow's milk. Kumyss. Kefir. 

Albuminoids (casein, etc.), 4 1 4 

Butter, 4 2 2 

Sugar of milk 5 2\ 2 

Lactic Acid, - — 1 1 

Alcohol, — x\ 1 

Water and salts, 87 92 90 

Physiological Action. 
The normal adult human organism, doing ordinary work, loses daily by 
its metabolism 4^ oz. of albuminous or proteid matter, besides 14-2 oz. of carbo- 
hydrates, 3 oz. of fat, 1 oz. of salts and 2 \ quarts of water, these quantities being 
largely increased during the performance of laborious work. A correspond- 
ing amount of these substances must be daily ingested in order to supply material 
for the repair of the tissues and for the production of heat and other forms of 
force. The albuminoids are most important alimentary principles, their chief 



> 



> 



98 ALBUMIN' AND ALBUMINOIDS. 

office being the repair of the tissues, they being the only foods containing nitro- 
gen, an essential element in the formation of every structure which manifests 
any form of energy. They can replace each other in supplying nutrition to the 
tissues, their composition is identical with that of the same substances in the 
blood and other tissues, and they consist wholly of nutritive material in concen- 
trated and digestible form. They undergo digestion in the stomach by the acid 
gastric juice, also in the intestine by the pancreatic juice, the respective ferments 
of which convert them into soluble peptones, the form in which they enter the 
blood. The digestive changes through which they pass are — (1) proieid, the 
albuminoid, as ingested; (2) acid-albumin or syntonin in the stomach, alkali- 
albumin in the intestine; (3) propeptone or hemialbumose; and (4) peptone. 
The chief products arising from their oxidation within the body are C0 2 , H 2 
and urea, the latter containing nearly all their nitrogen. They are mainly 
obtained by the ingestion of animal food, as flesh, milk, eggs, etc., but they are 
also contained in vegetable products, especially the seeds of certain plants, 
those of leguminous plants (peas, beans, lentils,) containing more proteid ma- 
terial than any kind of meat. 

The increased ingestion of albuminoid food, by persons who have previously 
used it sparingly, improves the quality of the blood by increasing the number 
of the red corpuscles, and causes a rise in the sp. gr. of the urine and a greater 
excretion of urea and uric acid. Individuals who consume albuminoids in ex- 
cess of their requirements are lean but muscular, irritable in temper and prone 
to excessive sexual appetite. The exclusive use of animal food develops a super- 
abundance of muscular force, so that a nation of meat eaters is usually one of 
hunters possessing a warlike and savage disposition. 

Disease may be produced by food of any kind through excess or deficiency 
in quantity, special characteristics of quality, or imperfect digestibility. Al- 
buminoid food in excess produces congestion and enlargement of the liver and 
probably other organs. If exercise is not taken at the same time, the albumi- 
noids are imperfectly oxidized, and deleterious products are retained in the system, 
or the eliminating organs are irritated by the passage through them of material 
which they are not adapted to remove. A great excess of albuminoids, with- 
out other food, produces in a few days marked febrile symptoms, malaise and 
diarrhea; and if persevered in albumin appears in the urine. Gout probably 
arises in the same way, partly from the use of alcohol, which delays metamor- 
phosis, partly from using too much albuminoid food, and partly from want 
of exercise. A diet which is deficient in albuminoids causes a lessening of bodily 
activity and the gradual oncome of an adynamic condition which predisposes 
the subject to infectious diseases and modifies the course of many affections, 
typhoid fever running its course in such cases with less elevation of temperature 
than is usual and with less excretion of urea. Complete deprivation of albumi- 
noids produces loss of muscular strength, mental debility and feverish and dys- 
peptic symptoms, followed by anemia and prostration. 



M.IU'MIN AMI \l l.l MINOIPS. no 

The advantages of a meal diel are:— its large amount of nitrogenous ma- 
terial, the presence in ii of iron and important salts, and also much fat, the 
latter performing to great extent the office of the carbo hydrates in supplying 

fuel to the body. It is easily cooked, is very digestible whether raw or cooked, 
and is more readily assimilated than any vegetable food. Its great disad\ 
tage is that it contains neither starch nor sugar, hence it cannot supplv all the 
carbon needed by the body unless so large a quantity of it be taken (4^ lbs. 
of beef daily) as would soon impair the digestive organs. 

Beef contains alimentary principles which are most important for the nu- 
trition of the body. When of good quality, neither too old nor too young, hav- 
ing the fat and muscle suitably proportioned and unaltered by disease, and 
properly cooked, it is the best of the animal foods. 

Milk is an excellent albuminous food, but its proteid, casein, is coagulated 
by the acids in the stomach, even by the acid of the gastric juice, and is tolerated 
with difficult} - by many persons, especially in the large quantity which must 
be taken to itself maintain the nutrition of the organism. As an exclusive diet, 
for anyone above the infant age, it soon palls upon the appetite, and causes a 

se of emptiness at the epigastrium, a coated tongue and an unpleasant taste 
in the mouth. The subject of an exclusive milk diet is usually constipated, 
the stools being hard and of ochre-yellow color, but if diarrhea is produced it 
shows that the milk is not digested. The urine is greatly increased in quantity 
and the body-weight is gradually diminished to a certain point, where it remains. 
The pulse is quickened at first and arterial tension is lowered, but the pulse- 
rate falls as soon as the body ceases to lose weight. A sense of weakness is 
usually experienced, but many persons are greatly debilitated and some com- 
plain of vertigo. 

Kumyss has an acidulous and peculiar taste. In large quantity it can 
take the place of other food for a time, each quart equalling 4 oz. of solids. It 
is a powerful diuretic, especially in cold weather, and in warm weather it causes 
free perspiration. It is stimulant and tonic, increases the nutrition of the body 
and produces considerable somnolence. The stomach tolerates it well, even 
when it rejects all other food. It is easily assimilated and very nutritious. 

Eggs, like milk, constitute an almost complete food, as they contain all 
the elements required by the blood. According to Pavy an egg weighing 2 
oz. has no grains of albuminous material, 82 grains of fat and n grains of saline 
matter. The white, consisting chiefly of albumin dissolved in water, contains 
the larger proportion of nitrogenous material, and the yolk contains the greater 
quantity of fat. 

Gelatin is undoubtedly a food, as it increases vital action in the same direc- 
tion, if not in the same degree, as albumin (E. Smith). Like albumin, however, 
it must not be relied on alone, but should be mixed with a proper quantity of 
)ther foods. It is an efficient styptic and hemostatic. 



ioo albumin and albuminoids. 

Therapeutics. 

The chief affections in which nitrogenous food is required are diabetes mel- 
litus, anemia, obesity, phthisis and other wasting diseases, and long-continued 
fevers. In fever there is an excessive consumption of the proteids of the body 
and the eliminative processes are very active, the discharge of urea being often 
enormous. All this increases the demand of the organism for albuminoid food, 
but the digestive power of the stomach is, at the same time, greatly reduced, 
the secretion of gastric juice being diminished. In carcinoma of the stomach 
and some other affections hydrochloric acid is absent from the gastric juice, 
and in manv diseases gastric digestion is feeble or imperfectly performed. Hence 
it becomes important to furnish albuminoid foods in such form that they may 
be assimilated with the least possible expenditure of digestive energy. Pep- 
tones can be prepared outside the body and administered as food, but when 
artificially made they have little nutritive value, are unable to supply the need 
of the organism and are exceedingly disagreeable to the patient. Albumoses, 
the intermediate products, are readily absorbed, and being free from taste and 
not causing digestive troubles they are suitable foods for invalids and for sub- 
jects of weak digestion. 

Raw beef, scraped to a pulp, freed from fat and seasoned with salt and 
pepper, is used in the treatment of chronic diarrheas, also in debilitated con- 
ditions from any cause wherein it becomes necessary to administer an easily 
digested nitrogenous aliment. Its chief objection is the liability of tape-worm 
following the use of uncooked meat. Beef-tea, when made with boiling water, 
contains less than one per cent, of gelatin, the only nutritive principle yielded 
by meat to a hot aqueous solution. The other extractives obtained by boiling 
(creatin and creatinin) are simply effete muscular material on the way to the 
formation of urea. Hence beef-tea, bouillon and similar preparations of meat 
contain little except stimulating salts and are almost wholly devoid of nutritive 
properties. Cold drawn infusions of meat have considerable food value, as 
they contain much albuminous material. 

Blood is rich in nutritive elements and has been much employed as a food 
in wasting diseases, especially phthisis, the subjects of which often resort to 
slaughter-houses to drink the fresh blood of animals. The result is that the 
nutrition is improved, often to a remarkable extent, but the practice is open to 
the danger of the patient swallowing parasites. 

Albumen Ovi (white of egg), besides being a valuable food, is used in medi- 
cine as an antidote in poisoning by corrosives and irritants, especially corrosive 
sublimate, copper sulphate, silver nitrate and the lead salts. Shaken with alum 
it coagulates and forms the so-called Alum Curd, which is highly esteemed as 
an astringent and cooling application in acute conjunctivitis, also for burns 
and erysipelas. White of egg, diluted with water, sweetened and flavored, 
forms an agreeable and nutritious drink in gastritis. It is spread on silk or 



Al.iu \n\ \M> \i 1:1 MINOEDS. 101 

gold-beater's skin to make an adhesive plaster, which only requires moistening 

before application. 

Yolk of Egg is more nutrition'- and digestible than the white, and is highly 
esteemed in dyspepsia. The yolk of a hard boiled egg crumbles easily and 
is readily acted on by the gastric juice. It is a useful article of diet in exhausted 
conditions of the system, but its chief use in medicine is for emulsionizing oils 
and camphors. The Glycerite has the consistence of honey and forms an 
opaque emulsion with water. It is a good vehicle for cod liver oil, and an ex- 
cellent protective application for burns, erysipelas, fissure of the nipples, and 
many cutaneous disorders. It is used as a cosmetic, and may be employed 
a- an aliment. 

Gelatin is somewhat nutritious, but is usually employed as the basis of 

flavored jellies, which are esteemed rather as delicacies than as foods. It is 

highly praised as a styptic application in epistaxis and other hemorrhages. 

A normal saline solution containing 2 per cent, of gelatin is successfully used 

hypodermically or by rectal injection in hemoptysis, hematuria, and purpura 

hemorrhagica; while daily doses of §vj of a 10 per cent, solution internally have 

given satisfactory results in hemophilia. It has been efficiently used subcuta- 

neously by Lancereaux and Osier in the treatment of aneurisms, 250 Cc. of a 

1 per cent, solution in normal saline solution being injected every other day 

.-lowly into the thigh or abdominal wall. Isinglass has no advantage over any 

other form of gelatin. It is used for clarifying liquids and in solution as a test 

for tannic acid. The plaster, commonly called court-plaster, is a useful protective 

I for cuts, sores, etc. 

Milk is the only proper food for infants up to the age of eight months,"their 

digestive organs being unable to manage the farinaceous aliments. For those 

who are deprived of their natural milk the best substitute is cow's milk diluted 

ith about one-third part of water and sweetened with sugar, which should 

given at a temperature of ioo° F. and at intervals of about three hours. The 

lion of lime-water instead of ordinary water will make it more digestible. 

in exclusive diet for older children and adults, milk is employed with great 

.lit in many gastric and intestinal disorders; also in albuminuria, diabetes, 

-cites, anasarca, eczema, gout, aneurism, and in irregular and tumultuous 

liac action due to valvular disease of the heart. Skimmed milk is better 

borne than unskimmed milk in many affections of the gastro-intestinal tract. 

Milk is the one food available in typhoid fever and may be wholly depended 

s aliment in that disease. It is especially useful in scarlet fever, both as a 

utrient and a diuretic. In intestinal indigestion, cholera morbus, cholera 

fantum, and the ileo-colitis of children, it is necessary to supply only such 

3 are digested in the stomach, in order to give the intestine rest, hence 

milk, eggs, meat-juices and meat-broths are the suitable articles of diet in these 

• 

Buttermilk contains lactic acid, which does not exist in ordinary milk, hence 



102 ALCOHOL. 

it is more easily digested than the latter. It is particularly useful in gastric 
disorders, albuminuria and diabetes. 

Kumyss is an invaluable article of diet in many wasting diseases, especially 
phthisis. It is of great benefit in dyspepsia, the diarrheas of children, con- 
valescence from acute maladies, chronic affections of the kidneys, and other 
cachexia;. In cases of feeble digestive power an ounce every hour is sufficient, 
but as its digestion and assimilation increase it may be given almost ad libitum, 
and when used with other food a half-pint may be taken after each meal. Each 
quart is estimated to contain four ounces of solid food, besides from i to 3 per 
cent, of alcohol. 

ALCOHOL, Alcohol, Ethyl Alcohol, Ethyl Hydrate, C 2 H 5 OH. The offi- 
cial alcohol is Ethyl Alcohol, which is represented in the pharmacopoeia by the 
several preparations named Brandy, Whisky, and Wine, as also under the fol- 
lowing three forms, viz. — 

Alcohol Absolution, Absolute Alcohol, C 2 H 5 OH, — is Ethyl Alcohol, con- 
taining not more than 1 per cent, by weight of water. A transparent, inflam- 
mable, colorless, mobile and volatile liquid, very hygroscopic, of characteristic, 
agreeable odor, and burning taste. Sp. gr. not higher than 0.797 at 59 F. 
Used in the manufacture of Chloroform. 

Alcohol, — a liquid composed of about 92.3 per cent, by weight, or 94.9 
per cent, by volume, of Ethyl Alcohol, and about 7.7 per cent., by weight, of 
water. It is a transparent, inflammable, colorless, mobile and volatile liquid, 
of agreeable odor and burning taste, sp. gr. 0.816 at 6o° F. It is miscible with 
water in all proportions and without any trace of cloudiness; also miscible with 
ether or chloroform. Obtained by the distillation of fermented saccharine 
fluids. Used in preparing tinctures and spirits, also in some liniments, liquors 
and mixtures. 

Alcohol Dilutum, Diluted Alcohol, — a liquid composed of about 41.5 per 
cent., by weight, or about 48.9 per cent., by volume, of Absolute Alcohol, and 
about 58.5 per cent, of water. It is prepared by mixing together equal volumes 
of alcohol and distilled water. Sp. gr. about 0.936 at 6o° F. 

An Alcohol is a volatile organic compound, which contains no N, has a great affinity for 
water, and reacts with acids, forming therewith H 2 and ethers. Alcohols are therefore 
analogous to the metallic hydrates, as are Ethers to salts. Methyl Alcohol is obtained by 
the destructive distillation of wood, Phenyl Alcohol (Phenol) by that of coal-tar, and the 
fermented Alcohols (Ethyl, Amyl, etc.) from any vegetable substance containing sugar (or 
starch and the ferment Diastase, which converts the starch into sugar), by fermentation 
through the agency of the yeast-plant, which splits the sugar into Alcohol and C0 2 . The 
product contains much water, and is then distilled in order to separate the alcohol, which 
passes over first, with a certain amount of water, the greater part of the latter being left behind. 
In this country Alcohol is so produced from grain (chiefly barley), and is termed High Wine, 
being disposed of by the distillers to certain wholesale liquor dealers, many of whom proceed 
to "rectify" it by mixing and blending it with water, essential oils of corn, rye, etc., ethers, 
burnt sugar, and occasionally small quantities of genuine whisky, brandy, etc. The product 
is then labeled "Old Tom Gin," "Old Crow Whisky," etc., according to the requirements 
of the retail dealers. True Whisky is distilled from the mash of fermented grain (corn, 
wheat, and rye, or a mixture of all three), and should be not less than four years old, to be offi- 



ALCOHOL. IO,? 

rial; Brandy from the fermented juice of fresh grapes, and should he not less than foU] \> 
old. Wines are the product of the fermented juice of grapes, without distillation. 

Alcohol may be produced synthetically by shaking defiant Gas, CjH 4 , with strong 
Sulphuric Acid, then diluting and distilling. Absolute Ethyl Alcohol, which is only used 
for chemical testing and for the manufacture of Chloroform, is obtained by shaking Alcohol 
with Potassium Carbonate, decanting and distilling with slaked lime. 

Alcohol very slowly oxidized forms Aldehyde, C 2 H 4 0; if less slowly Acetic Acid, (\,II 4 ( ).,; 
if quickly, as in burning, C0 2 and H 2 0, which are in all cases the ultimate products of its 
continued oxidation. 

An Aldehyde is obtained from an alcohol by removing therefrom two atoms of hydro- 
gen, hence its name — ^4/cohol dehydrogenatum. Aldehydes lie in chemical constitution be- 
tween the alcohols and the acids, and have the power of reducing silver salts in darkness, 
which is shared also by living protoplasm. The principal aldehydes are — 

Acetic Aldehyde, Aldehyde, Ethyl Aldehyde, Ethylidene Oxide, C 2 H.,0, — a colorless, 
mobile liquid, antiseptic, locally irritant, anesthetic when inhaled, and a powerful depressant 
of the respiration, too dangerous for use. 

Formic Aldehyde, Formaldehyde, CH 2 0, — is a gaseous body prepared by subjecting 
methyl alcohol to oxidation. It is described under its own title. 

Paraldehyde, C e H,,0 3 , — is a polymeric form of Aldehyde and a valuable hypnotic. It 
is described under its own title. 

A Ketone bears the same relation to an aldehyde that an Ether does to an alcohol, being 
an aldehyde in which the hydrogen has been replaced by a radicle. The most important Ke- 
tones are — 

Acetonum, Acetone, Dimethyl-ketone, C 3 H e O, — See page 65. 

Hypnone, Phenyl-methyl-acetone, C 6 H 5 (CO)(CH 3 ) (Unofficial), — a hypnotic agent of 
moderate energy, described under the title Chloral. 

Principal Unofficial Alcohols. 

Methyl Alcohol, Methyl Hydrate, Wood-spirit, CH 3 OH, — also called Car- 
binol, Methol, Hydroxymethane, is a non-fermented alcohol, obtained from 
the destructive distillation of wood. Ordinarily it contains many impurities, 
which give it a very disagreeable odor, and mixed with ethyl alcohol it renders 
the latter so disagreeable as to be unfit for drinking. Such a mixture is sold, 
under the name Methylated Spirit, for use as a solvent in the arts, as a com- 
bustible in lamps, etc. 

Amyl Alcohol, Amyl Hydrate, Potato-spirit, Fusel Oil, C 5 H u OH, — is a 
fermented alcohol obtained from the potato, also occurring in the crude spirit 
produced by the fermentation of saccharine solutions with yeast, and separated 
by excessive distillation, passing over after the ethyl alcohol. It is oxidized 
into Valerianic Acid. From it is prepared Amyl Nitrite, by distilling with nitric 
and sulphuric acids and copper wire. It is an oily liquid, of penetrating and 
oppressive odor and burning taste: sparingly soluble in water, but soluble in 
all proportions in alcohol, ether and essential oils. 

Official Alcoholic Preparations. 

Spiritus Frumenti, Whisky,— obtained from the distillation of the mash of fermented 
grain ; rye, wheat, corn or barley, and at least four years old. It should have a specific gravity 
of not more than 0.945, nor less than 0.924 at 6o° F., corresponding to an alcoholic strength of 
37 to 47.5 per cent, by weight, or 44 to 55 per cent, by volume. It contains Ethers developed 
by the action of acetic and butyric acids on the alcohol, and traces of Amyl Alcohol (fusel-oil) 
even in the best. Dose, 3ij-oij- 

Spiritus Vini Gallici, Brandy,— obtained from the distillation of the fermented juice of 
grapes, and at least four years old. Sp. gr. 0.925 to 0.941. Has an alcoholic strength of 39 
to 47 per cent, bv weight, and CEnanthic and other Ethers developed by age. Pale Brandy 



I 



I 



104 ALCOHOL. 

is colored by the cask, the dark has caramel to color it. Is often prepared artificially by 
adding to high wines Acetic or Nitric Ether, Caramel, and Logwood or Catechu for astringency . 
Dose, i j — S i j - 

Spiritus Rectificatus, Rectified Spirit, (official in the B. P.), — is Alcohol 90 per cent, 
obtained by the distillation of fermented saccharine fluids. Sp. gr. 0.834. Is often spoken of 
as "56 over proof," meaning that to reduce 100 volumes of it to the strength of proof spirit 
requires 56 volumes of water. 

Vinum Album, While Wine, — should contain from 7 to 12 per cent, by weight of absolute 
alcohol, and is made by fermenting the unmodified juice of the grape, freed from seeds, stems 
and skins. California Riesling, Ohio Catawba, etc. Dose, 5j~5iv- 

Vinum Rubrum, Red Wine, — should contain from 7 to 12 per cent, by weight of abso- 
lute alcohol, and is made by fermenting the juice of colored grapes in presence of their skins. 
Native Claret, Burgundy, etc. Dose, Bj-Siv. 

Unofficial Alcoholic Preparations. 

Rum, — is obtained by the distillation of fermented molasses, and has about 42 per cent. 
by weight of alcohol. 

Gin, — has about the same alcoholic strength as rum, and approaches very nearly to the 
official Spiritus Juniperi Compositus. It is usually distilled from rye or barley, and fla- 
vored, in Holland, with juniper berries and hops; in England, often with oil of turpentine, 
various cheap aromatics, acetate of lead, sulphate of zinc, cayenne pepper, etc. Pure gin 
is slightly diuretic, from the oil of juniper contained in it. 

Spiritus Odoratus, Perfumed Spirit, Cologne -water, — prepared by adding to 800 parts 
of Alcohol, Water 158, Acetic Ether 2, Oil of Bergamot 16, Oil of Lemon 8, Oil of Rosemary 8, 
Oil of Lavender Flowers 4, and Oil of Orange Flowers 4 parts. A perfume and ingredient 
of lotions. 

Vinum Aromaticum, Aromatic Wine, — consists of Stronger White Wine 94 per cent., 
with Lavender, Origanum, Peppermint, Rosemary, Sage and Wormwood, of each 1 per cent. 
It was official in the U. S. P. 1880. 

Vinum Portense, Port Wine, — is not a natural wine, spirit being added during the 
processs of manufacture, and the alcoholic strength raised to 30 or 40 per cent. 

Vinum Xericum, Sherry Wine, — a dry, spirituous white wine, generally made to order 
by the dealers, and having from 20 to 35 per cent, of alcohol. 

Sparkling Wines, as Champagne, Hock, Catawba, — are more or less sweet, and charged 
with carbonic acid, being bottled before fermentation is completed and the grape sugar all 
converted into alcohol. They contain 8 to 10 per cent, of absolute alcohol. 

Sweet Wines, as Burgundy, Tokay, Muscatel, Malaga, Angelica, Madeira, etc., — are 
of low alcoholic strength, 6 to 7 per cent, unless fortified. 

Light Red Wines, as Claret, Red Rhine, Concord, — have 5 to 7 per cent, alcohol, tannic 
acid, grape coloring matter, etc. 

Dry Acid Wines, as Rhine and Moselle, California Hock, Kelley Island Catawba, — in 
these fermentation is complete, and the alcoholic strength from 5 to 7 per cent. 

Beer, Ale and Porter, — are fermented liquors, made from malted grain, with hops and 
other bitters added. Beer is made by slow fermentation, the yeast sinking; Ale by rapid 
fermentation, the yeast floating. Their alcoholic strength is 2 to 3 per cent, in beer, 4 to 6 
per cent, in ale and porter, — and they also contain malt extract, carbonic acid, lactic acid, 
various aromatics, potassium and sodium salts, etc. 

Kumyss, — is obtained by the fermentation of milk, that of the mare being used in Tar- 
tary, where it is employed as a food. It contains from 1 to 3 per cent, of alcohol, sugar, lactic 
acid, casein, fat, salts, carbonic acid and ethers. [See page 97.] 

Incompalibles. 

Incompatible with Alcohol are: Acacia, Acids (mineral), Albumin, Bromine, Chlorine, 
Chromic Trioxide, Mercuric Chloride, Potassium Permanganate, Salts (inorganic). Physio- 
logically incompatible are Cocaine, Caffeine, Strychnine. 



VLC0H01 105 

Physiological Action of Alcohol. 

The Alcohols of the series to which the above mentioned belong are all 
narcotic poisons when taken in sufficiently large doses; and have the general 
effect of paralyzing the nerve-centres in the inverse order of their development. 
The symptoms produced may be divided into stages, — (a) stimulant, (b) anodyne 
and anesthetic, (r) narcotic, (d) paralytic; therein closely following the action 
of 1 he volatile anesthetics derived from them, though wanting in the profound 
degree of anesthesia which the latter produce. Ethyl Alcohol, the effects of 
which are detailed below, has the most typical action, and in poisoning by it 
these stages follow each other in regular order. In poisoning by Methyl Alcohol 
the excitement is greater, the subsequent stages succeed each other more rapidly, 
and if the dose be insufficient to cause death, the effects pass off more quickly, 
They all lower the body-temperature. 

Methyl Alcohol is an active and dangerous poison, differing from ethyl 
alcohol in that it is only partly oxidized in the system, and forms within the 
organism the highly toxic formic acid. In mam' cases it has caused permanent 
blindness, even when taken in small quantities, and has frequently caused death. 
It is extensively used as a substitute for ethyl alcohol in the manufacture of 
extracts, spirits, bitters, and medicines, intended for human consumption, such 
as Jamaica ginger, essence of peppermint, and lemon extract. 

The post-mortem appearances, after acute poisoning by the alcohols, show changes in the 
blood, stomach, intestines, liver, lungs and kidneys; some of which are probably due to the 
asphyxiation resulting from the paralysis of respiration. The Blood is dark and clotted in 
the heart. The Stomach and Intestines are congested and softened, especially so if the in- 
gested alcohol has been undiluted. The Liver is very much congested, soft and friable. 
The Spleen is gorged with blood and softened. The Lungs are congested and show small 
extravasations of blood, and in the Kidneys also hemorrhages are found. 

Physiological Action of Ethyl Alcohol. 
Externally applied, Alcohol is refrigerant, astringent, anhidrotic, rubefacient, 
and slightly anesthetic. Pure alcohol is not germicidal to dry bacteria, but that 
of 60 to 70 per cent, alcohol strength is efficient against most forms, and is a 
good antiseptic and disinfectant. Applied to the skin it evaporates quickly, cooling 
the surface, temporarily contracting the superficial vessels, and checking per- 
spiration. If its evaporation is prevented, as by covering with a watch-glass 
or a piece of rubber, or if the alcohol is rubbed in, it absorbs water from the 
tissue and hardens it. It coagulates the albumin of the part, but the coagulum 
is soon redissolved by the fluids of the tissues. It then dilates the vessels of 
the derma, producing a sensation of warmth and a rubefacient effect upon the 
skin. Upon the mucous membrane of the mouth and pharynx similar effects 
are produced by the same application. If the alcohol is concentrated, a burn- 
ing sensation is felt immediately; also an increased flow of saliva and quick- 
ened pulse, due to reflex action. Then follows a slight local anesthesia of the 
part, and if the alcohol be held there for some time, the mucous membrane 



( 



< 



! 



106 ALCOHOL. 

becomes whitish and opaque, from coagulation of the albumin, abstraction of 
water from the tissue and congestion of its vessels. This soon disappears, as 
resolution of the albumin occurs. 

Internally in moderate quantity and single dose, Alcohol acts briefly as a 
cerebral, cardiac and general stimulant; in large doses as an anesthetic, an 
intoxicant and deliriant, and finally as a narcotic poison and paralyzant of the 
nerve-centres. It is somewhat antipyretic, also diuretic and antispasmodic, and 
is hypnotic in many cases. 

A single dose of a strong alcoholic preparation, for example an ounce of 
neat brandy, introduced into the stomach, immediately produces important 
and valuable reflex effects. The cardiac rate is quickened, and its force is in- 
creased; the vessels of the entire body are dilated, especially those of the skin; 
the blood-pressure is raised, and a sense of glowing heat is produced. These 
reflex effects are well seen in the prompt restoration of a fainting person by the 
administration of a single dram of whisky or brandy. By the same means 
the nausea, paleness and other unpleasant symptoms produced by tobacco are 
promptly counteracted. 

Internally, in small quantity diluted, Alcohol dilates the gastric vessels, 
reddens the mucous membrane of the stomach, produces a sense of warmth 
and comfort, stimulates the gastric glands to increased production of gastric 
juice, and increases the activity of the gastric movements. Taken moderately, 
immediately before or during meals, it promotes the appetite and assists diges- 
tion; lessens the elimination of waste-products (urea and C0 2 ), causes a sub- 
jective sensation of heat, and slightly raises the body-temperature. It briefly 
stimulates the heart, prolonging its systole and reducing the length of the dias- 
tole, and increases the functional activity of all the organs. The effects of large 
doses are very injurious; the vaso-motor nerves are partially paralyzed for a 
time, causing dilatation of the arterioles throughout the body; the pepsin of 
the gastric juice is precipitated, the gastric and hepatic vessels are congested, 
the walls of the stomach are rendered hyperemic, and the gastric glands and 
hepatic cells are over-stimulated to the production of pathological secretions. 
If the ingestion is continued, even in moderate quantities frequently repeated, 
chronic gastritis ensues, gastric mucus is poured out in large amount, the gastric 
glands soon atrophy, and the permanent dyspepsia of drunkards is set up, with 
morning vomiting of glairy mucus. The further effects of large doses are the 
total arrest of digestion, the production of intoxication, perhaps hallucinations 
and delirium, also great incoordination of thought and motion, depressed sen- 
sibility, depression of the heart and respiration, lowered arterial tension and 
body-temperature, abolished reflexes, stupor, and, if the dose be sufficient, 
coma and death. 

Upon the Blood the action of Alcohol is to first increase and then diminish 
the ameboid movements of the white corpuscles, also to affect the red corpuscles 
so as to prevent the oxyhemoglobin from readily parting with its oxygen. It 



ALCOHOL. 



107 



consequently diminishes the oxidation of the tissues, and may lead to an imper- 
fect combustion of fat, which then accumulates. The result is obesity in many 
persons who habitually consume large quantities of alcoholic beverages, espe 
dally if these contain much saccharine material. 

Upon the Heart and Circulation the first effects of Alcohol are those of slight 
and brief stimulation by reflex action. After its absorption the same effects 
are exhibited in a more marked degree. The pulse becomes fuller, the action 
of the heart is quickened and its force increased, due mainly to direct stimula- 
lation of its accelerator nerves. The vaso-motor system is inhibited, causing 
dilatation of all the vessels of the body, especially those of the periphery, and 
producing a sense of increased body-heat. The blood-pressure is raised, the 
great increase of cardiac action overcoming the results of the vascular dilatation. 
The mental and bodily functions are all stimulated for a time, the subject feels 
better for the dram, his muscular power seems to be increased, more urine is 
passed, and perspiration is freer. But these effects are very transitory, and 
after a brief period of stimulation reaction sets in, and the entire organism is 
depressed to a lower point than where it was before the ingestion of the alcoholic 
stimulant. Large doses do not stimulate the heart at all, but immediately de- 
press it, both by reflex action and by direct paralysis after their absorption. 
A toxic dose may paralyze the heart almost immediately by direct depressant 
action, but usually, after a very brief period of excitement, insensibility is pro- 
duced, also stertorous breathing, dilated or contracted pupils, complete mus- 
cular resolution, and death by paralysis of the heart and respiration. The 
action of alcohol upon the heart clearly exemplifies two therapeutic laws: (1) 
That excessive stimulation is necessarily followed by depression, and (2) that 
drugs which in moderate doses excite a function are very apt in large doses to 
paralyze it. 

The extremists, who find no good whatever in alcohol, hold that it is a fallacy to apply 
the term "stimulant" thereto, that alcohol is a paralyzant from first to last, that its apparent 
cardiac stimulation is in reality the result of its narcotism of cardiac inhibition, and that every 
special sense is blunted by even small doses of this poison. They calmly ignore the fact 
that their premises apply to every stimulant in its special field of action as well as to alcohol 
in its sphere, and forget that their conclusion (that alcohol has no place in medicine except 
as a poison) applies by the same reasoning to every other stimulant. Hence, to be consistent, 
they should advocate the banishment of all stimulant drugs from the materia medica. 

On the Skin and Kidneys Alcohol is mildly diaphoretic and diuretic, act- 
ing partly by its vascular dilatation, partly by stimulation of glandular activity. 
On the Intestines it has a slightly astringent effect at first, but in those who use 
it habitually to excess the bowels are always very loose, and the evacuations 
watery. 

Upon the Nervous System Alcohol has specific and selective action. By 
a moderate dose this entire system is briefly stimulated, chiefly as a result oi 
increased blood supply due to the vascular dilatation and cardiac elevation. 
Reaction, however, soon occurs, and if the dose be very large, the period of 
exaltation quickly passes into one of profound cerebral depression, hut this is 



IOS ALCOHOL. 

usually preceded by marked incoordination of thought and of muscular move- 
ment, shown by incoherency of language, difficult speech, and staggering gait. 
The reflex activity of the spinal centres is abolished next, the urine and feces 
are discharged involuntarily; the depression extends to the respiratory centre, 
breathing becomes difficult and the face cyanosed; profound coma supervenes, 
respiration and the heart are paralyzed, and the patient dies. 

The reflex depression occurs early in the case, and accounts for the im- 
punity with which a drunken man will often bear an injury which would cause 
death by shock to a sober one. 

The action of Alcohol upon the nervous system illustrates well, in the order of its events, 
the physiological fact that excessive stimulation is followed by depression; as well as the 
law that drugs which affect the functions progressively exhibit their earliest powers upon 
those functions which are highest in development (being those latest acquired by the indi- 
vidual and last to appear in the species), and influence next the next lower, and finally the 
lowest, those of respiration and circulation. The primary stimulation and subsequent de- 
pression of function proceeds, in a descending scale from the highest or least firmly fixed and 
latest acquired function, to the lowest or most firmly fixed one. Thus, by Alcohol, the 
intellect is affected very early and the judgment abolished very soon, even though the imagina- 
tion, the emotions and the powers of speech remain stimulated. Soon these follow the same 
course, imagination is abolished, the patient loses command over his emotions, cries and 
laughs immoderately and without reason; next loses control over his organs of speech, talking 
incoherently and thickly, and then can only make a noise. At the same time other delicate 
and lately developed movements, as those required for writing, feeding, etc., are incoordi- 
nately performed and soon paralyzed. General muscular movements, being less highly 
and earlier developed, are next to become implicated, being first incoordinated, and soon 
abolished. The paralysis of reflex action follows, though lowered earlier in the case, then 
paralysis of respiration and finally paralysis of the heart. 

The antipyretic action of Alcohol is partly due to its power of lessening 
oxidation, but chiefly to the dilatation which even moderate doses produce in 
the vessels of the surface. This dilatation subjects the warm blood from the 
interior of the body to the cooling influence of the atmosphere, also to the cool- 
ing due to evaporation from the skin; and if kept up by repeated drams in a 
freezing temperature will soon so chill down the blood as to kill the subject. 

Under ordinary conditions the contraction of the cutaneous vessels, in a person exposed 
to cold, prevents the warm blood from approaching the surface in any great quantity and 
becoming cooled; but this mechanism is temporarily paralyzed by every dose of alcohol, 
admitting the hot blood to circulate freely over the surface, and to be rapidly cooled down 
until the patient may be absolutely frozen to death as a result of repeatedly taking "some- 
thing to keep him warm." This fact is well known to Arctic travelers and to the lumbermen 
of the northern forests, who have been taught by bitter experience to let alcohol alone when 
exposed to severe cold. 

Delirium Tremens occurs after an alcoholic debauch, usually in cases where 
the stomach is so deranged as to prevent the ingestion or assimilation of food. 
So long as the toper can eat and digest his food he is practically not liable to 
this affection. It generally begins in from two to four days after the patient 
has lost his appetite and commenced to reject or vomit his food; and is marked 
by great restlessness, obstinate insomnia, a peculiar tremor of the tongue and 
limbs; also delusions connected with the sense of sight, the patient imagining 
that he sees animals around him (dogs, rats, snakes, beetles, etc.). The delir- 
ium is constant and active, may become violent and pass into mania, or the 



ALCOHOL. 



IO() 



patient may die suddenly while in this state, without any warning symptoi 
In several cases observed by the writer the delirium appeared lour and five days 
after the last alcoholic dose was taken, though the patient was eating, sleeping, 
and working during the interval, apparently convalescent. Under treatment, 
and especially if sleep is brought on, the delirium usually subsides gradually, 
and the patient recovers. 

Chronic Alcoholism is the result of the ingestion for a considerable length 
of time of an excessive quantity of alcohol, even though perhaps never suffi- 
cient to cause acute intoxication. One of the earliest symptoms usually ob- 
served is the vomiting of watery fluid or glairy mucus in the morning after ris- 
ing. The bowels are generally loose, and the evacuations watery. The skin 
has a greasy look and a satiny feel, and the cutaneous capillaries on the fan- 
may become permanently dilated, giving to the cheeks a characteristic, dusky- 
red hue, and a flaming red color to the nose. In old drunkards, the latter 
organ often becomes covered on its tip with dusky-red tubercular enlargements, 
making it a very unsightly appendage. The stomach and liver are in a state 
of chronic congestion, the food is not digested and often to a great extent aban 
doned, the patient, in fact, living upon alcohol. Eructations of gas and flatu- 
lence are constant and distressing; the body is usually puffed and bloated, the 
eyes bleary, red and watery. One of the most graphic descriptions of the drunk- 
ard's personal appearance is that by Trollope, in "Orley Farm," chapter 57. 

After a time the connective tissue of the liver increases (hyperplasia), its 
parenchymatous structure atrophies or undergoes fatty degeneration, the organ 
contracts (sclerosis), the portal circulation is impaired, the veins of the ab- 
dominal integument become prominent, and soon ascites ushers in the final 
stage. Sclerosis of the kidneys may accompany that of the liver. The general 
impairment of function extends early to the nervous system, the mental powers 
are dulled, the temper becomes irritable, and tremor appears in the tongue, 
lips and hands. As a result of the prolonged use of alcohol very serious patho- 
logical changes take place throughout the organism. It exerts its essential 
and most injurious influence on the vital organs by its presence in the circula- 
tion, being thus brought into direct contact with the cellular tissue of the vital 
organs. It sets up hyperplasia of the connective tissue, resulting in sclerosis, 
especially in the stomach, brain, liver and kidneys; produces fatty degeneration 
(steatosis) of the blood, the arterial walls and the parenchyma of the various 
organs, depresses the brain, the heart and the arterial tension. Chronic dis- 
ease of the heart, the arteries and the mucous lining of the stomach and intes- 
tines, gout, diabetes, Bright's disease of the kidneys, paralysis, ataxia, peripheral 
neuritis, epilepsy, amaurosis, and insanity may result from the continued use 
and abuse of alcohol. The malt liquors (beer, ale, etc.) are less prone than 
spirits to affect the brain, but are even more apt to set up fatty degeneration 
of the heart and liver. The heart is very liable to undergo gradual hypertrophy, 
partly by reason of the constant whipping up it receives from every dram of 



IIO ALCOHOL. 

alcohol taken, and partly as a result of renal sclerosis. Several of the largest 
hearts ever seen by the writer at autopsies, some of which were veritable in- 
stances of cor bovinum, occurred in subjects of chronic alcoholism associated 
with employment involving exposure and great anxiety, as in masters of steam- 
ships, superintendents of mines, etc. 

Impurities in Alcohol increase greatly its toxic action; so that inferior brandy 
from a public liquor shop has a lethal action nearly one-half greater than that 
of pure ethyl alcohol. (Dujardin-Beaumetz.) 

Alcoholic Coma may be easily confounded with that of apoplexy, opium narcosis, con- 
cussion of the brain, acute pneumonia, uremia and epilepsy, the differential diagnosis being 
almost impossible to make with accuracy when the coma is deep. The pupils afford no 
trustworthy indication, as they may be either dilated or contracted in alcoholism. They 
are often unequally contracted in apoplexy, and in apoplexy of the pons varolii they may be 
equally and minutely contracted, as in opium-poisoning. The difficulty of diagnosis is in- 
creased by the common practice of giving a dram of whisky as a reviver, so that a stranger 
found insensible on the street and brought to a hospital may smell of alcohol without having 
been the subject of alcoholism. When no accurate history of the case can be obtained the 
diagnosis is impossible in many cases. 

Alcohol is rapidly diffused throughout the organism, which oxidizes a por- 
tion of it, about an ounce and a half for the adult in 24. hours, the oxidation 
yielding force, which is utilized as nervous, muscular, and glandular power. 
A large quantity is decidedly poisonous, as it sets up structural changes in the 
various organs, and lowers the power of resistance to morbific influences. It 
renders its victims particularly liable to phthisis, and has frequently caused 
directly an intractable form of that disease, pulmonary sclerosis. It makes 
patients bad subjects for withstanding any severe illness, especially pneumonia, 
or to successfully undergo severe surgical operations. 

The portion not oxidized is excreted unchanged by the lungs, the skin and 
the kidneys, but does not appear in any quantity in the urine unless very large 
amounts have been ingested. The very young and the very old bear more 
alcohol relatively than the adult. It has been proven to exist normally in the 
human organism, and within the limit above stated it is undoubtedly a food, 
as is shown by the fact of its retention and combustion in the body, supplying 
the place of other foods, so that the quantity of food which without it would 
be insufficient, with its aid becomes sufficient to maintain the body-weight. 

Researches as to the action of alcohol upon vital resistance to infection, by Drs. Abbott 
and Delearde, seem to show that it has a decidedly injurious influence upon animals inocu- 
lated with cultures of the germs of certain infectious diseases. Alcoholized rabbits died 
when inoculated with Streptococcus pyogenes and Bacillus coli communis in attenuated cul- 
tures which did not kill non-alcoholized control ones. Animals vaccinated against tetanus 
and afterwards alcoholized, soon lose their immunity; and those vaccinated against tetanus 
and at the same time alcoholized, do not readily acquire immunity. Similar results were 
obtained with regard to rabies and anthrax. The conclusion is drawn that strong doses of al- 
cohol should not be administered to persons suffering from certain infectious diseases, as 
pneumonia, or from certain intoxications, as that produced by snake-venom, during which an 
increase in the number of leucocytes appears to be a necessary part of any process leading lo 
the cure of the patient. 



ALCOHOL. , i i 

Therapeutics of Alcohol. 

The external and local use of alcohol in medicine includes many applications 
of its antiseptic, astringent, refrigerant and rubefacient qualities. Diluted, in 
the proportion of four parts to one of water, it makes an excellent lotion for 
bruises, sprains, and other slight injuries, where it is desired to cool the part 
and check impending inflammation. A perfumed spirit, as Cologne water, is 
commonly used as a lotion to the forehead for the relief of headaches. Alcohol 
does good service as an application to prevent bed-sores and cracked nipples, 
as it hardens the inflamed skin by abstracting water therefrom and coagulating 
the albumin temporarily. Diluted alcohol is applied on the surface of the 
body in fevers, to cool the skin and check excessive sweating. Alcoholic lini- 
ments (linimentum camphorae, etc.) are rubbed into the cutaneous tissue for 
their rubefacient effect, to aid the absorption of inflammatory products and to 
relieve pain, in chronic rheumatism, lumbago, and myalgia. As a gargle or 
spray, diluted alcohol is one of the very best local agents in tonsillitis, pharyn- 
gitis, and other inflammatory affections of the throat, especially diphtheria, 
in which disease it fulfils several important purposes, acting as an efficient local 
antiseptic, astringent and anesthetic. Among miners, hunters, frontiersmen 
and others, lotions of whisky or brandy are in common use as applications to 
wounds and sores, and they could not find a more efficient agent for the pur- 
pose, when conjoined with thorough cleanliness of the lesions. 

Internally, in small quantities taken just before or during a meal, alcohol 
is an efficient aid to digestion, especially in the aged and feeble, or persons who 
are greatly exhausted by overwork. In the atonic indigestion of nervous and 
depressed subjects and in cholera infantum, good brandy is universally found 
to be beneficial. Care must be taken, however, not to exceed the amount 
which agrees with the case, for large quantities precipitate pepsin, paralyze 
the gastric secretions, and set up a subacute gastritis, which will become a 
chronic one if the indulgence is persisted in, with eventual atrophy of the gas- 
tric glands. Many cases of gout have their origin in the habitual use of alco- 
holic beverages, especially the malt liquors and heavy red wines; and all forms 
of alcohol should be avoided by subjects of the uric acid diathesis. 

In the form of a sparkling wine, as champagne, or as brandy and soda- 
water, alcohol may control vomiting from many causes, especially that of yellow- 
fever and sea-sickness. A single full dose of strong whisky or brandy is often 
a very efficient combatant of fainting or of collapse, by its prompt reflex stimu- 
lation of the circulation. Diarrhea of simple form may be checked by a dram 
of good brandy, acting as a tonic astringent to the intestines. An attack o\ 
acute corvza, or a cold from exposure beginning with a chill, may frequently 
be aborted by a full dose of spirits in hot water taken just before going to bed, 
for the purpose of relaxing the peripheral vessels and thus promoting diap 
resis and restoring the disturbed balance of the circulation. In anemia and 
chlorosis good red wines are almost indispensable, also in convalescence from 



112 ALCOHOL. 

acute diseases, sudden and profuse hemorrhages, and many other morbid con- 
ditions. In phthisis alcohol does good service if it promotes assimilation and 
assists digestion, shown by increase of the body-weight during its employment. 
It is invaluable in poisoning by cardiac depressants and snake-venom, and im- 
pending cardiac failure from any cause. It is the most efficient antidote in 
poisoning by Phenol (carbolic acid), as besides diluting the poison, it has de- 
hydrating and astringent action on the tissues which prevent the absorption of 
the phenol to a great extent. 

In fevers Alcohol is often very serviceable, but may do harm if used with- 
out discrimination. Its powers of lessening oxidation, of being itself" oxidized 
in the body and acting as a food, of reducing body-temperature and promot- 
ing perspiration and sleep, are all indications for its beneficial employment 
in most febrile conditions; while its stimulant action on the heart may be avail- 
able in such diseases as typhoid fever, and lobar pneumonia, to tide that organ 
over a brief period of depression or a condition of impending collapse. Fur- 
thermore, for some unexplained reason, it often slows the pulse in fever, and 
when it does so its moderate use will be of general benefit to the patient. The 
danger is that if continuously given in such affections it may fail to make the 
required impression when an emergency calling for it occurs. The best rule 
to observe for its administration in typhoid, diphtheria, pneumonia and other 
fevers is to withhold it until the first sound of the heart becomes feeble and 
dull, and then to use it boldly but not excessively. Many authorities urge its 
continuous administration in diphtheria, probably from a belief in its antisep- 
tic action on the poison in the blood, similar to that which it undoubtedly exer- 
cises against the venom of the rattlesnake. It is an absolute necessity in the 
treatment of acute lobar pneumonia, if the patient has been accustomed to its 
daily use as a beverage; but in other subjects of this disease it is best given at 
the crisis only, to tide the patient over a brief period of extreme danger. 

Absolute Alcohol has been successfully used in the treatment of mammary 
carcinoma, from 30 to 60 minims of a 30 to 60 per cent, solution being injected 
around the circumference of the growth, with the object of obliterating its ves- 
sels and lymphatics. This method is painful, but Hasse reports 35 cases so 
treated over a period of 25 years without a single relapse. 

The use of alcoholic beverages in moderate quantity by healthy persons is 
violently condemned by extreme total abstinence advocates, who make use 
of garbled quotations from medical authorities to support their arguments. 
Physicians generally agree with Mr. Lawson Tait, who declared himself "fully 
persuaded after thirty years of life, as hard in work and as full of responsibility 
as well could be, that the moderate use of alcohol is a necessity in our modern 
life." Dr. Robert Farquharson sums up the case for moderate drinking as 
follows. "All stimulant is unnecessary for the young and for people living 
perfectly healthy lives. But, under the stress and struggle of modern civiliza- 
tion, few of us beyond middle age are placed under normal physiological con- 



AL1.TRIS — ALOE. 



I 13 



ditions, and a little alcohol helps us to round the corners, and to plane away 
the asperities of existence. In turns it may lie a stimulant, or a sedative, or a 
tonic, or a digestive, or an actual food; and unless we run on into excess, no 
physical damage can possibly be done to our tissues. The argument in its favor, 
when wisely and prudently used, seems complete. It does us good, and can 
do us no harm." 

ALETRIS, Colic-root (Unofficial), — is the rhizome of Alctris jarinosa, the Starwort, an 
indigenous perennial plant which grows in grassy places and in sandy woods. It contains 
starch, and a bitter principle, but no tannin. This plant was formerly official, and is now 
widely advertised by the proprietors of an Aletris Cordial, as being tonic, emetic, purgative, 
diuretic, carminative, sialogogue and anti-rheumatic, also "the most powerful of uterine 
stimulants," a specific for dysmenorrhea and a wonderful remedy for colic, dropsy, and 
chronic rheumatism. It is little more than a simple bitter in small doses, though in very 
large ones it may prove emeto-cathartic. Dose, of the powdered root, gr. x; of the infusion 
(3j to the pint), oss. 

ALLIUM, Garlic (Unofficial), — is the bulb of Allium sativum, a plant of the nat. ord. Lil- 
iacere, indigenous to Asia, but cultivated in Europe and America. Its odor is pungent and 
disagreeable and its taste warm and acrid. It contains a Volatile Oil, which consists mainly 
of the Sulphide of Allyl (C 3 H 5 ) 2 S, on which its qualities depend. Allied species are Allium 
Cepa, the Onion, and Allium Porrum, the Leek. 

Syrupus Allii, Syrup of Garlic (Unofficial), — contains 20 per cent, of Garlic, Sugar and 
Dilute Acetic Acid. Dose, 3j-iv, according to age. 

Garlic, Leeks and Onions are stimulants to the digestion and to the nervous system, and 
are supposed to have a special influence upon the bronchial secretion. Garlic is also thought 
to be emmenagogue and anthelmintic. It promotes diaphoresis and diuresis, and acts as a 
tonic and carminative. Many persons use it as a condiment. Large doses will often pro- 
duce gastric irritation, flatulence, hemorrhoids, headache and fever. In domestic practice 
it is frequently employed as an external application in the cutaneous eruptions of children, 
and as a poultice or liniment in infantile disorders of many kinds. Internally it is of real 
benefit in feeble digestion and flatulence, chronic catarrhal affections of children, nervous 
and spasmodic coughs, and nervous vomiting. 

ALNUS, Alder-Bark (Unofficial), — is the bark of Alnus serrulata, the common American 
Alder, a small tree of the nat. ord. Betulaceae. It has similar properties to those of A. glu- 
linosa, the European Alder, and A . urcana, the Tag Alder, and contains a tannic acid, an oil, 
and a resin. The bark and leaves are astringent and bitter, and are chiefly used as gargles 
for the throat, as local applications to wounds and ulcers, and to restrain the secretion of 
milk. Dose of the powdered bark gr. x, in decoction or infusion, several times a day. The 
Tag Alder is highly recommended as a hemostatic. 

ALOE, Aloes, — is the inspissated juice of the leaves of Aloe vera, Aloe 
Chinensis,Aloe Perryi, or other species of Aloe, a plant of the nat. ord. Liliacese. 
It occurs in masses of yellowish-brown color, fragrant odor and bitter taste, 
soluble in alcohol and in boiling water. It contains a peculiar volatile oil, a 
resin, and Soaloin, C 15 H 16 7 , a variety of the principle Aloin, which is common 
to all varieties of aloes, — also Aloetic and Chrysammic Acids. Dose, gr. j-vj, 
[av. gr. iv.] 

Aloinum, Aloin, — is a neutral principle obtained from Aloes, chiefly pre- 
pared from the Curafao variety, and varying in composition and properties 
according to the source from which it is obtained. It is soluble in about 65 
of water, n of alcohol, 21 of acetone, 664 of ether, at 77 F. Dose, gr. ss-ij, 
[av. gr. j.] 
Q 



114 ALOE. 

Preparations. 
Aloe Purificata, Purified Aloes, — prepared from Aloes by melting and mixing with \i\\ 
its" weight of Alcohol, straining and evaporating. The product is in irregular, dull-brown, 
brittle pieces, almost entirely soluble in alcohol. From it are prepared the following prepara- 
tions. Dose, gr. j-v, [av. gr. iv.] 

Extractum Aloes, Extract of Aloes, — prepared by mixing i part of Aloes with 10 parts 
of Boiling Water, standing 12 hours, decanting, straining, and evaporating. Dose, gr. ss-v, 

[av. gr. ij.] 

Tinctura Aloes, Tincture of Aloes, — has of Aloes 10, Glycyrrhiza 20, Diluted Alcohol to 
100 parts. Dose, njx-5 j, [av. ttjxxx.] 

Tinctura Aloes et Myrrhae, Tincture of Aloes and Myrrh, — Aloes 10, Myrrh 10, Glycyr- 
rhiza 10, Alcohol and Water to 100 parts. Dose, ttjx-5 j, [av. njfxxx.] 

Pilulae Aloes, Pills of Aloes, — each has Aloes and Soap, 2 grains of each. Dose, ij. 

Pilulae Aloes et Ferri, Pills of Aloes and Iron, — each pill contains gr. j each of Aloes, 
Sulphate of Iron and Aromatic Powder, with Confection of Rose. Dose, ij. 

Pilulae Aloe et Mastiches, Pills of Aloes and Mastic, {Lady Webster's Pill), — each pill 
has of Aloes gr. ij, Mastic gr. ss, Red Rose, gr. ss. Dose, ij. 

Pilulae Aloes et Myrrhae, Pills of Aloes and Myrrh, — each pill contains of Aloes gr. ij, 
Myrrh gr. j, Aromatic Powder gr. ss, mixed with Syrup. Dose, ij. 

Pilulae Laxativae Compositae, Compound Laxative Pills, — each pill contains of Aloin 
gr. i, Strychnine gr. T i F , Belladonna Extract, gr. \, Ipecac, gr. T \, with Glycyrrhiza and 
Syrup. Dose, ij. 

Pilulae Lapacticae, Lapactic Pills (Unofficial)) — each pill contains of Aloin gr.\, Strych- 
nine gr. ^5, Extr. Belladonnae gr. J, Ipecac gr. t l. Dose, ij-viij. 

Aloes is a constituent of Pilulae Rhei Compositae and Tinctura Benzoini Composita 
(which see, under Rheum and Benzoinum respectively). 

Incompatibles. 
Incompatible with Aloes are Mercury Nitrate, Silver Nitrate; with Aloin are Alkaline 
Hydrates, Bromine -water, Ferric Chloride, Lead Acetate (basic), Tannic Acid. 

Physiological Action and Therapeutics. 

Aloes is a tonic-astringent and resin-bearing purgative, an emmenagogue 
and an anthelmintic against the thread-worm. As a cathartic it acts chiefly 
on the lower half of the large intestine, doses of 1 to 4 grains producing in about 
10 hours copious soft evacuations with some griping pain. This effect is pro- 
duced whether the drug be taken internally or absorbed from an exposed sur- 
face, so that it probably diffuses into the blood and is eliminated by the mucous 
membrane of the colon. It is a stomachic tonic in small doses, a stimulant 
of the hepatic functions, and an excitant of the pelvic circulation. It may 
cause abortion in the female and priapism in the male, and is said to have fre- 
quently produced hemorrhoids, which if existing it will aggravate. Given to 
nursing mothers it imparts a purgative quality to their milk. 

Aloes is chiefly used in combination with iron, myrrh, and nux-vomica, for 
amenorrhea and chronic constipation with atonic dyspepsia and hypochondriasis. 
It is curative in certain forms of hemorrhoids especially those occurring after de- 
livery and where the condition is not one of active pelvic congestion. It is also 
used internally and as an injection in gonorrhea, and for simple atonic jaundice. 
It must be avoided in irritable rectum, hemorrhoids of active form, menorrhagia 
and pregnancy, unless given in small doses and with care. The Pil. Aloes et 



ALTH/KA — ALUMINUM, 1 [g 

Ferri is perhaps the most generally used agent in the anemia, amenorrhea and 
constipation of girls at the period of puberty. 

ALTHAEA, Marsh- Mallow, — is the root of Althcea officinalis, a European planl of the 
oat. ord. Malvaceae. It contains about 35 per cent, each of vegetable mucus and starch, 

with 2 per cent, of Asparagin, also pectous matter, sugar, fixed oil, but no tannin. It is a 
constituent of Massa Hydrargyri and Pilulse Phosphori, and is much used as an excipient in 
extemporaneous pharmacy. Dose, indefinite. 

Althaea is one of the best mucilaginous drugs, but has no active medicinal properties. It 
is used in Europe to make pectoral teas and syrups, and is extensively employed as a mui ilagi- 
nous demulcent. The powdered root makes a good emollient poultice, in the Phar. I 
a Compound Althaea Tea is official, which under the common name, "German Breast Tea," 
is a popular demulcent drink in bronchial affections, coughs, etc. 

Asparagin (Unofficial), — is an organic principle, occurring in large rhombic crystals, and 
found in many other plants, as in the shoots of asparagus, vetches, potatoes, licorice, the 
sweet almond, the root of the locust, etc. It jis considered a derivative of Succinic Acid, and 
has diuretic properties, besides being sedative to the circulation. It may be used in ascites, 
especially in children, in the anasarca of Bright's disease, and in gout. Dose, gr. ij-iij, in 
water. 

ALUMINUM, Al. — This metal is widely distributed in nature, chiefly in 
the form of the silicate, constituting clay, kaolin, and many common rocks. 
Its official salts are the following-named: — 

Alumen, Alum, {Potassium Alum, Aluminum and Potassium Sulphate), Al 2 K 2 (S0 4 ) 2 -f 
I2H 3 0, — occurs in large, octahedral crystals, or cubes, of sweetish astringent taste and 
acid reaction, soluble in 9 parts of water and in 0.3 of boiling water, insoluble in alcohol. 
The Ammonia-alum (*Alumini et Ammonii Sulphas) was formerly official, and is still sold 
and dispensed as Alum. Dose, gr. v-x, [av. gr. vijss.] — as an emetic 5j for a child. 

Alumen Exsiccatum, Exsiccated Alum, — is a white, granular powder, slowly soluble in 
23 parts of water at 59 F., and quickly soluble in 1.4 of boiling water. Dose, gr. j-v. 

Alumini Hydroxidum, Aluminum Hydroxide {Hydraled Alumina), Al 2 (OH) B , — is a 
white, light, amorphous, tasteless (powder, insoluble in water or alcohol, but soluble in 
strong alkaline or acid solutions. Dose, gr. iij-xx in powder or mixture. 

Alumini Sulphas, Aluminum Sulphate, A1 2 (S0 4 ) 3 + i6H 2 0, — is a white crystalline 
powder, soluble in 1.2 of water at 59° F., almost insoluble in alcohol. Used locally. 

Kaolinum, Kaolin, — is a native Aluminum Silicate, powdered and freed from gritty par- 
ticles by elutriation. It is a fine white clay, derived from the decomposition of the felspar of 
granitic rocks. It is used as an excipient for the easily reduced metallic salts, and as an in- 
gredient of — 

Cataplasma Kaolini, Cataplasm of Kaolin, — contains Kaolin, Glycerin, Boric Acid, 
Thymol, Methyl Salicylate, Oil of Peppermint. It is identical with the trade preparation 
known as Antiphlogistine, (see under Glycerinum). 

Incompatibles. 
Incompatible with Alum are: Alkaline Hydrates, Borax, Carbonates, Galls, Kino, Lead 
Acetate, Lime-water, Magnesia, Magnesium Carbonate, Mercury salts, Phosphates, Tartaric 
Acid, Potassium Chlorate. 

Unofficial Compounds. 
Alumnol, — is the trade name of an aluminum salt 'of naphtol-sulphonic acid, and is 
readily soluble in cold water. It is markedly antiseptic and astringent, and though precipi- 
tating gelatin and albumin, the precipitate is soluble in an excess of either, so that when it is 
used on purulent discharges they do not clog up cavities, and desirable penetration below the 
surface is accomplished. Incompatible with it are Albumin, Alkalies, Gelatin, and Silver 
Nitrate. 

Zinol, — is a mixture of Alumnol 4, Zinc Acetate 1, and occurs as a colorless and odorless 



Il6 AMMONIUM. 

powder, freely soluble in water. It is astringent and bactericidal, and is used in ij to 3 per 
1000 solutions in vaginal catarrh of gonorrheic origin, and as a dressing for bed-sores and sup- 
purating wounds. 

Physiological Action and Therapeutics. 

Alum is an astringent, coagulating albumin and stimulating muscular con- 
traction. At first it excites the flow of saliva and then markedly diminishes 
it. It coagulates pepsin and arrests digestion, stops peristalsis, and usually 
causes constipation, though sometimes inducing diarrhea. Although coagulat- 
ing albumin, even in weak solution, it enters the blood, constricts the capillaries, 
arrests secretions, especially those of mucous surfaces, and stops capillary hemor- 
rhage. In teaspoonful doses it is an efficient and non-depressant emetic. In 
large doses it is a gastro-intestinal irritant, one ounce and five-eighths of dried 
Alum having caused the death of an adult in eight hours. 

Alum is used locally as an astringent in chronic catarrhs, leucorrhea, gonor- 
rhea, hemorrhoids, bed-sores, ulcers, relaxed throat, colliquative sweats, catar- 
rhal ophthalmia and granular lids. The dried powder is escharotic, destroying 
granulations and warty growths, and is used by insufflation in chronic nasal 
catarrh. Internally it is beneficial in gastric catarrh, gastralgia, enteralgia, 
passive hemorrhages, lead colic and constipation. As an emetic it is employed 
in croup, and it is a good antidote in lead-poisoning. Alum is best administered 
alone, as it forms precipitates with a large number of drugs. 

Aluminum Hydroxide is a feeble astringent and dessicant, occasionally used 
as a local application in inflammatory skin affections, and internally in diarrhea. 
The Sulphate is antiseptic and astringent, and is chiefly employed in 5 per cent, 
solution locally for ulcers, and in 8 to 10 per cent, solution for foul mucous dis- 
charges. A saturated solution is mildly escharotic, and ma)' be used as a daily 
application for enlarged tonsils, nasal polypi, ulceration of the os uteri, and 
various chronic enlargements. 

Alumnol does not irritate or cause pain, and is employed dry and in solu- 
tion as a dressing for wounds and ulcers, acute inflammatory diseases of the 
skin, and acute and chronic inflammations of mucous membranes. In 1 to 3 
per cent, solution it makes a good injection for gonorrhea, and a 4 per cent, 
solution is used to check the lachrymal discharge during an examination of 
the eye. 

Earth, in the form of clean, yellow clay, was used by Dr. Hewson as a sur- 
gical dressing for wounds, and as an application for erysipelas, but has been 
abandoned since the introduction of antiseptics and the discovery of soil infec- 
tion by pathogenic organisms. 

AMMONIUM, NH 4) — is a hypothetical compound radicle, which does not 
exist in the free state, but in combination with acids forms salts which closely 
resemble those of the elements Potassium and Sodium. Many of its salts are 
official, as well as the aqueous solutions of the gas Ammonia, NH 3 , which is 
produced during the putrefaction of all organisms and many organic nitrogen- 



AMMONIUM. | 

ous compounds. Ammonia exists free in the air and the soil, and is contained 
in the products of the dry distillation of many nitrogenated compounds. The 
so railed "gas liquor," a by-product in the manufacture of illuminating gas, 

when neutralized by hydrochloric acid, yields Ammonium Chloride, Nll,('l, 
and from this salt are derived all the other ammonium compounds employed 
in medicine. 

Ammonium Sails and their Preparation. 
Liquor Ammonii Acetatis, Solution of Ammonium Acetate, (Spirit oj Mindererus), is 
prepared by neutralizing dilute acetic acid with ammonium carbonate. It contains about 
7 per cent, of the acetate and is an ingredient of Liquor Ferri et Ammonii Acetatis. It should 
be freshly made as it soon deteriorates. Dose, oj-oj, [av. oiv.] 

Ammonii Benzoas, Ammonium Benzoate, NH 4 C 7 H 6 2 , — minute four-sided lami- 
nar crystals, soluble in 5 of water and 28 of alcohol at 59 F. Dose, gr. v-xx, [av. gr. xv.l 

Ammonii Bromidum, Ammonium Bromide, NH 4 Br, — prismatic crystals or a granular 
salt, soluble in 1 h of water and 30 of alcohol at 59° F. Dose, gr. ij-xx, [av.gr. xv.) well diluted. 
Children bear it well if epileptic from reflex causes; a child 1 year old will tolerate gr. v every 
4 hours (Barton). 

Ammonii Carbonas, Ammonium Carbonate, C 2 H n N 3 O s , — occurs in white masses con- 
sisting of both the acid carbonate and carbamate, which on exposure to air become a white 
powder. Soluble in 5 parts of water. Dose, gr. iij-x, [av. gr. iv.] For children small doses, 
gr. J-ij, frequently repeated. 

Ammonii Chloridum, Ammonium Chloride, (Sal-ammoniac), NH 4 C1, — a white, crys- 
talline powder, of saline taste, and slightly acid reaction; soluble in 3 of water and very spar- 
ingly in alcohol. Dose, gr. j-xx, [av. gr. vijss.] 

Trochisci Ammonii Chloridi, Troches of Ammonium Chloride, — each contains 1$ 
grains of the Chloride. Dose, j-x troches. 

Ammonii Iodidum, Ammonium Iodide, NH 4 I, — a deliquescent, granular, white salt, 
soluble in 1 of water and in 9 of alcohol at 59 F. Dose, gr. ij-x, [av. gr. iv.] 

Ammonii Salicylas, Ammonium Salicylate, NH 4 C 7 H 6 3 , — colorless prisms or plates, or 
a white powder, soluble in 0.9 of water, and in 2.3 of alcohol at 77 F. Dose, gr. j-x, [av. 
gr. iv.] 

Ammonii Valeras, Ammonium Valerate (Valerianate), NH 4 C 5 H O 2 — white, quad- 
rangular plates, deliquescent, very soluble in water and in alcohol. Dose, gr. j-x, [av. gr. vijss.] 

Preparations of Ammonia. 
Aqua Ammonia?, Ammonia Water, — is an aqueous solution of Ammonia, containing 
10 per cent, by weight of the gas. It is a colorless liquid of pungent odor, acrid taste and 
strongly alkaline reaction. Dose, TTgy-3ss, [av. njxv.] well diluted. 

Aqua Ammonia? Fortior, Stronger Ammonia Water, — contains 28 percent, by weight of 
the gas. Sp. gr. 0.901 at 59° F. 

Spiritus Ammonia?, Spirit of Ammonia, — is a 10 per cent, solution of the gas in alcohol. 
Sp. gr. about 0.810. Dose, nB.x-5 j, diluted, [av. rrgxv.] 

Spiritus Ammonia? Aromaticus, Aromatic Spirit of Ammonia, — contains Ammonium 
Carbonate, Aqua Ammonia?, Oils of Lemon, Lavender, and Nutmeg, Alcohol and Water. 
L'sed in the Tinct. Guaiaci Ammoniata and the Tinct. Valeriana? Ammoniata. Dose, njjxv- 
5j, [av. njfxxx.] 

Linimentum Ammonia?, Ammonia Liniment, — has of Aqua Ammonia? 35 parts, Cot- 
ton-seed Oil 57, Alcohol 5, Oleic Acid 3. 

Raspail's Eau Sedative (Unofficial), — consists of Aqua Ammonia? o ij» Sodii Chloridum 
3ij> Spiritus Vini Camphorat. §iij, Aqua Sxxxij. For local use. 

Incompatibles. 
Incompatible with Ammonia preparations are Acids, Acid salts; with the Aromatic Spirit 
are Acids, Acid salts, Lime-water, Aqueous fluids; with the Acetate are Alkaline Carbonates, 



1 



Il8 AMMONIUM. 

Potassium and Sodium Hydroxides; with the Bcuzoate are Acids, Liquor Potassae, Ferric 
salts; with the Carbonate are Acid salts, Alkaloids, Alum, Salts of Copper, Iron, Lead and 
Silver, Magnesia, Magnesium Sulphate, Mercurous and Mercuric Chlorides, Potassium 
Bitartrate and Bisulphate, Tartar Emetic, Zinc Sulphate; with the Chloride are Alkalies and 
their Carbonates, Alkaline earths, Lead and Silver salts. 

Physiological Action. 

The gas Ammonia is intensely alkaline and irritant to mucous membranes; 
inhaled it causes spasmodic cough and a sense of suffocation. Its prolonged 
inhalation will produce violent inflammation of the air-passages and edema 
of the glottis. It stimulates the nasal branch of the fifth nerve, exciting the 
vaso-motor centre by reflex action, and thus raising the arterial tension. Ap- 
plied to the skin and allowed to evaporate, it has a slight rubefacient effect, but 
if evaporation be prevented it penetrates the epidermis, and has a powerfully 
vesicant action. The Aqua, swallowed undiluted, may cause death quickly by 
suffocation from the action of its vapor upon the air-passages; if not, it may 
excite gastro-enteritis accompanied by coma, differing in the latter respect from 
potassium or sodium poisoning. After absorption it stimulates both the respi- 
ration and the circulation by direct action on their respective nerve-centres. 
Ammonia exists normally in the circulation, where it keeps the fibrin in solu- 
tion and thus maintains the fluidity of the blood. It increases the glycogenic 
function of the liver, and is converted finally into urea. It is a powerful irritant 
to muscular tissue, causing tetanic contraction and subsequent rigor mortis when 
directly applied. 

All Ammonium Salts stimulate and finally paralyze the spinal cord, motor 
nerves and muscles in animals, but the order and intensity of the action vary 
with the salts employed, some having a predominating influence on the cord, 
others on the motor nerves. In general they may be said to form a series, of 
which the members at one end stimulate the cord, and those at the other paralyze 
both the cord and the motor nerves. At the stimulant end are Ammonia and 
the Chloride; at the paralyzant end the Iodide; the Bromide, Phosphate and 
Sulphate lying between (Brunton). In medicinal doses they act on man as 
stimulating expectorants, in large quantity they injure the structure of the red 
blood-corpuscles, and if long continued they produce rapid emaciation by im- 
pairing digestion and increasing tissue-waste. 

The Chloride has decided cholagogue powers, increases the excretion of 
urea, in 20-grain doses is purgative, and is considered to have a selective action 
upon the gastric mucous membrane. The Carbonate is a powerful and very 
diffusible stimulant; when administered internally in moderate doses it is prob- 
ably decomposed by the HC1 of the gastric juice, nascent ammonia being set 
free and absorbed. It stimulates the respiratory centre, acts as a stimulating 
expectorant, and in very small doses stimulates the secretion of the gastric juice. 
It is also emetic, and has been supposed to prevent iodism when administered 
conjointly with potassium iodide. The Solution of the Acetate is an active 
diaphoretic if the body be warm, or a diuretic if it be cool. In wineglassful doses 



AMMONIUM. ng 

it will counteract many of the immediate effects of alcohol. The Phosphate 

is diuretic, and is believed to decompose the insoluble sodium urate in the blood, 
converting it into the soluble salts ammonium urate and sodium phosphate, 
and thus promoting its elimination. The Benzoate is also diuretic, and like 
benzoic acid it passes out of the system in the urine as bippuric acid. It stimu- 
lates the liver, and acidifies the urine where there is a phosphatic tendency 
thereof. The Nitrate and Sulphate are only used for the preparation of other 
salts, while the Iodide, Bromide and Valerate correspond in action to that of 
their bases, and are described under the respective titles, Iodum, Bromum 
and Valeriana. 

Therapeutics. 

The stronger Water of Ammonia may be used as a rubefacient and vesi- 
cant, and its vapor, by cautious inhalation, in syncope and the results of shock. 
Locally, it is a good application to bites of the less venomous reptiles and to the 
stings of insects. The Carbonate is used internally in the eruptive fevers, de- 
lirium tremens, continued fevers, and pneumonia, when much depression exists; 
as a stimulating expectorant in chronic bronchitis, in the broncho-pneumonia 
of children, and in cardiac asthma. It is highly recommended in scarlet fever 
in doses of 3 to 5 grains every one, two, or three hours, all acid drinks or fruits 
being prohibited while it is being administered. With ten-minim doses of 
tincture of capsicum in an ounce of some bitter infusion it is exceedingly effi- 
cient, in 5- to 10-grain doses, for the sinking sensations and craving for stimu- 
lants experienced by subjects of alcoholism. It may be used as an emetic in 
bronchitis, when the tubes are choked with mucus and the circulation of the 
patient is weak. It may also be employed by inhalation, and administered in- 
ternally, for similar purposes as Aqua Ammonias. In doses of 5 grains, ad- 
ministered hypodermically in the vicinity of wounds caused by poisoned arrows, 
it was employed by Parke in Africa, with entire success in saving life when used 
immediately after injury, though those so wounded at too great a distance for 
treatment invariably died within a short time. 

The Chloride has high repute in catarrh of the stomach, with anorexia, bad 
taste in the mouth, flatulence, coated tongue, etc., in short, the symptoms of 
so-called "biliousness"; also, in chronic congestion of the liver, jaundice from 
catarrh of the bile-ducts, nervous and sick headaches, myalgia, amenorrhea, 
muscular rheumatism and neuralgia. In the latter affection it should be given 
in 30-grain doses several times a day. It is also efficient in bronchial catarrh 
without fever, and in chronic bronchitis when the secretion is scanty and tough. 
It is remarkably efficient in straightening up a victim of acute alcoholism; ad- 
ministered to one on the verge of delirium tremens, in dose of \ drachm in half 
a pint of water, swallowed at one draught, it is said to restore the patient's facul- 
ties so quickly as to astonish those who have never seen it so employed. Locally, 
in solution, it has been well employed as a lotion for inflammatory swellings, 
as sprains, inflamed joints, orchitis; also to allay itching in prurigo, to remove 



I2 o AMYGDALA. 

ecchymoses and glandular enlargements. Eau Sedative is often a good local 
application for headaches. 

The Solution of the Acetate is especially beneficial in the exanthemata, 
influenza, coryza, anomalous febrile conditions of children, acidity and vomit- 
ing; also in acute alcoholism and in erysipelas when there is feeble circulation, 
cyanosis and delirium. It is frequently combined with spirit of nitrous ether, 
as a diuretic and diaphoretic in febrile affections. The Phosphate is particularly 
applicable to gout and lithemia, and is a very efficient cholagogue. The Ben- 
zoate is useful in cystitis with alkaline urine and phosphatic deposits, as it acidu- 
lates the urine, at the same time stimulating and disinfecting the mucous coat 
of the bladder. 

Aqua Ammoniae has been administered by intra-venous injection, with effi- 
cacy and safety, in sudden or threatened thrombosis, impending cardiac paral- 
ysis during chloroform anesthesia, and in poisoning by hydrocyanic acid and 
other cardiac depressants. In the same manner, it has been employed, but 
unsuccessfully, in poisoning by the bite of venomous reptiles. Ten drops of 
the stronger Aqua are diluted with three parts of water, and carefully injected 
into a vein, all air being rigorously excluded from entrance into the circulation. 

The therapeutics of the Iodide, Bromide and Valerate are stated under 
the titles Iodum, Bromum and Valeriana respectively. 

AMYGDALA, Almond. — The seeds of two varieties of Prunns Amygdalus, 
nat. ord. Rosaceae, namely Amygdala amara and Amygdala dulcis, are official, 
together with several preparations, some prepared from one variety, some from 
another, while one is from either and one from both. Amygdalin, C 20 H 27 NO n , 
is a crystalline glucoside, existing in Amygdala amara but not in Amygdala 
dulcis; while the ferment Emulsin is common to both varieties. The reaction 
which occurs between these two substances in the presence of water produces 
Hydrocyanic Acid. (See ante, page 74.) 

Amygdala Amara, Bitter Almond, — is the ripe seed of Primus Amygdalus, 
var. amara, a tree of the nat. ord. Rosaceae, indigenous to Asia, but cultivated 
in many other parts of the world, especially in Spain and the Balearic Islands. 
The seed has an embryo of bitter taste, which, when triturated with water, 
emits the odor of hydrocyanic acid. 

Amygdala Dulcis, Sweet Almond, — is the ripe seed of Prunus Amygdalus, 
var. dulcis, a tree of the nat. ord. Rosacea?. The bitter and sweet almond trees 
are identical botanically, and the fruits and seeds of the two varieties resemble 
each other closely, only differing in taste and the presence or absence of amyg- 
dalin (see above). The sweet almond is largely cultivated about Malaga and 
in California. 

Preparations. 

Oleum Amygdalae Amarae, Oil 0} Bitter Almond, — is a volatile oil, of peculiar and aro- 
matic odor, bitter, burning taste, and neutral reaction; soluble in 300 of water, but freely in 
alcohol and ether. Dose, tteJ-j, in mixture, fav. njss.] 

This essential oil should yield not less than 85 per cent, of Benzaldehyde, and not less 



AMVLIS N1TKIS. 12 1 

than 2 per cent, and nol more than 4 per cent, of Hydrocyanic Acid which may be removed 
by distillation with caustic potash. Nitrobenzol, Oil of LVIirbane, closely resembles the oil of 
hitter almond, and like it is used for flavoring. It contains no I [ydroi yanic Acid, hut is a dan- 
gerous poison, producing toxic effects when inhaled, even in small doses. 

Oleum Amygdalae Expressum, Expressed Oil 0} Almond, -is the fixed oil expressed 
from Bitter or Sweet Almond. Used in Uhguentum Aqua? Rosa', and as a bland local appli- 
cation in skin affections. Dose, oj-ojss, [av. 5j-] 

Aqua Amygdalae Amaras, Bitter Almond Water, — is a weak solution of the Oil in Dis- 
tilled Water | 1 to tooo). Is only a flavored water. Dose indefinite, [av. 3j] 

Spiritus Amygdalae Amarae, Spirit of Bitter Almond, (Essence oj Bitter Almond), has 
of the Oil 1, dissolved in Alcohol So, and Water added to 100 volumes. Dose, njjv-x, [av. 

IH'.viij.] 

Syrupus Amygdalae, Syrup oj Almond, — has of the Spirit of Bitter Almond 1 per cent., 
with Orange-flower Water 10, and Syrup to 100. Dose, 5ss-jss, [av. oj] 

Emulsum Amygdalae, Emulsion oj Almond, — has of Sweet Almond 6 per cent., with 
Acacia, Sugar and Water. A demulcent drink, much used as a vehicle for cough mixtures. 
Dose, 3j-vj, [av. oiv.] 

Benzaldehydum, Benzaldehyde, C 7 H e O, — an aldehyde, produced artificially or obtained 
from natural oil of Bitter Almond or other oils; soluble in alcohol, ether, and oils, and in 300 
oi water. Dose, nj£- j, [av. it^ss.] 

Physiological Action and Therapeutics. 

The bitter and sweet varieties of the species Primus Amygdalus differ in 
action only through the agency of the principle Amygdalin contained in the 
former. The Sweet Almond is demulcent and nutritive, while the fixed oil 
expressed from either variety is a bland application, having the same action as 
olive oil. The action of the Bitter Almond and its oil is due to the hydrocyanic 
acid contained in them. 

The Oil of Bitter Almond is used as a flavoring agent, and may be employed 
locally or internally in lieu of hydrocyanic acid. The Syrup is somewhat seda- 
tive, but is generally used as a demulcent or for flavoring purposes. The Emul- 
sion is used in catarrhal affections and as a vehicle for cough-mixtures. The 
poisonous character of the Bitter Almond and its essential oil should be kept 
in mind when prescribing them. Of 39 cases of poisoning by bitter almond 
preparations, the oil caused 28, the spirit 4, the almonds themselves 4, the water 
2, and the emulsion 1. 

The Expressed Oil of Almond is a good demulcent, also laxative in doses 
°f oj to 3ij. It is used externally for excoriations, chapped hands and inflam- 
matory affections of the skin, and may be applied in the external auditory canal 
for earache. Almond Bread is made from the cake remaining after the fixed 
oil is expressed from the sweet almond. The cake is ground into a meal or 
flour, and is an excellent substitute for wheat bread in the diet of diabetics, as 
it contains no starch. 



AMYLIS NITRIS, Amyl Nitrite, — is a liquid containing about 80 per 
cent, of Amyl Nitrite, C 5 H u N0 2 , together with variable quantities of undeter- 
mined compounds. It occurs as a clear, yellowish liquid, of ethereal and fruity 
odor, aromatic taste, and neutral or slightly acid reaction, extremely volatile, 



122 AMYLIS NITRIS. 

insoluble in water but freely soluble in alcohol, ether, chloroform and benzin. 
It is produced by the action of nitric acid upon amylic alcohol, and when impure 
may contain nitric or hydrochloric acid. Dose, — internally "lj-j dissolved in 
alcohol—by inhalation "lij-v; but larger doses are probably safe, [av. "liij.] 

Analogous Compounds. 

Spiritus Glycerylis Nitratis, Spirit oj Glycerl Trinitrate, Spirit oj Nitroglycerin (Spirit 
oj Clonoin), — is an alcoholic solution, containing i per cent, by weight of Glyceryl Trini- 
trate. Dose, truss— ij, [av. njj.] 

Tabellae Trinitrini, (B. P.), Tablets oj Nitroglycerin, — are tablets of chocolate, each 
containing gr. ,,',,; of pure Nitroglycerin. Dose, j-ij. 

Sodii Nitris, Sodium Nitrite, NaN0 2 , and Potassii Nitris, Potassium Nitrite (the latter 
unofficial), — are used as substitutes for Amyl Nitrite and Nitroglycerin. The former is a 
white, crystalline powder, deliquescent in the air, in which it gradually oxidizes to sodium 
nitrate; has a mild, saline taste, but no odor; very soluble in water, slightly in alcohol. Dose, 
gr. ss-iij, [av. gr. j.] according to individual susceptibility. 

.flithylis Nitris, Ethyl Nitrite, C 2 H 5 N0 2 , — constitutes about 4 per cent, of Spirit of 
Nitrous Ether (See page 88). 

Te tranitrin, Erythrol Telranilrate (Unofficial), — occurs in large scales, which are soluble 
in alcohol, insoluble in water, and explode on percussion. Dose, gr. ss-j. 

Incompatibles. 
Incompatible with Amyl Nitrite are Alcohol, Antipyrine, Potassa; with the Nitrites are 
Acetanilide, Antipyrine, Chlorates, Chromates, Gold Chloride, Hypophosphites, Iodates, 
Iodides, Mercurous and Mercuric salts, Permanganates, Sulphites, Tannic Acid, and vege- 
table astringent preparations; with Nitroglycerin are Alkalies, Carbonates, Hydrochloric 
Acid, Hydriodic Acid. Physiologically incompatible are Chloroform, Cocaine, Morphine, 
Strychnine, Ergot, Digitalis, Atropine, Picrotoxin, and all other agents which increase the 
functional activity of the spinal cord and sympathetic, though by reason of their slower rate 
of diffusion this antagonism may not be always available. 

Physiological Action. 

Amyl Nitrite and the other Nitrites agree closely in their general action, 
producing great vascular dilatation by paralyzing either the sympathetic system, 
the vaso-motor centre or the muscular coat of the arterioles, — which, is yet 
undecided. They cause tumultuous action of the heart by relaxing its inhibi- 
tion; lowered respiration, from paralysis of the respiratory muscles and im- 
pairment of the ozonizing function of the blood; diminution of sensation, motil- 
ity, and reflexes; a sense of heat, but lowered body-temperature; also throb- 
bing pain in the head, beating carotids, quickened pulse, flushed face and ver- 
tigo. The effect of an ordinary inhalation of Amyl Nitrite on man is very 
transitory, excepting the headache, which may last several hours. Of all the 
nitrites it is the most prompt but least enduring in action, and is best admin- 
istered by inhalation. It causes sugar to appear in the urine and increases 
the quantity of urine voided. Mixed with blood it forms methemoglobin, 
which is not so readily deoxidized as hemoglobin, and under its influence the 
blood in the body becomes of a dark chocolate color both in the arteries and 
in the veins. 

Nitroglycerin acts similarly, but less promptly, and its action is more en- 
during. Its headache is of intensely frontal character, and persists for hours 
after the other effects have passed off. It is more suitable than amyl nitrite 






AMMIM. 12,3 

for internal administration. Sodium Nitrite is also slower in action than amy] 
nitrite, and does not cause so much throbbing headache as nitroglycerin. It 
may be given in solution with water. The action of all these agents is probabh 
due to the nitrous acid contained in them. Tetranitrin is a vasodilator, acting 
as such by reason of its nitrate constituents. 

Therapeutics. 

The inhalation of Amyl Nitrite is a useful palliative in angina pectoris, 
epilepsy, tetanus, and many of the respiratory neuroses, as spasmodic asthma, 
whooping cough, laryngismus stridulus, etc. It is indicated in migraine of the 
pale-face form, and in the cold stage of intermittents and pernicious remittents, 
to prevent internal congestion, — also in convulsions of various kinds, including 
the puerperal form. It has been sometimes used in threatened death from 
chloroform anesthesia, and in poisoning by strychnine. 

Nitroglycerin is employed with benefit in neuralgic dysmenorrhea and sea- 
sickness; also in chronic interstitial nephritis, by redistributing to the kidneys 
their blood-supply cut off by degeneration of the renal ganglionic centres. It 
promptly relieves hiccough, also migraine of spasmodic character, and has 
afforded immediate relief in neuralgia of the fifth and in sciatica. Its admin- 
istration in angina pectoris, though not producing such prompt results as that 
of Amyl Nitrite, gives excellent and much more lasting effects. It is useful 
in the weak heart of the aged, or that from fatty degeneration, or when, as in 
Bright 's disease, the arterial tension is above normal; also in irritable and 
overacting heart, which it relieves by rapidly dilating the arterioles and thereby 
lowering arterial tension. It is employed with benefit in epilepsy, in alternation 
with bromide treatment. 

Sodium Nitrite has been successfully used in angina pectoris, in hemicrania, 
and in asthma of purely bronchial and neurotic origin. It has proved decidedly 
beneficial in the abnormally high arterial tension of chronic desquamative ne- 
phritis, especially when complicated with a weakened and dilated heart. Dis- 
agreeable symptoms caused by it may be prevented by prescribing it with spirit 
of chloroform or ammonia water and small doses of morphine. 

Tetranitrin is highly recommended in asthma, angina pectoris, arterio- 
sclerosis, interstitial nephritis, gout, and lead-poisoning, for the purpose of 
reducing high arterial tension. Brunton prefers a mixture of Potassium Nitrite 
gr. ss, with Potassium Nitrate, gr. xviij, and Potassium Bicarbonate gr. xxv, 
once daily in a glassful of water. It acts less promptly and less intensely than 
Tetranitrin, but its effects are more enduring. 

AMYLUM, Starch, C 6 H 10 O 5 — is the fecula of the seed of Zea Mays, the 
Maize or Indian Corn, a plant of the nat. ord. Graminese. Though corn-starch 
is the only official kind, any other might be properly used, as the starch occur- 
ring in wheat, barley, oats, arrow-root, sago and tapioca, all of which were offi- 
cial in the U. S. P. of 1870. The last three are almost entirely composed of 



124 AMVLLM. 

h; wheat contains about 70 per cent., and rice nearly 90 per cent. The 
I; P. recognizes the starches from Maize (Zea Mays), Wheat (Triticum sativum) 
and Rice (Oryza saliva); the Ph. Ger. recognizes that from wheat alone. 

irch occurs in distinct grains (granules) which form irregular, angular masses, white, 
odorless and tasteless, of neutral reaction, easily pulverized and insoluble in alcohol, in ether 
and in cold water. In boiling water they swell, burst and form a mucilage which gelatinizes 
ooling and gives a deep blue color on the addition of Iodine, the color disappearing on 
warming and returning on cooling. Under the microscope the granules are seen to be len- 
ricular in form and differing somewhat in size and shape according to the plant from which 
are derived. Those from wheat are large and small mixed and show concentrated stria.- 
formed around a nearly central spot (hilum). Those from maize are smaller, have a hilum 
but no stria?. Those from rice are very minute, polygonal in shape, with a small hilum but 
no striae. 

Starch is converted into grape-sugar (glucose) by the action of diastase, 
ptyalin and pancreatin, also by boiling it with a dilute mineral acid, Dextrin 
being formed as an intermediate product. [See the article entitled Pepsixi-m.] 
By hot, concentrated nitric acid it is converted into oxalic acid, but cold, fum- 
ing nitric acid dissolves it, forming an explosive compound. By the action 
of ferments it is finally converted into alcohol and carbon dioxide. C H 10 O 5 = 
2 C 2 H 5 OH + 2CO,. 

Glyceritum Amyli, Glycerite of Starch, — has of Starch 10 parts, Water 10, Glycerin 80, 
triturated and heated to a jelly. A vehicle for external applications. 

Maltum, Malt, — is the seed of Hordeum distichum, Barley (nat. ord. Gramineae), caused 
to enter the incipient stage of germination by artificial means and dried. The germination 
is allowed to go far enough to develop the maximum amount of Diastase, the peculiar ferment 
by which the starch of the grain is converted into glucose. Malt is the source of beer, ale and 
whisky, and is composed of the germinated, dead grains with their acrospires and radicles. 
It should be fresh, not darker in color than a pale amber, and of agreeable odor and sweet 
taste. 

Extractum Malti, Extract of Malt, — is a liquid of the consistence of thick honey, con- 
taining all the soluble principles of malt in permanent form. It consists chiefly of diastase 
and glucose. Dose, oj-oj, [av. oiv.] 

Unofficial Derivatives and Analogues. 

Dextrin, — is produced by the action of dilute acids on starch, and is an intermediate 
product in trie conversion of starch into glucose. It is a transparent, brittle solid, soluble in 
water and in dilute alcohol, is not fermentable, and is not colored by Iodine. 

Cetraria, Iceland Moss, — is the lichen Cetraria islandica found in northern latitudes. It 
contains Lichenin or lichen starch, which forms as a jelly when the plant is boiled in water; 
also Cetraric Acid. 

Decoctum. Cetrariae, Decoction of Cetraria, — 5 per cent, strength. Dose, oij-iv. 

Horlick's Food, — is, like Mellin's and many other foods for children, a granulated ex- 
tract of malt. Hoff's Mall Extract is another such preparation in fluid form, containing 
alcohol, and corresponding to a concentrated beer. 

Cellulose, C e H 10 O 5 , — forms the basis of all vegetable fibre, and is isomeric with starch. 
It exists almost pure in cotton and in Swedish filter paper. Pyroxylin, Gun-cotton, is dinitro- 
cellulose. 

Glycogen, Animal Starch, — closely resembles starch in its properties, being converted 
into glucose by the same agents which so act on starch. It exists in the liver of all animals. 

Incompatibles. 

Incompatible with Starch in solution are: Acids, Alkalies, Alcohol, Diastase, Iodine, Lead 
Subacetate, Lime-water, Tannic Acid. 






AMVI.UM. 125 

Physiological Action. 

Starch and its derivative grape-sugar arc the chief members of the non- 

oitrogenous group of alimentary principles designated hydrates oj carbon or 
carbo-hydrates, so called because in them the constituent elements II and () 
exist in multiples of the same proportions as in water. Starch is met with 
only in the vegetable kingdom, occurring in the form of granules in many seeds, 
roots, stems, and in some fruits. It is formed by plants from inorganic ma- 
terial under the influence of light, and is stored up in their seeds as food for 
the young seedlings. In order to be absorbed by the animal organism starch 
must undergo digestion by the action of the secretions of the pancreas and 
intestinal glands, which convert it first into soluble dextrine and then into grape- 
sugar, in which form it passes into the blood. 

Food is required by the animal organism for two purposes, (1) to generate 
heat and other forms of force, (2) to repair the waste of the tissues. Both are 
essential to continued life, but the first is even more important than the second, 
for though the body may live a long time while wasting, it dies rapidly when 
the source of heat is removed or greatly lessened. The doctrine taught by 
Liebig — that the nitrogenous principles (albuminoids) are exclusively con- 
cerned in tissue repair, and the non-nitrogenous (starches, sugars and fats) 
in heat-production, — though not strictly accurate, still holds good as describing 
the leading office of each group. 

The carbo-hydrates (starches, sugars, etc.) represent in vegetable food the 
same office which the hydrocarbons (fats) represent in animal food, namely — 
the maintenance of heat-production and other forms of force. The glycogen 
in the liver and in the muscles is a store of insoluble fuel for emergencies, and 
is given up in the form of soluble grape-sugar as required. Any surplusage of 
carbo-hydrates goes to form fat, the adipose tissue of the body, another reserve 
of body-fuel. Being devoid of nitrogen the carbo-hydrates cannot enter into 
the actual structure of the tissues, the instruments of energy, but their oxidation 
supplies the motive power, they being the fuel of the body. When they are 
entirely burnt up and no more supplied the organism perishes of exhaustion. 
The adult human body of average size and weight requires according to its 
activity from 12 to 18 ounces of water-free carbo-hydrate material daily in 
some form of food. 

Starch and sugar occur in vegetable foods in from three to five times greater 
amount than proteid material. The latter exists in greater proportion in the 
leguminous vegetables (peas, beans, lentils) than in meat, but in other vegetables 
the proteid is much less. Cereal grains are by far the most important vegetable 
foods, and among them Wheal is the one most generally used. Its constituents 
correspond with the requirements of the human organism more closely than 
those of any other grain; in fact both life and health can be maintained on 
wheat alone for a very long period. As ordinarily used, however, it is deprived 
of much of its nutritive value, white bread being made from wheaten flour from 



I 



1 26 AMYLUM. 

which not only the indigestible cellulose has been removed but part of the starch 
and sugar and a large proportion of the gluten, which is the proteid material 
of the grain. Brown or Graham bread contains nearly all the nutritive ele- 
ments of wheat and is much more nutritious than white bread. Rye is a valuable 
grain, containing nearly the same proportions of starch, sugar, fat and proteid 
as wheat. Rice contains more starch than the others and its starch is very 
digestible, but it has practically no fat and only the smallest quantity of pro- 
teid. Its nutritive value is small, and it requires an oil and some albuminoid 
to be taken with it in order to make it a suitable diet. Maize is more nutritious 
than rice, but is less digestible. It contains much starch and some fat, but is 
deficient in proteid material (gluten). Oats are rich in fat but contain less 
starch than the other grains, and require prolonged cooking to render them 
digestible. Barley ranks about as wheat, contains rather more proteid and is 
rich in phosphates and iron. It is highly nutritious and was the principal diet 
on which the Grecian athletes were trained. The Potato contains about 20 
per cent, of a very digestible starch, is rich in salts and its juice is highly acid. 
It is an excellent antiscorbutic and is extensively used for food Arrow-root, 
Sago and Tapioca consist almost entirely of starch, without fat or proteid, and 
are readily digested. Peas and Beans contain about 50 per cent, of starch and 
sugar, also 22 per cent, of legumin or vegetable casein, albumin, etc. — a very 
large proportion of proteid material, more in fact than exists in any kind of meat. 
They are rich also in fat and salts, and form the best vegetable substitute for 
animal food. They are somewhat indigestible and require prolonged cooking 
before being eaten; but they are an excellent food, alone nourishing both men 
and beasts for a long time. 

The excessive consumption of starchy food delays tissue-metamorphosis, 
produces a superabundance of adipose tissue, and often causes acidity and 
flatulence. Undigested starch passes into the feces and the urine becomes 
saccharine in many cases. Profound disease does not necessarily follow, but 
if decided corpulence is produced the muscular fibres of the heart and many 
voluntary muscles decrease in size, the cardiac action becomes enfeebled and 
the usual results thereof are manifested. The deprivation of starch can be borne 
well for a long time if fat is taken with the food, but if both starch and fat are 
excluded and nitrogenous material is alone supplied, illness results in a few 
days. [See the article entitled Albumin, page 94.] 

Therapeutics. 
The principal affections in which the carbo-hydrates are imperatively re- 
quired are gastric disorders, diarrhea, dysentery, excessive secretion of bile and 
other hepatic disorders, Bright's disease, alcoholism, gout and rheumatism. 
In acute and continued fevers there is often an almost complete inability to 
take and digest any kind of food. This may last for weeks, the result being 
that the patient dies from so-called exhaustion, in reality starvation due to want 



ANIMU. I \TRACTS. 127 

of furl-food, the human fire going out in the absence of material to feed it. In 
such cases the need of soluble carbo-hydrate food must be supplied. Well- 
baked flour which contains much soluble dextrin, also milk-sugar or grape- 
sugar, should be added to the beef-teas which are so much used in the sick- 
room. Grape-sugar is digested starch and a very soluble carbo-hydrate; it 
may therefore be administered in lemonade or any other drink which the patient 
fancies. In gastric disorders accompanied by much acidity an uncrystallizable 
sugar like grape-sugar is preferable to cane-sugar or beet-sugar, the latter be- 
ing crystallizable sugars and readily undergoing the acetous fermentation. In 
diarrheal conditions the proper food is milk with some digestible carbo-hydrate, 
as arrow-root, sago, or tapioca. Rice-water makes an excellent drink in diar- 
rhea and dysentery, and has often arrested these conditions without medicinal 
aid. In the treatment of Bright's disease and chronic alcoholism a diet of carbo- 
hydrates should be inculcated and animal food reduced to a very small quantity. 
The same rule is imperative in the management of gout, especially when this 
disease occurs in persons of sedentary habits. In acute rheumatism the diet 
should be wholly non-nitrogenous, except for broken-down and debilitated 
subjects, or where serious nervous or cardiac complications exist. 

Starch is medicinally inert. It is employed as a vehicle for medicated 
enemata, as an antidote in poisoning by iodine or bromine, and as a protective 
and absorbent powder applied by dusting over the skin. Mixed with glue it 
makes an excellent stiff bandage for surgical purposes. 

Malt Extract, containing good food elements, is directly nutritive, and indirectly so from 
the presence of the ferment Diastase, which converts the starch of bread or other farinas into 
sugar. It is usefully employed in wasting diseases, and mixed with milk or oleaginous foods 
it aids their digestion and assimilation. It may be used to form a syrupy mixture with prepa- 
rations of Iron or Cinchona. 

Cetraria is nutrient, demulcent and feebly tonic. It has a popular reputation in pul- 
monary affections, and is of value in chronic catarrhs, chronic bronchitis, purulent discharges 
from mucous surfaces generally, also in chronic diarrhea and dysentery. 

ANIMAL EXTRACTS. — The organs, tissues and secretions of animals 
were extensively employed as medicinal agents in ancient times, and many of 
them were official in the pharmacopoeias of the last century. At present the 
only ones recognized in the U. S. Pharmacopoeia are the digestive ferments 
(pepsin and pancreatin), ox-gall (fel bovis), the secretion of the preputial fol- 
licles of the musk-ox (moschus), and the suprarenal and thyroid glands of the 
sheep. The first definite attempt in recent regular practice to apply animal 
tissues to the cure of disease was made in 1852 by Dr. Jackson of Philadelphia, 
who used as a tonic the blood of bullocks carefully dried in vacuo, giving 5 to 
10 grains thereof at a dose. Since then the drinking of fresh bullocks' blood 
has become a common practice in certain diseases. Raw meat was administered 
as a remedy for diabetes at St. Bartholomew's Hospital in London in 1874. 
The powdered Russian cockroach (Blatta orientalis) is still used as a diuretic 



128 ANIMAL EXTRACTS. 

in dropsies, and preparations of the bodies of various spiders and toads, also 
bee and serpent venoms, are recognized remedies in homeopathic practice. 

The use of glandular extracts as remedies in disease is very old. It was 
revived in 1889 by Brown-Sequard's advocacy of orchitic (testicular) extract 
for impotence and several nervous affections, and was profoundly stimulated 
by the results of Dr. Murray's suggestion in 189 1 of thyroid extract for the cure 
of myxedema. According to the theory promulgated by Brown-Sequard, all 
glands, in addition to their ordinary secretions, elaborate certain materials of 
unknown chemical composition, which pass into the blood and perform therein 
definite functions of some kind. We now know that such is the case with the 
thyroid gland, we suspect that it is equally true of the thymus, the spleen and 
the adrenals, and we have reason to believe it highly probable that the other 
glands of the body exert influences heretofore unsuspected over distant parts 
of the organism. 

The effect of the entire removal of the thyroid, the pancreas or the adrenal 
glands is to produce the symptoms of characteristic and fatal disorders; but 
if a portion of either gland be left behind these toxic symptoms do not develop, 
and the same is true of the thyroid and pancreas if, after their entire ablation, 
a portion be engrafted upon the peritoneum. It is evident therefore that the 
disorders so produced are of auto-toxic origin, the result of chemical poisons 
in the blood which were previously neutralized, destroyed or eliminated by the 
removed gland or some of its secretions. It has also been shown that the sub- 
cutaneous injection of an aqueous extract of the dead gland will dispel the 
toxic phenomena which follow the removal of that gland, proving that the active 
principle thereof is a chemical substance existing in the gland itself, and that 
the previous immunity was not due to any action of its living cells other than 
that required to produce the active agent. The discovery that ablation of the 
testicles causes retrogression of the hypertrophied prostate, and that removal 
of the ovaries will cure osteomalacia, as also the long-known facts that castrated 
individuals usually grow very obese and develop massive skeletons, while giants 
are generally endowed with atrophied testicles, — clearly point to the same con- 
clusion. 

The animal extracts form a group of active medicinal agents which are 
worthy of careful investigation both physiologically and clinically. The study 
already given to them has yielded much new knowledge, and has shown in- 
dubitably that their employment as therapeutic agents rests on a scientific 
basis; but most of them are as yet on trial, and the limits of their utility in 
medicine are by no means defined. They contain leucomaines, extractives and 
other chemical substances, all of which possess physiological powers, many 
proving distinctly poisonous when their excretion is prevented. Excepting thy- 
roid extract and perhaps some others, the animal extracts are active medicinally 
only when injected subcutaneously or by the rectum, as most of them are de- 
stroyed or altered in the stomach, or prevented by the liver from entering the 






\\l\l \1. I \ ! KA( IS. 



I 2() 



genera] circulation. Physiological chemists are endeavoring to separate their 
active principles, a line of research which promises more accurate and positive 

results. It is already demonstrated that some of their principles are the most 
powerful of all alteratives, and that others possess the most energetic action 
upon the muscular fibres in the walls of the arterioles. 

The initial doses of many animal extracts should he very small, in order 
to avoid the possible systemic disturbance which has been frequently noticed 
by clinical observers as following on their administration. 

Sodium Phosphate in solution, administered hypodermically, is considered by Luton and 
Crocq, of Rheims, to be equally effective in reconstructive power with the animal extracts. 
(See under the title Phosphorus). 

Thyroid Gland and its preparations are the most efficient as medicinal 
agents of the entire class, especially in the treatment of myxedema, which a 
few years ago was classed among the incurable diseases, but is now considered 
curable by thyroid feeding, or by the use of an extract of the thyroid gland of 
the sheep. Myxedema is a combination of symptoms due to thyroid absence 
or inadequacy, and occurs as a result of the removal of the gland or of disease 
impairing its functional activity. It is characterized by imperfect oxygenation 
of the blood, lowered body-temperature, impairment of intellect, memory and 
speech, also increase and subsequent mucoid degeneration of fibrous tissue, 
with thickening of the skin, drying of the surface and shedding of the epithelial 
structures. When caused by ablation of the thyroid the disease is fatal to cats 
and dogs in a very few days, but their life has been saved by engrafting a por- 
tion of the removed gland in other situations, and also by intravenous injections 
of thyroid extract. This treatment of the idiopathic form of myxedema was 
suggested and commenced by Professor George R. Murray, of the University 
of Durham, in 1891, and has since proved remarkably successful. At first the 
remedy was administered hypodermically, but it was soon found that the raw 
gland fed to the patient was equally efficient, or that a dry extract may be used. 
The latter represents the entire thyroid, divested only of its water, is easily 
administered and proves very efficient, improvement being usually noticed within 
a few days, and going on steadily to apparent perfect recovery if the remedy 
is continued. The thickening of the skin disappears, the normal body heat 
returns, and speech, memory and intelligence are restored. In mild cases re- 
covery is effected in a few weeks, but in severe ones several months of treat- 
ment are necessary; and in most cases the symptoms of the disease return when 
the thyroid treatment is stopped, disappearing again when it is resumed. It 
is probable that the subjects of this disease will require to take a certain quan- 
tity of the remedy regularly and continuously for many years, perhaps for life. 

A large dose of thyroid extract gives rise to marked constitutional symp- 
toms, and several cases are recorded in which it has caused death. Nausea, 
vomiting, neuralgic pains in the back and limbs, cardiac irritability and weak- 
ness even to syncope, slight pyrexia, dyspnea, progressive emaciation, head- 



' 



! »o ANIMAL EXTRACTS. 

ache, diarrhea, nervousness, tremor, pruritus, and insomnia, are the principal 
manifestations of thyroidismus produced by its excessive use. It powerfully 
stimulate- metabolism and elimination, increases largely the secretion of urine 
and the excretion of urea and other urinary constituents, and acts as a specific 
vasodilator, thus inducing perspiration and lowered blood-pressure. In one 
case all the symptoms of diabetes developed under its continuous administra- 
tion for psoriasis (James). In another instance a typical attack of gout came 
on, but subsided when the extract was stopped, and reappeared when it was 
again administered (Harris). 

Thyroid extract has produced great amelioration in cretinism (congenital 
myxedema) which is a thyroid disease, and the improvement has been steady 
and progressive in many cases while the remedy was used, but ceased as soon 
as it was discontinued. In psoriasis, eczema, ichthyosis, pityriasis rubra, lupus, 
universal alopecia and some other skin affections, it has been employed as a 
stimulant of the cutaneous functional activity with most satisfactory results; 
several cases of psoriasis treated with this remedy alone recovering completely 
in the course of a few weeks (Bramwell). In the insanity of the adolescent, 
climacteric and puerperal periods, the thyroid treatment has seemed to be espe- 
ciallv beneficial (Bruce) ; but in several cases of insanity where there was par- 
enchymatous (not cystic) enlargement of the thyroid, the extract was used with- 
out result upon the mental affection though it diminished the size of the goitre 
and caused a marked loss of weight (Reinhold). It is beneficial in simple 
goitre, but is contraindicated in the exophthalmic form. In many cases its 
continued administration has produced emaciation, which fact suggested its 
employment for the reduction of obesity, and it has been successfully used for 
this purpose in many cases (Guttmann). A loss of weight at the rate of from 
2 to n pounds per week is produced in some cases; but after a time a limit is 
reached, beyond which further loss does not occur. Thyroid extract has given 
satisfaction in several other affections, including lupus, ozena, obstinate ulcers 
of the leg, progressive myopathy, endometritis, menorrhagia, uterine fibroma 
and carcinoma, and some forms of syphilis. It has been successfully used to 
promote consolidation in obstinate fractures, having well-recognized effects in 
disordered nutrition of osseous tissue (Gauthier). It has seemed to act as an 
efficient galactagogue in some cases, increasing both the flow and the quality 
of the milk (Stawell). It is contraindicated in diabetes mellitus, also in cases 
presenting much emaciation. 

Iodolhyrin is a proteid substance existing in the gland, and is probably the 
chief active principle, though not the only one. It contains iodine in varying 
amount and a large proportion of nitrogen, also sulphur and phosphorus. So 
far as studied it appears to represent the physiological and therapeutic powers 
of the gland. It is administered in tablet form and in doses of gr. j-v thrice 
daily. Thyreo-an/itoxin, isolated by Frankel, contains no iodine, and seems 
to be inactive. 



ANIMAL EXTRACTS. 



131 



Preparations, 

Glandulae Thyroideae Siccae, Dessicated Thyroid Glands, the thyroid elands of the 
theep, freed from fat, cleaned, dried and powdered. Dose, gr. iij x, [av. gr. iv.] 

Thyroid Extract (Unofficial),- one grain equals ten grains of the crude gland, or one- 
sixth of a dessicated thyroid. Dose, gr. ss, thrice dailj . gradually increased to gr. v. 

Thyroid Tablets (Unofficial), — each tablet contains two grains of dessicated thyroid, 
equal to ten grains of the fresh gland. Dose, j to ij, thrice daily. 

Adrenal Extract. — Ablation of the suprarenal glands in guinea-pigs and 
frogs is followed by serious nervous disturbances, shown by lowering of the 
body-temperature and progressive paralysis, and culminating in convulsions and 
death by failure of respiration. Brown-Sequard made these observations in 
1856, and later showed that the subcutaneous injection of extracts of the healthy 
glands in such cases restored the animals to almost a normal state for a time. 
In 1895 Schafer and Oliver demonstrated that the secretion of these glands 
strongly stimulates the muscular system by direct action, especially affecting 
the vaso-motor apparatus and the cardiac muscle, causing contraction of the 
arterioles and an extraordinary rise of blood-pressure, followed by slowing and 
strengthening of the heart's action through the vagus and the cardiac motor 
ganglia. These effects are of short duration and are produced by a very small 
quantity, the ^th of a grain of the dried gland causing a maximal result on 
the heart and arteries in a dog of twenty pounds weight. The rise of blood- 
pressure is greater than that produced by any other known substance. Locally, 
the extract is a powerful constrictor of the blood-vessels. The active principle 
is rapidly eliminated by the kidneys, and is largely oxidized in the liver. 

Epinephrin, a principle isolated by Abel, is found only in the medulla of 
the gland, and in very small quantity, but it is very active, the g^Vo' of a grain 
per kilo of body-weight producing a distinct effect on the blood-pressure. Taka- 
mine has isolated another principle, named Adrenalin, which is said to mani- 
fest all the properties of the gland substance in greater concentration, being 
the most powerful hemostatic and astringent known, and a cardiac stimulant 
of great energy. It is claimed to be 600 to 1,000 times more powerful than 
the extract, the a ^ 6 b of a gramme (xrEnro of a grain), administered intra- 
venously, producing a distinct effect upon the adult man; and the fraction of 
a drop of a solution of 1 in 10,000 blanching the normal conjunctiva within 
30 to 60 seconds. Its intravenous administration acts powerfully on the mus- 
cular system, especially the muscle of the heart and blood-vessels, causing an 
enormous rise of blood-pressure. It is non-irritant, non-toxic, non-cumulative, 
devoid of injurious properties, and has little or no effect upon the cerebrum. 
It has no anesthetic power in itself, but when used in connection with cocaine, 
holocaine, etc. it prolongs the duration of the anesthesia produced by them. 

By internal administration this extract has given good results in nasal, pul- 
monary and gastric hemorrhage, acute and chronic bronchitis, bronchial asthma, 
congestion and edema of the lungs, edema of the glottis and diabetes insipidus. 
Internally and locally it has proved of very great benefit in the treatment of 



» 



132 ANIMAL EXTRACTS. 

hay-fever. It has been employed in pernicious anemia and diabetes mellitus 
with some benefit in a few cases; also in Addison's disease when the lesion was 
not cancerous or tuberculous. It will be found useful in chronic muscular affec- 
tions, especially those involving loss of tone or degenerative changes, and will 
probably lie found valuable in all conditions in which the vaso-motor tone is 
impaired. Being a powerful but temporary stimulant of the heart it may be 
used cautiously in cardiac weakness, in failure of the heart from any cause and 
in valvular diseases of that organ. 

By local application the angiostenotic properties of suprarenal extract have 
been successfully utilized in the treatment of local congestions, inflammations 
and hemorrhages, especially those of the eye, ear, nose and throat. It is an 
excellent hemostatic for hemorrhage following operations on the nose, and is 
used as an application to inflamed tissues prior to their being anesthetized by 
cocaine, also to the mucous membrane of the turbinated bodies in ulceration 
or hypertrophy thereof. 

Adrenalin has been employed with great satisfaction in all affections to which 
adrenal extract is applicable. Its powerful angiostenotic properties are utilized 
for bloodless operations on the nose and throat, in epistaxis, menorrhagia, and 
other forms of hemorrhage, in asthma, laryngitis, conjunctivitis, coryza, and 
many other affections. Its prompt and powerful stimulation of the heart and 
vaso-motor system will be found invaluable in collapse during anesthesia and 
surgical shock, before cocainization to prevent cocaine intoxication, in opium 
and morphine poisoning, and in sudden failure of the circulation from any cause. 

Preparations. 

Glandulae Suprarenales Siccae, Dessicated Suprarenal Glands, — the suprarenal glands 
of the sheep, freed from fat, cleaned, dried and powdered. Dose, gr. iij-vj, [av. gr. ivj. 
For local use 4 to 50 per cent, sterile aqueous solutions of a glycerin extract are applied, 
as a spray or by cotton swab or a brush; but they should not be used hypodermically, as 
they readily become putrid and may be septic. 

Adrenalin Chloride (Unofficial), — is not stable in its dry form, but is so in solution, 
if protected from heat, light, and oxidation. It is marketed in a 1 to 1,000 solution, con- 
taining 0.65 per cent, of sodium chloride, and 0.5 per cent, of chloretone. This solution 
is diluted for local medication, to 1 in 5,000, or 1 in 10,000. Dose, internally, Ttjrv-x, every 4 
hours; equal to gr. 5^ s - T b^ of the chloride itself. 

Orchitic Extract, Didymin, Testicular Juice, (Unofficial) — was the sub- 
ject of a communication to the Societe de Biologie at Paris, in 1889, from Pro- 
fessor Brown-Sequard, in which the aged and distinguished writer declared 
that he himself had experienced a wonderful degree of rejuvenescence after its 
use, and recommended it as a general tonic for the aged and for subjects of 
impotence or a debilitated nervous system. In subsequent communications 
made to the Academie des Sciences by Brown-Sequard and his assistant 
DArsonval, it was claimed that general paralysis, locomotor ataxia, contrac- 
tures, and certain forms of insanity, also affections due to organic lesions of 
the nervous system or impairment of its functions, are cured or ameliorated 
by injections of testicular juice; and that organic or constitutional diseases 



ANIMAL EXTRACTS. [33 

due to defective nutrition of the organs, as anemia, glycosuria and tuberculosis, 
may be arrested by this procedure. Its remedial effects they held to be due 
to the action of a ferment or diastase contained in the fluid, which replaces the 
natural ferments produced by normal testes and other glandular organs of the 
body. 

resticle Extract is fully noticed in the "Seplasium or the Druggist's Shop Opened," 
by W. Salmon, published about [685. In this hook the author describes the testicles taken 
from man or beast as consisting of "a Flegm, Spirit, Sulphur and Volatile Salt joined with 
some Earthy Particles; the chief used are from Hull, Horse, Goat, Ram, Boar and Buck," 
which were cut out. carefully dried, and used to make a tincture, a spirit, an oil and a volatile 
salt. Salmon further says that "their virtues are very great, for they refocillate the Spirits, — 
Natural. Vital and Animal, — comfort the Head, Brain and Nerves, and resist all Diseases 

afflicting them, .... they restore in Consumptions are also good 

against the Collick, and particularly strengthen the Instruments of Generation and provoke 
Lust." The same extract was also recommended by J. Fr. Leaulte, who wrote in 1 7 1 7. 

>rding to Pliny the ancient Greeks and Romans ate the testicle of the ass for the purpose 
of curing impotence. 

Testicular extract injected into the human subject is said to produce a 
steady increase of oxyhemoglobin in the blood, the cardiac force is strengthened, 
the vascular tone is exalted, and the oxygenation of waste products is promoted, 
as shown by the increased excretion of urea and the lessened amount of phos- 
phoric acid in the urine. Intestinal peristalsis is slightly stimulated, the mind 
becomes clearer and more active, and the body temperature is usually raised 
but may remain unaffected. The crude extract is said to be mildly bactericidal. 
These effects closely coincide with those produced by Spermine (see p. 134), 
and this substance is believed by Poehl to be the active principle of the juice, 
but it does not possess the powerful reconstructive properties of the latter, and 
cannot be efficiently substituted therefor. 

This extract has been employed by many physicians in several diseases, 
often with beneficial results. It is claimed to be a powerful tonic, especially 
in the decrepit subject of old age or exhaustion from wasting disease, as it stimu- 
lates the tissues and organs to renewed activity and endows the body with greater 
strength and with a feeling of increased well-being. It has been used in gen- 
eral adynamia, anemia, atonic gastro-intestinal affections, scurvy, malaria, epi- 
lepsy, cancer, nymphomania, perverted sexual habits, impotence, neurasthenia, 
hysteria, melancholia, diabetes, tuberculosis, hemiplegia, paralysis agitans and 
locomotor ataxia, with more or less benefit according to the reports of its ad- 
ministrators. No specific action is claimed for it in any of these affections, 
but all observers agree that it acts by stimulating functional activity. Many 
of the results observed have been ascribed to mental suggestion, but after the 
application of check experiments in similar cases the weight of evidence seemed 
to be in favor of the remedy. Later clinical results have not confirmed the 
claims made for it, and it is now rarely used in medicine. 

The composition of the emulsion prepared by D'ArsonvaPs process is very 
complex, but it is supposed to include at least four active principles, viz. — 
Phosphorized Albumins, in large quantity, Lecithin, known as phosphorized 



134 



ANIMAL EXTRACTS. 



' 



fat, Spermine, and Nuclein. The first two have undoubted value as nerve 
foods, the third is believed to increase the oxygen-carrying power of the blood 
corpuscles, and the last possesses bactericidal properties. 

D'Arsonval prepared this extract or emulsion in the following manner. The testicles 
of bulls, enveloped in their membranes, washed in a 10 per cent, solution of sublimate, and 
again with sterilized water, are each divided into five or six parts, placed in aseptic glycerin 
(a pint to the pound of testicle) and allowed to macerate therein for 24 hours. An equal quan- 
tity of a 5 per cent, solution of common salt in boiled water is then added, the mixture is 
filtered and sterilized by being subjected to a pressure of 30 atmospheres of carbon dioxide. 
The dose is 10 to 20 minims, hvpodermically once daily or every other day, with strict aseptic 
precautions as to the syringe used and the site of injection; the latter should be washed with 
a 1 to 1000 sublimate solution or a 2 per cent, solution of carbolic acid. The extract seems 
to have little or no effect when given by the mouth, but is efficient when used by the rectum. 

Phospho-Albumen, (Unofficial). Under this trade-name and the sub-title Syrup oj 
Di-Oleyl-Lecithin, an animal extract is prepared in Chicago, which is said to be derived 
solely from the testes, spinal cords and brains of bulls. The juice is sterilized by D'Arsonval's 
carbon dioxide process, and is mixed with simple syrup as a preservative menstruum and 
some flavoring material. It is supposed to contain lecithins, spermine, nuclein, and phos- 
phorized albumins, and is apparently a favorite tonic with many physicians. It is not pat- 
ented, copyrighted or advertised, is sold only on physicians' prescriptions, and its manu- 
facturers assure the profession that so far as their methods of promotion are concerned it 
will remain practically inaccessible to the laity. 

Spermine (Unofficial) has been found in the form of a phosphate in the thyroid and 
thymus glands, the spleen, the ovaries and the blood, as well as in the testes. Poehl believes 
it to be an alkaloidal product of the retrogressive metamorphosis of albumins (a leucomaine), 
and a most powerful intraorganic restorative of the oxidizing properties of the blood. He 
states that it should not be regarded as a specific for any particular malady, but should be 
used as a means of promoting oxidation in the bodv. It has been employed with decided 
benefit in ataxy and delirious epilepsy (Poehl), as a tonic in tuberculosis (Upenski), also 
in senile marasmus and the nervous affections of the aged (Victoroff). The Hydrochlorate 
is used hvpodermically, in doses of J grain twice daily, in the morning and at noon, avoiding 
evening administration, as it may cause insomnia. No reaction follows its injection. 

Brain Extract, Cerebrinin (Unofficial), — is obtained from the gray matter 
of the sheep's brain by digestion in 5 times its weight of pure glycerin and then 
adding an equal quantity of a 12 per cent, solution of common salt. Its effects 
are almost identical with those of orchitic extract, the most noticeable being 
increased strength and a feeling of well-being, regulation of the organic func- 
tions and increase of the cardiac force. It has been employed with benefit 
in locomotor ataxia, neurasthenia and allied affections, nymphomania, per- 
verted sexual habits of cerebral origin, hysteria, melancholia, insomnia, the 
general debility of malaria, chlorosis and even more profound anemias (C. 
Paul); also in cases of defective development of the spinal apparatus, as Fried- 
rich's ataxia. Mental derangement is not helped by it, or at most but tempo- 
rarily. Febrile reaction, cardiac weakness, and prostration, have followed its 
administration. 

The dose is 16 minims (1 Cc.) once daily or every other day, administered 
subcutaneously. 

Cerebrine (Unofficial) an extract of the entire brain of the ox, was prepared by the 
late Dr. Hammond of Washington, by digestion for six months in a mixture of glycerin, 
alcohol, and a saturated solution of boric acid, and filtration through porous stone. The 
dose is 5 minims diluted with an equal quantity of distilled water at the time of adminis- 
tration by hypodermic injection. Hammond prepared similar extracts of the spinal cord 



ANIMAL EXTRACTS. I .■; S 

(mtdvlline), the heart (cardine), the pancreas (paiia-nitinc), etc., and advocated their use 
medicinally on the organopathic theory that they are curative of depressed conditions of 
^responding human organs. 

Bone Marrow Extract (Unofficial). — Rod bone marrow has been long 
known to be one of the sources of the red blood corpuscles, and it is probable 
thai it contains chemical ingredients which may stimulate the production of 
blood cells by other blood -forming organs in which such natural stimulus may 
be lacking. In pernicious anemia the marrow of the long bones shows char- 
acteristic changes, which fact suggested the administration of red bone marrow 
as a remedy for that disease. This treatment has proved remarkably success- 
ful in some cases which were apparently hopeless. It was first suggested by 
Dr. Dixon Mann, who administered a glycerin extract thereof in cases of hemo- 
philia, chlorosis, profuse hematemesis and other anemic affections, with good 
results. It has been used in leucocythemia, with no great success; but it is 
indicated in disorders characterized by hyperfluidity of the blood, from what- 
ever cause; and it may render good service in any debilitating or blood-impov- 
erishing affection, and in convalescence after severe osteitis. The raw marrow, 
freed from spicules of bone, may be administered to the amount of about 3 
ounces daily in divided doses; or it may be given as a paste made with wine, 
glycerin, and gelatin. Tablets, containing from i£ to 5 grains each of the dried 
marrow, are on the market and may be used if preferred. Carnogen is a proprie- 
tary preparation containing red bone marrow and hemoglobin. 

One of the most striking cases of pernicious anemia recorded is that of the gardener 
patient of Professor Fraser of Edinburgh. Under the use of raw bone marrow by the stomach 
his blood corpuscles increased in number from less than 900,000 to over 4 millions per cmm., 
the proportion of hemoglobin rose from 18 to 35 per cent., and the man became well 
enough to resume his occupation. 

Splenic Extract (Unofficial). — Excision of the spleen, or its serious impair- 
ment by disease, is usually followed by marked tissue changes and great suscep- 
tibility to alterations of temperature, especially in malarial subjects. The pos- 
session of bactericidal power by some secretion of the spleen is strongly indi- 
cated by certain facts, among which are the evident incompatibility of tuber- 
culosis and malaria and the enlargement of the spleen in acute infectious dis- 
eases, as though working against pathogenic germs. It has therefore been 
suggested that the splenic substance of animals naturally immune against cer- 
tain of these diseases be employed as a remedy in tuberculosis, malaria, and 
typhoid fever, and it has been used in the latter affection with great benefit. 
Some relation between the spleen and the thyroid body is suggested by the fre- 
quent enlargement of the former organ in myxedema and cretinism. Splenic 
substance has been used medicinally in various disorders of the blood, with 
the idea of supplying to that tissue some material which may be necessary to 
its health; and Dr. H. C. Wood has used the extract in exophthalmic goitre 
with results which indicate that it is worthy of trial in this intractable disorder. 
It has also been found useful in cases of insanity due to physical exhaustion, 



i 



136 ANIMAL EXTRACTS. 

as in puerperal weakness or anemia. Given by the mouth in sufficiently large 
doses it is apt to cause nausea, and when used hypodermically it frequently 
produces local abscesses. 

Thymus Extract (Unofficial). The thymus gland is active only during the develop- 
mental period of life, and becomes atrophied about the age of two years. The suggestion 
has been made that an extract thereof may prove useful in diseases characterized by defective 
development, as rachitis and pseudo-hypertrophic paralysis. It has been used with reported 
benefit in leucocythemia, chlorosis, idiopathic and pernicious anemia, and in Paltauf's so- 
called "status thymicus." It appears to be useless in exophthalmic goitre, but beneficial 
in the other form. Of 30 cases of goitre treated with it 20 were improved but only 2 were 
cured (Kinnicut). A saccharine extract, named Pertussin, has given brilliant results in 
whooping-cough and all forms of bronchial trouble associated with asthma (Fischer). 

Pancreatic Extract (Unofficial). — In many cases of diabetes decided structural changes 
have been observed in the pancreas after death, and the ablation of this gland in animals 
is followed by emaciation and glycosuria; but these symptoms will not occur if a portion 
of the pancreas is left, or if part of it be engrafted on the peritoneum after its removal from 
its proper location. These facts have suggested the probability of the possession by the 
pancreas of power over carbohydrate metamorphosis, through the action of some substance 
elaborated by the peculiar, vascular epithelioid tissue which occurs in isolated patches through- 
out its substance, and which is not found in any other duct-bearing gland in the body. Upon 
this theory the pancreas, both in substance and extract, has been administered as a remedy 
for diabetes, but the results have been negative in nearly all the cases. A few instances are 
recorded in which its use was followed by some temporary amelioration of the symptoms 
of the disease. 

Pineal Extract (Unofficial). — The pineal gland is present during the entire life of the 
individual, and its removal has been followed in animals by structural changes in the central 
nervous system. It is thought that the substance of this gland may act remedially in organic 
and functional affections of the brain attended with failure of cerebral nutrition, as chronic 
softening, chronic mania and dementia. 

Pituitary Extract (Unofficial). — The complete removal of the pituitary body (or gland) 
gives rise to symptoms which occur in a definite order, beginning with lowered temperature 
and loss of appetite, then twitchings, tremors and nervous phenomena, and finally dyspnea 
and death. Many of these symptoms have abated considerably after the administration of 
pituitary gland substance or an extract thereof. This organ has been found enlarged in 
cases of myxedema in which the thyroid was functionally absent, and other observations 
point to some connection between it and the disease known as acromegaly. Internally 
administered it causes increase of the cardiac force, and a rapid rise of blood -pressure due 
to direct contraction of the vessels and slowing of the pulse; also increased elimination of 
phosphates without corresponding increase of the nitrogenous elements. It has been ad- 
ministered with the view of reestablishing perverted brain nutrition and function, also with 
the object of supplying tone and structural growth to the entire nervous and muscular systems, 
on which its secretion seems to act as an alterative. Of 13 cases of acromegaly treated with 
pituitary preparations 7 showed varying degrees of improvement, 5 none, and 1 became 
worse. In 2 cases the violent headache and neuralgic pains in the limbs were diminished, 
and in one case decrease of the affected extremities occurred (Kinnicut). It has been tried 
in epilepsy, but with no benefit, and there is no condition known in which it is of therapeutic 
use (Wood). 

Parotid Extract (Unofficial). — An extract of the parotid gland has been employed by 
Dr. Robert Bell of Glasgow with good results in ovarian disorders, particularly enlarged and 
tender ovaries associated with dysmenorrhea, metrorrhagia, chronic endometritis and sub- 
involution of the womb. 

Ovarian Extract (Unofficial). — The substance of the ovaries has been administered 
with some benefit in the nervous manifestations and pathological conditions which occur 
when the ovarian functions are partially or wholly arrested, as in cirrhosis or malignant Ai>- 
eas . or after the operation of ovariotomy. It is said to be a serviceable remedy in cases of 
depression or other mental disturbance coincident with the climacteric, to relieve ovarian 
congestion and neuralgia, and to be remarkably efficient in the treatment of delayed or scanty 
menstruation. 

Uterine Extract (Unofficial). — The substance of the uterus has been employed as a 
remedy in those disorders and cachexia? which seem to be consequent on the removal of this 



ANIMAX EXTRACTS. 137 

i .mil its appendages. The available data art- not, however, sufficient to enable any 
conclusions to be formed as to its efficac) . 

Mammary Gland Extract (Unoffii ial), has given satisfaction in fibroma and carcinoma 
of the uterus, also in menorrhagia, dysmenorrhea and enlarged and sensitive womb ( Bell). 

Nuclein (Unofficial), — is a proteid substance, possessing a large propor- 
tion of Phosphorus in the form of Nucleink Acid, which is combined with a 
highly complex base, the latter being different in the various tissues. Nu- 
cleins are the chief chemical constituent of cell nuclei, and their number is 
limited only by the varieties of the cells. They are found in both animal and 
vegetable tissues; wherever there is a nucleus we find a nuclein. They are 
generally insoluble in dilute acids, but are soluble in dilute alkalies, and resist 
peptic digestion. Their functions in the organism are supposed to be (1) that 
of a natural antiseptic, to destroy toxic products which may accumulate through 
"aulty elimination, and (2) that of a natural bactericide, to resist microbic in- 
vasion. Two nucleins only have been clinically studied in this country, that 
obtained from yeast-cells and that from the thyroid and thymus glands. 

Nuclein is harmless, causing no functional derangement when administered 
by the stomach or subcutaneously, even in very large doses. When injected 
hypodermically its principal effect is to produce a very marked increase of 
leucocytic activity (an artificial leucocytosis), both in healthy and in tuberculous 
subjects. The increase is observed to affect chiefly the polynuclear leucocytes; 
it varies in degree with the individual, appears within three hours after ad- 
ministration of the nuclein, and disappears after forty-eight hours or there- 
abouts (Huber). The effect is to energize any existing inflammation, or to 
awaken such when comparatively quiescent, as in latent tuberculosis (See). 

Nuclein was introduced into medicine by Professor Vaughn of the Univer- 
sity of Michigan. Its employment as a therapeutic agent is based on the as- 
sumption that for immunity against and the cure of bacillary diseases we should 
look to non-toxic germicides of cellular origin, and to substances which stimu- 
late the activity of those organs whose function it is to protect the body against 
such invasion. As the nucleins apparently fulfil these requirements they have 
excited considerable attention among the advocates of animal extracts. Nu- 
clein has been successfully used in diphtheria, suppurative tonsillitis and other 
suppurative disorders, also in chronic rheumatism and malaria, chronic bron- 
chial catarrh and neurasthenia, and has been employed in tuberculosis with 
encouraging results (Vaughn). In one case an ulcer of twenty years' standing 
was cured in four months by the local application of nuclein. A physician 
reports his own case, one of genito-urinary tuberculosis, as apparently cured 
by nuclein injections. In simple anemia, chlorosis, typhoid fever, debility 
from any cause, and convalescence from acute diseases, such as pneumonia 
and influenza, the beneficial results of nuclein medication are prompt and 
permanent (Aulde). As bactericides the nucleins may prove useful by reason 
of their harmlessness to the human subject. 

Xucleins are prepared from separate animal tissues and glands, as the thy- 



i 



1 



ANISUM— ANTHEMIS. 

roid, thymus, liver, spleen, animal nucleins; also from all the tissues and glands 
combined, protonuclein, and from yeast cells, vegetable nuclein. Vaughn uses 
a solution of yeast nuclein, containing i per cent, of nucleinic acid. The dose 
of this solution is 30 minims, administered hypodermically, and increased daily 
1- long as no unfavorable symptoms appear. Tablets of nuclein are on the 
market, for administration by the mouth, the dose being 1 grain or more, as 
may be deemed advisable. 

Protonuclein (Unofficial), — is the trade-flame of an extensively advertised product, 
which is said to be a combination of nucleins obtained from all the available lymphoid struc- 
tures of bullocks and pigs, including the entire brain, the pancreas, liver, spleen, salivary 
glands, thyroid, thymus, gastric and intestinal glands, etc. The manufacturer claims that 
it is "the true tissue-builder of the organism" and its "natural antitoxic agent," and pub- 
lishes the usual florid literature, which includes clinical reports of the therapeutic efficacy 
of protonuclein in some forty-five different affections. It is sold in tablets and powder; also 
in a special powder containing no milk-sugar, and intended for inhalations and injections. 
The dose is 3 grains every 3 or 4 hours. 

Lymphatic Extract (Unofficial). — An extract prepared from the lymphatic glands -of 
animals has been employed in exophthalmic goitre, lymphadenoma, and other glandular 
swellings, but there are no trustworthy reports as to the results. 

ANISUM, Anise, — is the ripe fruit of Pimpinella Anisum, a European 

plant of the nat. ord. Umbelliferae. It occurs in ovate bodies, \ inch long, hairy, 

of grayish color, aromatic odor, and sweet, spicy taste, resembling conium fruit 

in appearance. Dose, gr. v-x, [av. gr. vijss.] 

Oleum Anisi, Oil 0} Anise, — is a volatile oil distilled from Anise, and represents the 
medicinal qualities of the plant. It contains Anethol, C 10 H,,O, or Anise-camphor, congeals 
at 50 to 5q° F., is soluble in an equal part of alcohol, and is an ingredient of Tinctura Opii 
Camphorata, Trochisci Glycyrrhizae et Opii, and the two following preparations. Dose, 

njrj-v, [av. njyij.] 

Aqua Anisi, Anise Water, — has in 500 parts 1 of Oil of -Anise triturated with Talc, and 
mixed with distilled water. Dose, indefinite, [av. 5iv.] 

Spiritus Anisi, Spirit 0} Anise, — is a 10 per cent, solution of the oil in alcohol. Dose, 
oss-ij, [av. 3j] 

The Volatile Oil is the active constituent of Anise. It has a slightly stimu- 
lant action on the heart and the digestive organs, and liquefies the bronchial 
secretion, being probably excreted in part by the bronchial mucous membrane. 
It is a favorite flavoring ingredient of cough-mixtures, and relieves slight in- 
testinal colic and flatulence in children. In full doses it has weak narcotic 
power. 

ANTHEMIS, Chamomile, — the flower heads of Anthemis nobilis, a European perennial 
of the nat. ord. Composite, collected from cultivated plants. They contain a volatile oil, a 
camphor and a bitter principle, but no alkaloid. Dose, gr. xx- 5 j [av. gr. xxx.] There are no 
official preparations. An infusion ( 5iv to Oj) may be given in doses of oj-ij- 

Oleum Anthemidis, Chamomile Oil (Unofficial), — the volatile oil, is of a dark blue or 
green color, and is composed of various ethers, the Angelates and Valerianates of Butyl pre- 
dominating. Dose, Ttijij-x, on sugar. 

Incompatible with Anthemis are: Cinchona infusion, Gelatin, Iron and Lead salts, 
Mercuric Chloride, Silver Nitrate. 

Chamomile is a stomachic tonic. It improves the appetite and aids digestion by increasing 
the vascularity of the gastric mucous membrane. In large doses the warm infusion is emetic, 
and perhaps diaphoretic, though the latter action is chiefly due to the hot water. The . il 



ANTIMONII \l. 



I 59 



is remarkably efficient in reducing reflex excitability in frogs, even after its excitation by 
strychnine or brucine. 

Chamomile is popular in domestic practice. An infusion is used internally for many 
infantile complaints, and externally as a fomentation to relieve pain, as in colic. The oil 
is very efficient in reflex cough, pulmonary catarrh, acute dyspepsia, diarrhea of children, 
spasmodic asthma, whooping-cough, colic, and the spasmodic and pseudo-neuralgic affections 
of hysterical women. It should prove useful in poisoning by Strychnine, from its power over 
reflex excitability. 

The Chamomilh of the homeopaths is the Matricaria Chamomilla, or German Chamo- 
mile, official in the U. S. Pharmacopoeia as Matricaria, which see. 

ANTIMONIUM, Antimony, Sb. — Metallic antimony is not official, and 

is not used in medicine. It is represented, however, by the following official 

salt and preparations, viz. — 

Antimonii et Potassii Tartras, Antimony and Potassium Tartrate, {Tartar Emetic), 
2K.SbOC 4 H 4 ( ,.H,0, — small white crystals or a granular powder of sweet, disagreeable 
metallic taste, soluble in 17 of water at 59 F., and in 3 of boiling water, insoluble in alcohol. 
It is decomposed by alkalies, and by Lead salts. Dose, gr. j\-$, [av. expectorant gr. -Jg ; 
emetic, gr. A.] but after tolerance is established as high as gr. ij may be given. It is an ingre- 
dient of the two following, viz. — 

Vinum Antimonii, Wine of Antimony, — has of Tartar Emetic 4, Boiling Distilled 
Water 65, Alcohol 175, White Wine to 1000. Contains about 2 grains of Tartar Emetic to 
the 5, and is an ingredient of Mistura Glycyrrhizag Composita. Dose, njv-xx, [av. irgxv.] 

Syrupus Scillee Compositus, Compound Syrup 0} Squill, Cox's Hive Mixture, Hive 
Syrup (see under Sciixa), — contains about 1 grain of Tartar Emetic to the o, with Squill, 
Senega, etc. Dose, ttpj— 5j, cautiously in children, [av. itjjxxx.] 

Incompatibles. 

Incompatible with Tartar Emetic are: Acacia, Acids (mineral), Albumin, Alcohol, 
Alkalies, Ammonia, Ammonium Carbonate, Antipyrine, Bicarbonates, Carbonates, Calcium 
Chloride, Gelatin, Lead salts, Lime-water, Mercuric Chloride, Metallic salts, Sulphides, 
Tannic Acid, and astringent vegetable preparations. 

Physiological Action. 
Tartar Emetic in its action represents the antimonial preparations, and 
is a cardiac, arterial and general depressant, a protoplasmic poison, a systemic 
and local emetic, a specific gastro-intestinal irritant, an expectorant and a dia- 
phoretic. Like aconite, arsenic, hydrocyanic acid and potassium salts, it is 
destructive to protoplasm, destroying function in all nitrogenous tissue, and 
paralyzing the spinal cord, the motor nerves, the muscles and the sensory nerve 
terminations. It is especially depressant to the heart-muscle and the cardiac 
motor ganglia; it combines with the red blood-corpuscles, lessening their oxid- 
izing power, lowering the blood-pressure and reducing the body-temperature. 
Its taste is styptic and one of its earliest effects is the production of constric- 
tion of the fauces. It promotes waste and rapid excretion of waste products, 
carbonic acid and urea being especially increased. Being eliminated by all the 
excretory organs, including the skin, it excites follicular inflammation at the 
points of elimination; resulting in an eruption which is papular at first, then 
becomes vesicular, and finally pustular, the pustules being umbilicated like 
those of variola. This same eruption is also produced by the application of 
the drug to the skin with friction. Aphthous ulcerations, extending from the 



( 



1 40 ANTIPYRINA. 

mouth to the stomach, with salivation and painful deglutition, may also result 
from its continued use. 

In small doses Tartar Emetic stimulates secretion in the bronchial and sali- 
vary glands, the stomach, intestinal canal, liver and pancreas. In larger doses 
it excites nausea, vomiting and purging, with evacuations like the "rice-water 
discharges" of cholera, and great prostration of the vital powers. Toxic doses 
produce similar symptoms, besides epigastric pain, cyanosis, delirium, cramps, 
motor and sensory paralysis, suppression of urine and collapse, — the same phe- 
nomena as in Asiatic cholera. 

Therapeutics. 
Tartar Emetic was formerly much employed as an antiphlogistic on account 
of its power to cut short acute inflammations of sthenic type, but its use was 
greatly abused, so that it has now gone out of fashion as a remedy. The contra- 
stimulant treatment of pneumonia and other inflammatory diseases, by large 
doses of this salt after tolerance was established, is only worthy of reference as 
an historical fact. The same may be said of its external use as a counter- 
irritant as well as of its employment as an emetic, in both of which capacities 
it is too severe, while its emesis is too tardy in action to be of any value in poi- 
soning. It is, however, a very efficient agent in many grave affections, if used 
in small doses (gr. ^V - to); being highly efficacious in acute inflammatory 
affections of the respiratory tract, especially pneumonia, broncho-pneumonia, 
acute edema of the lungs, feverish and catarrhal colds, bronchitis, laryngitis 
and tonsillitis. In many respects it acts like Aconite in these and kindred affec- 
tions, producing copious diaphoresis, slowing the pulse and allaying restlessness. 
It is considered a good remedy in puerperal peritonitis, mammitis, and orchitis, 
in lumbago and other muscular rheumatisms, also in photophobia and in gas- 
tric indigestion after beer-drinking. In still smaller doses (gr. y^ 7 hourly) 
it is particularly efficient in catarrhal inflammations of the respiratory mucous 
membrane in children, accompanied by rattling breathing and much mucus, 
which is expelled with difficult}-. Such cases often simulate asthma, the attacks 
being marked by cough, wheezing, and difficult respiration, with sibilant rales 
in the chest, and usually follow on severe colds or on measles. The Compound 
Syrup of Squill is commonly used as an expectorant and nauseant in the treat- 
ment of bronchitis and croup, but the quantity of tartar emetic in it (gr. j to the 5) 
^'inuld be remembered when administering it to children. (See under Scilla.) 

ANTIPYRINA, Antipyrine, Phenyl-dimethyl-pyrazolon, C u H 12 N 2 0,— offi- 
cial in the B. P. under the name Phenazonum, Phenazone, — is a crystalline 
substance obtained from phenyl-hydrazine, and prepared by a patented and 
complicated process. It is a synthetical base, forming salts which are analo- 
gous to those of Ammonium; and occurs as colorless and inodorous scaly crys- 
tals, with a bitter taste, freely soluble in water, alcohol and chloroform, less 



AXTITYRINA. I.|l 

soluble in ether. It gives a deep red color with ferric chloride, .1 deep green 
with nitrous acid, and with nitric acid a yellow color which deepens to crimson 
on warming. Dose, gr. j-x [av. gr. [v.] 

/><>.*<• and Administration. 
The B. P. gives the dose as gr. v-xx. For children ihe dose is gr. ', per year of age be- 
tween a and 10 years, not exceeding gr. iv for any child under [5 years. It has but little 
Savor, is not unpleasant to the taste, and is readily taken by children. It is best given in 
aqueous solution with one-half its quantity of Sodium Bicarbonate. In capsule or powder 
it frequently irritates the stomach. It may be used hypodermically, in half its weight of 
hot water, hut sphacelus is liable to follow on this method. 

Incompatiblcs. 

Incompatible with Antipyrine are: Alum, Ammonia-water, Amyl Nitrite, Benzoates, 
Beta-naphtol, Bromine, Butyl-chloral Hydrate, Calomel, Chloral Hydrate, Copper Sulphate, 
Chromic Acid, Cinchona alkaloids, Euphorin, Ferric Chloride, Ferric salts in solution, Ferrous 
Sulphate, Hydrocyanic Acid, Iodine, Iodides, Lead Subacetate, Mercuric Chloride, Nitrites, 
( >rthoform, Phenol, Potassium Permanganate, Pyrocatechin, Pyrogallol, Resorcin, Sodium 
bicarbonate, Sodium Salicylate, Spirit of Nitrous Ether, Tartar Emetic, Tannic Acid, Thymol, 
Ure thane; also Tinctures of Catechu, Cinchona, Hamamelis, Iodine, and Rhubarb; and 
Infusions of Catechu, Cinchona, Rose-leaves, and Uva Ursi. 

Antipyrine and Euphorin liquefy when rubbed together. Antipyrine may be decomposed 
when brought into contact with Nitrous compounds, a new and poisonous substance being 
supposed to be formed, of uncertain composition, but resembling the Anilin greens. The 
mixture of this drug with Spiritus /Etheris Nitrosi is therefore highly dangerous if this sup- 
posed reaction is at all likely to occur. 

Unofficial Preparations and Derivatives. 
Acetopyria,— a combination of Antipyrine and Aspirin, has been used with benefit in 
rheumatism and neuralgia. Dose, as an antipyretic gr. vij-xv; in rheumatism gr. xlv-3j- 

Ferropyrin, — is a compound of 3 molecules of Antipyrine with 1 molecule of Ferric 
Chloride, and contains of Antipyrine 64 per cent., of Chlorine 24, and of Iron 12. It occurs 
as an orange-red, impalpable powder, soluble in 5 of water, freely in alcohol, insoluble in 
ether. Incompatibles are Alkalies, Carbonates, and Bicarbonates. Dose, gr. v-viij internally; 
as a styptic a 20 per cent, aqueous solution. 

Hypnal, — is a combination of Antipyrine and Chloral, heated together, which is credited 
with hypnotic and analgesic power. It is described under Chloral. 

Migranin, — is a double Citrate of Antipyrine and Caffein, lately brought forward in 
Germany as a specific for sick headache and neuralgia. A report is published that the police 
authorities of Hamburg have issued a notice forbidding its free sale in the local pharmacies, 
and warning the public against using it except under a physician's direction (Squibb). The 
dose is placed at about gr. xv. 

Phenopyrin, — is prepared from equal parts of crystalline Phenol and Antipyrine. It is 
an oily liquid, colorless and odorless, insoluble in cold and sparingly soluble in hot water. 
It has as yet no medicinal properties. 

Pyramidon, Dimethyl-aniido-antipyrine, — is a derivative of Antipyrine by a substitution 
process, and is highly praised as an antipyretic and analgesic. It occurs as a yellowish- 
white, crystalline powder, soluble in 10 parts of water. Its applications are the same as 
those of Antipyrine, but it is less soluble, slower in action, more lasting in effect, and the same 
results may be produced by it with about one-third the dose. Dose, gr. iv-viij, thrice daily. 

Salipyrin, Antipyrine Salicylate, — is formed by combining Salicylic Acid 57-7, and Anti- 
pyrine 42.3 parts; and is the only salt of the base which has much therapeutic importance. 
Described under Salix. 

Physiological Action. 
Antipyrine is a powerful antipyretic, a local anesthetic, and a general anal- 
gesic, also possessing diaphoretic, mydriatic, antiseptic, hemostatic and slight 
hypnotic powers. After the ingestion of a large medicinal dose (gr. xx), there 



I 4 2 



ANTIPYRINA. 






is a stimulant stage of short duration, in which the heart's action is increased, 
and a subjective sense of heat is experienced, with flushing of the face. This 
is soon followed by profuse sweating, coldness of the surface, slowed pulse, 
considerable depression, and by lowered temperature if fever be present; the 
latter effect coming on within half an hour after taking the drug, and its degree 
being in direct ratio to the quantity administered, as also its continuance, — the 
former usually from 3 to 5 degrees, and the latter from 1 to 10 hours, a fair 
average being about 2 hours. In one case a fall of 12 F. was observed. When 
given with Kairin, the mixture of the two drugs has been found to produce a 
much greater fall of temperature, with longer continuance down, than that 
produced by an equal quantity of either drug given alone. After the anti- 
pyretic effect of the dose has passed off, the temperature in fever commences 
to rise again, — the onset being usually preceded by a chill, which is of slight 
degree when compared with the severe rigors and dangerous depression occur- 
ring under the action of kairin, chinolin and other members of the group. 

In health the administration of a full dose gives rise to slight nausea, sing- 
ing in the ears, and a reduction of the body-temperature of scarcely any extent, 
about T V° F. It slightly raises the arterial tension and blood-pressure; some- 
times induces vomiting and may cause such a degree of depression as to almost 
amount to collapse. It has little or no effect upon the respiration, but acts as 
a sedative upon the cerebrum, leaving a somewhat depressant influence on the 
brain. In some persons a single dose of ten grains produces an urticarial erup- 
tion on the skin, and this is occasionally accompanied by swelling and irrita- 
tion of the mucous membrane of the respiratory tract, the subject feeling as if 
the nose and throat were swollen so that breathing became difficult. 

In toxic dose Antipyrine probably acts as a primary stimulant and a second- 
ary depressant of the spinal cord, paralyzes both the motor and sensory nerve 
trunks, decreases the arterial pressure, and exerts a poisonous influence on the 
blood, altering the shape of the red corpuscles, separating the hematin, and 
causing decomposition of that tissue. A peculiar livid discoloration of the 
surface is one of the most characteristic symptoms of antipyrine poisoning, and 
is probably due to the formation in the blood of methemoglobin or some similar 
compound. 

As an antipyretic, Antipyrine, like alcohol, acts by a double mode of oper- 
ation, — by diminishing oxidation, and by promoting heat-loss. The latter is 
attained by dilating the cutaneous vessels, allowing free radiation from the 
surface, and by the refrigerant action due to evaporation of the sweat. As an 
analgesic it has considerable power, in common with the chinolin derivatives; 
but its property in this respect is found to act almost entirely upon pain due 
to manifestations of the rheumatic diathesis. In general anodyne action, it is 
not to be compared with the derivatives of opium. Its hemostatic power is 
claimed to be superior to that of ergotin. It is rapidly absorbed and slowly 
eliminated, so that it should not be administered in frequently repeated doses. 



ANTIPYRINA. 143 

THEB mm rics. 

One of the most popular of the modern antipyretics, Antipyrine deserves 
high rank in professional esteem, being an excellent analgesic and one of the 
most certain and most powerful depressants of temperature, though somewhat 
dangerous, and devoid of any other influence upon the course of febrile dis- 
orders. Its principal applications are as follows: As an antipyretic it has been 
employed in all diseases with high temperature, and it may be used in asthenic 
fevers, as it has little effect upon the circulation. It has held a high place for 
several years in the treatment of acute rheumatism, and affords valuable aid 
in the pyrexia of intermittent fever, a stage in which the slow action of quinine 
prevents that drug being available for immediate relief. As an analgesic it is 
highly efficient except when the pain is dependent upon a local inflammation, 
in which case it is of no value for this purpose. It is often remarkably effi- 
cient in migraine and other headaches, in the fulgurant pains and pain-crises 
of locomotor ataxia, and in other paroxysms of suffering dependent on disease 
of the nerve centres, or having the character of nerve storms. It is very service- 
able in neuralgia, neuritis and other painful affections, especially when of rheu- 
matic origin, as lumbago, sciatica, hemicrania, supra-orbital neuralgia, in which 
ten-grain doses are generally sufficient and may be given hypodermically. It 
often relieves dysmenorrhea, also the painful affections of hysteria, pain from 
cerebral tumors, and that due to cardiac disease. In acute gout, a preliminary 
dose of 25 grains, followed by 10-grain doses every two hours, promptly relieved 
the pain and shortened the duration of the paroxysms in one very carefully ob- 
served and thoroughly reported case. In chronic gout, very remarkable results 
are reported as due to it, indicating a specific and curative influence on that 
disease. For the relief of pain, the conjoint administration of Antipyrine and 
Morphine is said to be much more efficient than the use of either agent alone. 
To allay nervous irritation; it has been used with extraordinary success in nervous 
urticaria, and is often employed with benefit in the restlessness of hysterical 
subjects. In the urticaria-like eruptions of children its action is so promptly 
efficient as to indicate for it a direct influence upon the vascular nerves; and 
as a symptomatic remedy against itching it is equally efficient in nervous pruritus, 
true prurigo, urticaria, erythema, pemphigus vulgaris and lichen ruber. To 
antagonize excitability of the motor nerve centres, as in laryngismus stridulus, 
whooping-cough, tetanus, epilepsy and chorea. In the latter disease Anti- 
pyrine is held in high esteem as a curative remedy, and although it often fails 
entirely in epilepsy, it sometimes acts therein with extraordinary power, especially 
when given in combination with ammonium bromide. As a preventive remedy 
for whooping-cough it ranks high among the remedies used for that purpose. 
To affect secretion, as in infantile diarrhea, in which it has rendered signal ser- 
vice, administered in doses of \ to i£ grain; and as an antigalactagogue, when 
it is desired to arrest the secretion of milk, doses of gr. iv every two hours will 
prove efficient. It has also been employed with benefit in both forms of dia- 



I 



' 



144 APIOLUM. 

betes, and has been found remarkably effective in promoting the absorption of 
pleuritic effusions. As a local anesthetic it is equal if not superior to cocaine, 
if applied to the mucous membranes in a 30 to 50 per cent, solution (St. Hilaire). 
As a local hemostatic, it is highly efficient in 15 per cent, solution as a spray 
for epistaxis, and hemorrhages of almost any kind are checked by the applica 
tion of stronger solutions. It has the advantage of constricting the small ve 
sels without causing any external clot which may break down. As an anli 
septic though feeble it possesses properties which compare favorably with those 
of the anilin and coal-tar derivatives. 

Antipvrine has rendered good service in bronchial asthma, in sea-sickness 
in cerebro-spinal meningitis, and in croupous pneumonia. In the latter affec- 
tion it has been employed in combination with camphor and small doses of 
morphine with excellent results. In erysipelas it is thought to be contraindi- 
cated, as when administered in that disease it has usually caused anuria and 
a profound fall of temperature. In doses of gr. vij, up to a daily maximum of 
3j, it has rendered good service in puerperal septicemia. The profuse sweat- 
ing caused by it may be prevented by giving in advance a small dose of atropine 
or agaricine. 

Ferropyrin is used as a styptic in 20 per cent, aqueous solution on cotton 
tampons, or applied directly in the form of the powder. It has given satis- 
faction in severe epistaxis, puerperal and other hemorrhages. Internally it 
has been used with benefit in anemic conditions accompanied by headache 
and gastralgia, and in the dyspepsia of chloranemia. 

APIOLUM, Apiol, (Unofficial), — is an oily liquid, of green color, acid 

reaction and pungent taste, soluble in alcohol, ether, chloroform, and in glacial 

acetic acid. It is extracted from the fruit of Petroselinum sativum, Parsley, 

a biennial plant of the nat. ord. Umbelliferae, which also contains a gelatinous 

substance named Apiin, and a Volatile Oil which is by some considered to be 

the true emmenagogue principle of the plant. Apiol is probably a mixture of 

several substances, and as found in commerce is often an impure oleoresin. 

Dose, "uij-x in capsule two or three times a day; as an emmenagogue, i*ix\ 

in one daily dose. 

A camphor, also named Apiol, C^H^O^, is obtained from the same source, and occurs 
in white needles, of a feeble parsley odor, insoluble in water, but freely soluble in alcohol 
or ether. Dose, gr. xv as an antiperiodic, gr. v-s against dysmenorrhea. 

In small doses ("liij-v) Apiol is carminative, diuretic, diaphoretic, expector- 
ant, and stimulant to the circulation. In full doses (»lxv) it is decidedly em- 
menagogue and feebly antiperiodic, but produces headache, tinnitus aurium, 
intoxication, and giddiness, its action generally resembling that of quinine. 
Large doses (»H,xxx--5J) are decidedly narcotic. 

Apiol has had some reputation in intermittents and in malarial neuralgia-, 
but is most frequently employed in amenorrhea and dysmenorrhea, being of 
especial advantage in the amenorrhea of anemia, also when the menstrual 



APOCYNUM — AQUA. i (.5 

discharge is fetid. It is becoming fashionable as a supposed abortifacient, 
but is useless for tin's purpose, and if freely used may produce decided narcot 
i>m, especially it" the preparation employed should happen to be an active one. 
Cases of poisoning by Apiol are seldom seen, as the French preparation in cap 
sules sold in this country over the counters of drug-stores to any applicant are 
generally inert for either good or evil, though an important source of revenue 
to the druggists. 

APOCYNUM, Canadian Hemp, — is the root of Apocynum cannabinum, an indigenous 

perennial plant of the nat. ord. Apocynaceoe, and is inodorous, but of bitter, disagreeable 

taste. It contains a peculiar active principle, Apocynin, also tannic and gallic acids, resin, 

wax, caoutchouc, etc. Dose of the powdered root, gr. v-xxx, [av. gr. xv.] A decoction 

5ss to the pint) may be given in doses of oj-ij thrice daily. 

Fluidextractum Apocyni, Fluldextract oj Apocynum, — ntjv-xxx, [av. njj.xv.] 
Apocynum is powerfully emetic and cathartic in full doses, also diaphoretic, expectorant 
and sometimes actively diuretic. It lowers the pulse-rate, produces much nausea, and in- 
duces drowsiness. It should not be confounded with the Indian and American Hemps 
(Cannabis sativa), which have entirely different qualities. 

The only condition in which Apocynum has proven of much value is dropsy, especially 
ascites and the anasarca of Bright's disease, in which 15-grain doses are indicated. The 
active principle, Apocynin, is a good expectorant, in doses of gr. \ to gr. i. 

Apocynum Androsaemifolium (Unofficial), is said to act chiefly on the liver and the 
mucous coat of the gastro-intestinal canal. It is reported to be an ideal cholagogue and to 
have proved almost specific in the so-called "bilious" condition. 

AQUA, Water, H,0, — is potable water, in its purest attainable state; a 
colorless limpid liquid, devoid of odor or taste, and of neutral reaction. Be- 
sides entering into the composition of most of the official extracts, fluid extracts, 
and many other pharmaceutical preparations, from it are prepared the 17 offi- 
cial Waters (Aquae), and also the following: — 

Aqua Destillata, Distilled Water, — H 2 0, — 1000 parts of water are distilled, the first 
100 parts obtained being thrown away, 800 parts are preserved. It is as near chemically 
pure water as can be obtained. 

Aqua Carbonata, Carbonated Water, Soda Water (Unofficial), — is described under Carbo. 
Incompatible with Water are: Alcoholic extracts and tinctures, Alkaloids generally (not 
their salts), Collodion, Fats, Oils, Resins, Resinous extracts and tinctures, Gum-resins. 

Nomenclature oj Water. 

Aqua Fluvialis, River-water. Aqua Destillata, Distilled Water. 

Aqua Pluvialis, Rain-water. Aqua Bulliens, Boiling Water. 

Aqua Fontana, Spring or Well-water. Aqua Fervens, Hot Water. 

Aqua Marina, Sea-water. Aqua Communis, Common Water. 

AQUA Carboxata, Carbonated Water, Soda Balneum Maris, Warm-water Bath. 

Water. Balneum Vaporis, Vapor Bath. 

Mineral Waters. 
Natural Water differs from distilled water in containing saline and other 
constituents in varying proportions, — from common water (aqua communis), 
in which they are so small in quantity as not to alter the taste, color, etc., up 
to sea-water, having 3^ per cent., and that of the Dead Sea with 26^ per cent. 
Spring waters, impregnated with foreign substances so as to have a decided 
taste and a marked action on the human system, are called Mineral Waters, 



146 AQl'A. 

which may be subdivided into various groups, according to their prevailing 

constituents, as Carbonated, Alkaline, Saline, Sulphuretted, Silicious, etc. Full 

analyses of all the principal mineral waters of Europe and America are given 

in Squire's Companion to the British Pharmacopeia, also in the 15th edition 

of the United States Dispensatory, but a few of the most prominent will be 

mentioned here. 

Alkaline Mineral Waters. 

Ems. Germany. Bladon Spring, Ala. Hot Spring, Ya. 

Salzbrunn, Germany. Congress Spring, Cal. Warm Spring, Ya. 

( 1 Uickenberg, Austria. Seltzer Spring, Cal. Berkeley Spring, Va. 

Vichy, France. St. Louis Spring, Mich. Bethesda Spring, Wis. 

Yals, France. ■ Buffalo Lithia Spring, Va. Gettysburg Spring, Pa. 

These waters are generally cold, those of Vichy and Ems being warm. They contain 
a considerable amount of Sodium Carbonate, also Sodium Chloride and Sulphate, and various 
other Chlorides, Carbonates and Sulphates, with Carbonic Acid gas in varying quantity. 
Vichy and Vals waters depend for their efficacy almost wholly on the quantity of Sodium 
Carbonate contained in them, which is for Vichy from 26 to 50 grains and for Yals about 
60 grains to the pint. 

Saline Mineral Waters. 

Friedrichshall, Germany. Seidlitz, Bohemia. Kreutznach, Prussia. 

Hunyadi Janos, Germany. Marienbad, Bohemia. Saratoga Springs, N. V. 

Baden-Baden, Germany. Cheltenham, England. Ballston, X. Y. 

Wiesbaden, Germany. Kissingen, Bavaria. Hot Springs, Arkansas. 

Carlsbad, Bohemia. Reichenhall, Bavaria. St. Catherine's, Ontario, 

Piillna, Bohemia. Adelheidsquelle, Bavaria. Canada. 

These waters are of more complex composition, the various waters of Saratoga contain- 
ing more than thirty constituent salts. Those usually present are the Sulphates and Car- 
bonates of Sodium, Calcium, Magnesium, etc. (Magnesian waters); Chlorides of Sodium, 
Potassium and Lithium (Chlorinated waters); Ferrous salts (Chalybeate waters), with Iodine, 
Bromine, Manganese salts, and Phosphates in some few. Carbonic Acid gas is present in 
all. Most of them are purgative, some are considered alterative, and manv are warm (ioo°- 
160 F.). 

The most powerful member of the saline group is Hunyadi Janos, which contains about 
150 grains each of Magnesium and Sodium Sulphates to the pint, and is, therefore, effectively 
purgative. Nearly as strong is Piillna water, with 124 grains of Sodium Sulphate and 93 
grains of Magnesium Sulphate to the pint. Friedrichshall is less powerful, but perhaps a 
better aperient water in doses of 6 to 10 fluid ounces. Marienbad contains no Magnesium 
Sulphate, but has 36 grains of Sodium Sulphate, 9 of Sodium Carbonate, 1 1 of Sodium Chloride, 
and a small quantity of Ferrous Carbonate to the pint; in transportation, however, it loses its 
Carbonic Acid and deposits the Iron. It is not aperient in ordinary doses. Carlsbad water 
contains 20 grains of Sodium Sulphate and 9 each of Sodium Carbonate and Chloride to the 
pint. The so-called "Carlsbad Salt" is simply Sodium Sulphate with a trace of the Carbon- 
ate. Hartnack gives the following formula for its artificial preparation; Sodium Sulphate 100 
parts, Sodium Bicarb. 80, Sodium Chloride 40; a dessertspoonful in water as a mild saline 
purgative. These waters are imported into, and made in the United States in large quantities. 
and may be ordered through any druggist. 

Sulphurous Mineral Waters. 
Aix-la-Chapelle, Prussia. Llandrindrod, Wales. Sharon Spring, N. Y. 
Bareges, S. France. Harrowgate, England. Yellow Sulphur Spring, Ya. 

Eaux-Bonnes, S. France. Blue Lick Spring, Ky. White Sulphur Spring, W. Ya. 

These waters all contain Sulphuretted Hvdrogen gas, also Carbonic Acid gas and Car- 
bonates, Chlorides and Sulphates of Sodium, Potassium, Magnesium and Calcium; some- 
times Carbonate and Oxide of Iron, Iodide and Bromide of Sodium. 

Carbonated Mineral Waters. 
These waters are cold, contain generally Carbonates of Calcium, Magnesium and Sodium 
(in some, Iron), which are held in solution by the excess of Carbonic Acid, also Chlorides 
of Sodium and Potassium, Sulphates, Phosphates, etc. They are described under Carbo. 



AQUA. j 47 

Silicious Mineral Waters. 
Hot Springs, [celand. Geysers of Yellowstone Park. 

The constituents of these waters are chiefly alkaline Silicates. 

Physiological Action of Water. 

Water is an essential constituent of all the tissues of the body, forming from 
0.2 per cent, of the enamel of the teeth to 77 per cent, of the ligaments. In 
the liquids of the organism it is contained in the proportions of 78 per cent. 
of the blood to 93 of the urine, and 99 of the tears. 

Cold water applied externally, as by a bath (4o°-6o° F.), abstracts a por- 
tion of the body-heat, lowering the surface temperature and depressing the cuta- 
neous nerves, producing spasmodic breathing and a quickened pulse. If the 
temperature of the water is not too low and the bodily vigor is good, reaction 
>ooa occurs, and the general effect is tonic to the muscular power, to the circu- 
lation and the respiration. If this does not take place a secondary chill occurs, 
and serious depression may result. Internally in moderate quantity during 
meals it is necessary to digestion, but in large quantity it impairs digestion by 
diluting the gastric juice so much as to weaken it. Ice-cold water, if freely 
used, suspends the action of pepsin, depresses the nerves of the stomach, and 
lowers its blood supply. The free use of water internally produces increased 
cutaneous and renal excretion, and promotes the elimination of some of the 
products of tissue-change, as urea and phosphoric acid. In some subjects it 
favors the deposition of fat, and with many persons a glassful of water taken 
before breakfast will act as a laxative. 

Warm water (95°-ioo° F.) applied to the surface of the body, as by baths 
of water or steam, packing, etc., acts in the opposite manner at first, increasing 
the circulation in the skin, the rapidity of the pulse and respiration and the 
body-temperature. Rapid tissue-change occurs, the waste products being elim- 
inated chiefly by the skin and the pulmonary mucous membrane. If long 
continued, precordial oppression, giddiness and muscular debility are expe- 
rienced. Warm water internally often causes nausea and vomiting, but hot 
water, sipped in small quantity frequently, will alleviate these symptoms in 
many cases. 

Hot water (iio°-ii2° F.) at first dilates the vessels of the part to which 
it is applied, and soon afterwards contracts them. It is a valuable means of 
relieving congestion and inflammation, and is a most effective hemostatic when 
the bleeding is from small vessels or of capillary character. Whether generally 
or locally applied it is one of the most reliable means of relieving spasm. Hot 
vapor applied to the surface accelerates the circulation and produces profuse 
sweating. Its general action is similar to that of warm water. 

Mineral waters taken internally act chiefly by virtue of the water, partly 
in accordance with the effects of their various constituents. As baths, their 
action is doubtless entirely due to their temperature. 



1 48 AQUA. 

Pathogenic Microbes of several diseases, notably those of cholera and typhoid fever, 
are conveyed to the human system in drinking water contaminated therewith. But these 
organisms' are destroyed by a temperature of 144 F. in the absence of their spores, while 
a temperature of 212° F., that of boiling water, maintained for five minutes, destroys the 
spores of all pathogenic organisms which have been tested (Sternberg). This fact is of the 
highest practical importance, as it shows that no germs of disease need ever gain entrance 
to our bodies through our drinking water, if only we will boil it. Many years ago an English 
physician's report was quoted in Braithwaite's Retrospect, in reference to the immunity of 
the Chinese from tvphoid fever, though he said that in Pekin there was no system of sewerage, 
but that all excreta were thrown on the ground to find their way into the watercourses by 
which the city was supplied, to soak into wells, etc. Yet, the author said, that contrary to 
all experience elsewhere, typhoid fever was unknown in Pekin. The reason is to be found 
in the fact that the Chinese boil all the water they drink. Those who know them best say 
that they never drink cold water, but always tea, i. e., boiled water. There must be some 
reason for their remarkable health under adverse hygienic surroundings. 

Therapeutics of Water. 

Cold water (or ice) has many external applications of value in the treat- 
ment of disease. As a wet pack it is used in tonsillitis, diphtheria and croup. 
Cold baths are the most effective antipyretic in the high temperature of fevers, 
and the cold wet pack is used for the same purpose. Ice or cold water is ap- 
plied to the head in acute cerebral congestion, and to the spine in chorea; also 
locally in hemorrhoids, bubo, orchitis, and to the uterus in post-partum hemor- 
rhage. Cold affusion to the body is employed as a preventive of spasmodic 
croup, as well as to lessen susceptibility to taking cold. 

Hot water externally, as fomentations, hot wet packs, baths, etc., is most 
effective in reducing local congestion and setting up resolution of local inflam- 
mation. Hot fomentations to the renal region are useful in functional inactivity 
of the kidneys. The hot spinal douche is used in affections of the spinal cord 
and meninges, and in the backache of women. The hot wet pack is highly 
esteemed in inflammation of the thoracic organs. The vaginal hot water douche 
is valued by gynecologists for many morbid conditions of the uterus and its 
appendages, especially catarrh of the vaginal and cervical mucous membrane, 
subinvolution of the uterus, also congestive, swollen and neuralgic conditions 
of the ovaries, tubes and adjacent tissues. The continuous hot water bath 
was commended in skin diseases by Hebra, who administered it in cases of ex- 
tensive burns, psoriasis, pemphigus and variola. The continuous immersion 
in very hot water of an indolent wound, ulcer or sore, is a method of great effi- 
ciency for the promotion of the healing process in cases which have resisted 
the ordinary stimulant applications. Hot water dressings for wounds are strongly 
favored by many high surgical authorities. Vapor and Turkish baths are used 
as diaphoretics in advanced kidney disease, in acute and chronic rheumatism, 
mineral poisoning, and syphilis. Warm baths, with cold applications to the 
head, are esteemed of value in infantile convulsions and chorea. 

Internally, water is chiefly of value as a diuretic, and if hot as a diaphoretic. 
A glass of cold water before breakfast daily is often an effective means of over- 
coming constipation, while the drinking of hot water an hour before each meal 
has been of great value to many dyspeptics. The value of the popular teas in 



AQUA. 140 

chronic diseases is almost entirely due to the diluent, diuretic and diaphoretic 
actions of the hot water used. Large draughts of water at regular intervals 
between meals are extremely useful in renal insufficiency, acute Bright's dis- 
ease, acute cystitis, gravel, and gout, increasing the urinary flow and the ex- 
cretion of urea, washing out the kidneys, lessening renal irritation and pro- 
moting the excretion of uric acid. 

The various methods of introducing water into the body, by enteroclysis, 
hypodermoclysis, and infusion, are of great therapeutic value, and have almost 
entirely replaced the older measure of the transfusion of blood into the cir- 
culation. The normal saline solution (3j of sodium chloride to the pint of 
w iter) is preferred to plain water, as it does not injure the blood corpuscles, and 
prevents the abstraction of vital salts when used in the intestinal canal. Entero- 

Is is the irrigation of the colon by large clysters of water, plain or medicated, 
hot (101 to 103 F.) or cold (65 F.), for the purposes of cleansing the canal, 
relieving intestinal obstruction, promoting diuresis and the elimination of toxins, 
preserving the body heat, and reducing fever; also as a stimulant in shock 
and collapse, and to supply lost fluid after copious hemorrhages, hyper-pur- 
gation, and other drains of the system. From 2 to 4 quarts may be used if 
injected slowly, and with proper position of the subject and suitable appliances, 
the injection may be carried to the caput coli. The medicinal agents usually 
employed are Sodium Chloride 1 to 140, making the normal saline solution, 
Tannic Acid 0.5 to 2 per cent., Boric Acid 1 to 500, Quinine Sulphate 1 to 1000, 
and Silver Xitrate 1 to 1,500; the two latter agents being used in amebic and 
chronic dysentery. Hypodermoclysis is the deep injection into the cellular 
tissue of a sterilized normal solution. When slowly administered, and at dif- 
ferent sites, from £ pint to a pint, at a temperature of about ioo° F., may be 
introduced without much pain or local irritation. The sites usually chosen 
are the thigh, buttocks, back, breast, and in women the sub-mammary region. 
Infusion is the injection of a sterilized normal saline solution, at a temper- 
ature of 120 F., directly into the vascular system, usually through a vein. 
These methods have proved extremely valuable in shock, hemorrhage, sepsis, 
uremia, diarrhea, acute, chronic and amebic dysentery, cholera, typhoid fever, 
poisoning by alkaloids, and other toxemic conditions. 

Therapeutics of the Mineral Waters. 
An undue value is placed by the laity and interested proprietors on the 
medicinal value of mineral waters, causing the various localities of the best 
advertised springs to become resorts for invalids and idlers from every civil- 
ized country. The benefit derived is in most instances due to the change of 
climate and scene, freedom from home cares and business worry, regularity 
of life and diet, drinking of water in quantity, and in many cases the substitu- 
tion of water for alcoholic beverages. In order to get the worth of their money, 
people will gladly submit to rigid hygienic and dietetic restrictions at a water- 



■5° 



ARGENT CM. 



I 



ing-place which they would totally ignore under treatment at home. The same 
may be said of the treatment at the so-called "hydropathic" or "water-cure" 
establishments. As a rule, those springs will prove of most value which are 
furthest removed from the patient's residence, — for "distance lends enchant- 
ment" in these matters as well as in many others. Invalids whose homes are 
in the vicinity of some wonder-working spring will not usually derive much 
benefit from its water, but will by that of another spring, similar in constituents, 
but located several hundred miles away. 

The principal affections in which mineral waters are esteemed most highly 
are the following: dyspepsia, cirrhosis of the liver, gout, rheumatism, lithiasis, 
diabetes of hepatic origin, constipation, strumous disorders, obesity, plethora 
of the pelvic organs, hypochondriasis, skin diseases, especially those dependent 
on gastric derangement, phthisis, constitutional syphilis, and metallic poisoning, 
in all of which the influences above mentioned are especially efficacious, and 
are no doubt the chief factors in producing any benefit which may be attainable. 
Aperient and purgative waters are useful in many cases where a prejudice exists 
against purgative medicine, but none against the same agents in a natural 
water. The strong saline-aperient waters, as Carlsbad, Hunyadi, and Fried- 
richshall, have considerable repute in the treatment of the uric-acid diathesis 
and calculous affections, and the waters of St. Catherine's wells are credited 
with decided influence upon local and chronic rheumatism. 

The special therapeutics of mineral waters are found in this volume under the heads 
of their principal constituents, as Acidum Carbonicum, Sodium Chloride, Sodium Sulphate, 
Magnesium Sulphate, etc.; also in the therapeutical part of the book. 

ARGENTUM, Silver, Ag, — is a white, lustrous metal, which occurs in the 
free state, also as a sulphide, a chloride, and other compounds. It resists the 
action of oxygen and caustic alkalies, but is attacked by sulphur, sulphides, 
and nitric acid. In medicine it is represented by three official salts, and several 
unofficial compounds. 

Official Salts oj Silver. 

Argenti Nitras, Silver X Urate, AgN0 3 , — occurs in colorless rhombic crystals, of bitter 
caustic taste and neutral reaction, soluble in 0.6 of water and in 26 of alcohol. Is best given 
in pill with Kaolin, or in distilled water; never with tannin or a vegetable extract, lest an 
explosive compound result. Dose, gr. \-\, [av. gr. I.] — if watched, up to gr. j may be given. 
When melted with 4 per cent, of Hydrochloric Acid, it makes — 

Argenti Nitras Fusus, Moulded Silver Nitrate, (Lunar Caustic), — for local use as a 
mild caustic and astringent. Argenti Nitras Mitigatus, Mitigated Silver Nitrate, — is the 
same salt melted with twice its weight of Potassium Nitrate. It is used locally by ophthal- 
mologists. 

Argenti Cyanidum, Silver Cyanide, AgCN, — has no medicinal use except for the ex- 
temporaneous preparation of Hydrocyanic Acid. (See p. 73.) 

Argenti Oxidum, Silver Oxide, Ag 2 0, — a brownish black powder, nearly insoluble in 
water and insoluble in alcohol. It is liable to decompose with violence when mixed or trit- 
urated with readily oxidizable or combustible substances, as creosote, phenol, potassium 
permanganate and many others. It should not be brought into contact with ammonia. 
Dose, gr. i-ij [av. gr. j.] in pill with Kaolin. It is not a dangerous internal remedy. 

All the silver salts should be protected from light in dark blue or amber-colored vials. 



ARf.l \ i i \1. 151 

Incompatible*. 

Incompatible with the Nitrate arc: Acetates, Alkalies, Alcohol, Antimony salts, Arsenites, 
Bromides, Carbonates, Chlorides, Chromates, Creosote, Cyanides, Copper salts, Ferrous 
Sulphate. Glucose, Hypophospbites, Iodides, Morphine salts, Oils, Manganous salts, ( >rganii 
substances, Phosphates. Sulphides, Sulphates, Tartrates, Vegetable astringent infusions and 
decoctions. Incompatible with the Oxide are: Antimony and Arsenic Sulphides; Salts of 
Bismuth, Copper, Iron and Mercury; Creosote, Iodine, Organic substances, Phosphorus, 
Tannic Acid. 

Unofficial Silver Compounds. 

Actol, Silver Lactate, — is a white, inodorous and tasteless powder, which coagulates 
albumin and is soluble in 20 of water. It lessens putrefaction in the bowel and constipates 
to some extent. A solution of 1 in 1000 destroys pathogenic microbes within five minutes. 
For gargles, mouth-washes, etc., solutions of 1 in Sooo to 1 in 4000 are used, though stronger 
ones do not irritate. In surgical affections it may be employed hypodermically. In ery- 
sipelas the amount thus administered daily ranges from 7 to 20 grains, but the solution used 
must not be stronger than 1 in 200, lest coagula of the albumin form and prevent the remedy 
getting into the circulation. 

Argentamin, — is a patented preparation consisting of Silver Phosphate 10 per cent., 
dissolved in a 10 per cent, solution of Ethylene-diamine. It is an efficient antiseptic and 
astringent, but the alkaline diamine renders it somewhat irritant. Aqueous solutions of 
various strengths, from 1 in 5000 to 1 in 1000, are recommended as urethral injections in 
gonorrhea. 

Argentol, Silver Oxy-chinolin-sul phonaie , — is a combination of Silver and Quinaseptol, 
and occurs as a sparingly soluble yellowish powder, which is used as a substitute for iodoform 
in wounds, skin diseases, syphilitic sores, etc., also as an injection for gonorrhea. In oint- 
ment the usual strength is 1 or 2 per cent., for injections 1 to 3 in 1000. 

Argonin, — is a patented combination of Silver (4 per cent.), Casein and an alkali, occur- 
ring as a white powder which is soluble in hot water, non-irritant, not precipitated by chlorides 
or albumin, and does not stain the hands or clothing. It is a weaker antiseptic than argenta- 
min or silver nitrate, and has no effect on intestinal microbes. In the conjunctival sac its 
solutions are non-irritant, but it is said to give good results in catarrhal and purulent con- 
junctivitis. In gonorrhea a 2 per cent, aqueous solution is first used, the strength being 
graduallv increased up to 10 per cent. Its solutions should be protected from the action of 
light. 

Argyrol, Silver Vitellin, — contains 30 per cent, of silver, and is very soluble in water. 
It is absolutely painless and non-irritant, even in concentrated solutions on the conjunctiva. 
Solutions of 2 to 10 or 20 per cent, strength are used as local astringents, of 1 in 1000 for 
irrigating the vagina, bladder, and urethra. It is strongly bactericidal and has great pene- 
trative power. 

Collargol, Soluble Metallic Silver, Colloidal Silver, — is an allotropic form of silver, con- 
taining 97 per cent, of the metal. It is soluble in 25 of water. Solutions of 1 in 10,000 
to 1 in 5,000 are used for irrigating the bladder, and as dressings. Dose, by the mouth, gr. 
ij-v; intravenously gr. iij-vij, in J to 1 per cent, solutions in distilled water. 

Unguentum Crede, — is an ointment containing 15 per cent, of Collargol, used for the 
endermic administration of silver. Dose, by inunction, gr. xxx-xlv, thrice daily. 

Ichthargan, Ichthyol Silver, — a compound of silver and ichthyol-sulphonic acid, con- 
tains 30 per cent, of metallic silver in organic combination. Solutions of 1 in 2000 to 1 in 
500 are used in gonorrhea. It is freely soluble in water, diluted alcohol, or glycerin, and 
is claimed to be more strongly bactericidal than Silver Nitrate and far less toxic. 

Itrol, Silver Citrate, — is a fine, light, inodorous and tasteless powder, soluble in 3800 
of water. Even in very weak solutions it is an energetic antiseptic, disinfectant and germicide, 
has a powerfully destructive action on gonococci, is readily borne by the urethral mucous 
membrane, has deep-reaching power but no injurious effect on the tissues, and therefore 
meets all the requirements of an efficient injection for gonorrhea (Werler). In that affection 
the solutions should be very weak at first, 1 in 8000, gradually increased as the inflammation 
subsides until the full strength of 1 in 3800 is reached. 

Largin, — is an albumin-silver compound, containing in the air-dried condition 11 per 
cent, of silver. It occurs as a gray powder, soluble in 10 of water, and is a powerful astringent 
and germicide, non-irritant and not precipitated by chlorides or albumin. It is used in 



J 5 2 



ARGENTUM. 



gonorrhea, the solutions being of \ to i| per cent, strength, according to the stage of the 
affection. 

Nargol, a compound of silver and nudeinic acid, contains 10 per cent, of silver, is 
very -table, soluble in water, and is used in i to 5 or 10 per cent, solutions. It is more stable 
than Protargol and less irritant, in solutions of equal strength. 

Picratol, Silver Trinitro-phenolate, — is a combination of silver and picric acid, contains 
30 per cent, of silver, and is soluble in 50 of water, also in alcohol, glycerin, ether and chloro- 
form. It is markedly antiseptic, alterative, and analgesic. 

Protargol, — is a protein-silver compound, containing 8 per cent, of metallic silver, and 
occurring as a yellow powder, readily soluble in water. It is claimed to be absolutely non- 
irritant, either in the conjunctival sac or the urethra, but its effective solutions are somewhat 
painful. It is highly praised as an antiseptic and astringent application in { to 2 per cent. 
solutions for affections of the conjunctiva, also for wounds and gonorrhea. 

Silver and Sodium Hyposulphite, — is very soluble in water, does not coagulate albu- 
min, and may be given by the stomach or hypodermically. It has been used internally for 
locomotor ataxia and is preferred to silver nitrate for local application to the throat, being 
more agreeable to the taste. It does not stain the skin or the clothing. Dose, by the mouth, 
gr. ss-iij; hypodermically, gr. £-} daily. 

Physiological Action. 
Metallic Silver is antiseptic, probably by forming a lactate with the lactic 
acid produced by microbes. In contact with colonies of germs it kills them 
without exercising any inimical action on the animal tissues (Crede). Locally 
the silver salts are antiseptic, astringent, irritant and caustic, according to the 
strength of the applications. They are less irritant than the salts of mercury 
and more so than the salts of lead. The soluble salts of silver, taken inter- 
nally in medicinal doses, are tonics to the nervous system, increase tissue change 
and promote the secretion of bile; in larger doses they depress the heart, re- 
duce the temperature and impair the respiration; in overdoses they act upon 
the central nervous system, producing tetanic convulsions or paralysis. In 
mammals they affect the medullary centres particular!}-, at first stimulating 
and then depressing them, causing a primary rise of blood-pressure which 
afterwards falls, also slowing and embarrassing the respiration, which finally 
fails from paralysis of the respiratory centre. The heart is but slightly affected 
and often continues to beat for some time after the breathing has stopped. 
The mucous membrane of the stomach and intestines shows congestion, ecchy- 
moses and ulceration, the kidneys are irritated and edema of the lungs often 
occurs. None of these effects have been observed in man, but in him the pro- 
longed use of the silver salts will produce chronic silver poisoning, known as 
Argyria. The first sign of this condition is a slate-colored line along the mar- 
gin of the gums, with some inflammatory swelling. Subsequently grayish 
patches appear on various parts of the skin and mucous membranes, and ex- 
tend over the whole integument, which becomes slate-colored. No organ of 
the body, except the parenchymatous cells and the epidermis, is exempt from 
this pigmentation, which is due to the deposit of silver, either in the metallic 
state or as an oxide or some organic compound, in the connective tissues. In 
the skin it is found in the derma, not in the epidermis. As a rule argyria does 
not produce any serious effect upon the health of the subject, though some 
authorities have ascribed to it gastro-intestinal catarrh, faulty assimilation, 



\Kt.l\ll'M. [53 

changes in the blood, and fatty degeneration of the heart, liver, and kidneys. 
It is probable that in most cases some degree of deranged nutrition is produced. 
A local argyria may be caused by the frequent topical application of a soluble 

silver salt for a long time. In a few cases general argyria has resulted from 
the local use of a silver salt, usually in the mouth or throat; and it appears 
in workers in the manufacture of artificial pearls, who use silver as a pigment. 
Argyria is incurable, though many attempts have been made to remove the 
discoloration by the administration of iodides. The only solvent is potassium 
cyanide, which is inadmissible by reason of its violent toxicity. 

Silver salts unite with albumin to form albuminates, which are soluble in 
the digestive fluids, but it is not certain that silver is thus absorbed. Accord- 
ing to some authorities the salts are reduced in the stomach and also in the 
intestinal canal, the tendency of such action being towards the separation of 
the metal, most of which passes through the alimentary canal unabsorbed, a 
very small portion finding its way through the lymphatics to the tissues and 
remaining imbedded therein indefinitely. 

The Nitrate is the most soluble of the silver salts. It is antiseptic, astrin- 
gent, hemostatic, irritant, and a limited escharotic, also antiphlogistic, antispas- 
modic and tonic. It has a strong affinity for albumin, with which it unites to 
form an albuminate. Locally applied in dilute solution it causes a marked 
contraction of the bloodvessels, but in stronger solutions it is irritant, dilating 
the vessels and acting as a superficial caustic by coagulating the albumin of 
the tissues to which it is applied and destroying their vitality. A dense layer 
is thus formed which prevents the further penetration of the salt and limits its 
escharotic action. This albuminous coating is at first white but soon turns 
black under the influence of light. The stains made by handling or applying 
it to the skin may be removed by washing with a strong solution of potassium 
cyanide, and may in great part be prevented by immediately neutralizing the 
silver salt with a solution of common salt. Internally, in small doses, the Nitrate 
stimulates the heart, promotes nutrition and acts as a nerve tonic. In large 
doses it produces violent gastro-enteritis, corrosion and ulceration of the gastro- 
intestinal mucous membrane, due to thrombosis of its veins. Burning pain is 
felt in the throat and stomach, followed by nausea, vomiting and often by purg- 
ing. Central impairment of the nervous system may occur, with loss of co- 
ordination power and paralysis. Collapse follows, with weak pulse, pinched 
face, coldness of the surface and shallow respiration; and this condition may 
be followed by coma, convulsions, and finally death from paralysis of the respira- 
tory centre. The lethal dose has not been determined. 

Therapeutics. 
The local uses of Silver Nitrate, which are the most important, depend on 
its antiseptic, hemostatic, astringent, caustic and stimulant properties. As an 
antiseptic it has proved an efficient prophylactic against ophthalmia neonatorum, 



'54 



ARGENHM. 



a drop of a i per cent, solution being instilled into each eye of the new-born 
infant. In this disease, when the discharge is purulent, a similar solution 
should be applied to the conjunctiva daily, and when the discharge is very 
profuse a 2 per cent, solution is not too strong. A solution of the latter strength 

ommonly employed in the purulent conjunctivitis of adults, applied once 
daily to the everted lids by a brush, after cleansing and drying the surface; the 
excess being removed by washing with warm water or by neutralization with 
a solution of common salt. When the cornea is intact a solution of J to | of one 
per cent, strength may be occasionally dropped into the conjunctival sac, but 
care must be taken that it does not come in contact with an inflamed or ulcer- 
ated cornea, as it is not well borne in such cases and may cause a permanent 
corneal opacity by the deposit of silver. 

In chronic purulent inflammation of the middle ear Silver Nitrate is one 
of the most valuable applications, in solutions varying from \ of one per cent. 
to saturation, applied by a special syringe through the perforated tympanic 
membrane or by dropping into the external meatus. Aural polypi have been 
successfully treated with solutions of from 6 to 20 per cent, strength. Weak 
solutions are useful in eczema of the ear and in external otitis, also for chronic 
inflammation of the lining membrane of the Eustachian tube, to abort aural 
furuncles, and to relieve pruritus of the external auditory meatus. 

In the local treatment of the nose and throat Silver Nitrate is useful but 
should be employed with care. The stick of caustic is brittle and liable to 
break off while in use, hence it might be swallowed and produce acute poison- 
ing. The danger of general argyria occurring from the prolonged use of the 
salt in this situation should be remembered. For ulcers on the nasal septum, 
vascular granulations arising after operations on the nose, fissures of the tongue 
and lips, and mucous patches and ulcers of the mouth, the fused stick or a moder- 
ately strong solution is a good application. In subacute and chronic laryn- 
gitis a weak solution is sometimes very effective, as it is also in ulcer of the 
larynx when not due to laryngeal tuberculosis. 

In genito-urinary surgery Silver Nitrate has many uses. In solutions of 
various strengths, 1 in 2000 to 1 in 500, it is an old remedy for gonorrhea, ap- 
plied to the urethra during the course of the disease. Stronger solutions, up 
to 5 per cent., have been employed in the early stage with the view of aborting 
the inflammation, but this procedure causes great pain and has many oppo- 
nents as well as many advocates. If it fails to cut the disease short it will prob- 
ably aggravate the inflammation considerably. The milder solutions are use- 
ful applications in chronic gleet, prostatorrhea, urethritis, vaginitis and chronic 
cystitis. In the form of gelatin bougies impregnated with the salt it may be 
applied to the urethral mucous membrane with more facility and with better 
results than by injection with a syringe. A 2 per cent, solution injected into 
the substance of buboes in their early stage has given satisfaction. Indolent 
sinuses from buboes or abscesses may be stimulated to healing by the appli- 



VSGENTUM. 155 

cation of lunar caustic rightly or a strong solution of the salt. It has been much 
used in the treatment of cervical endometritis and erosion of the os uteri. 

In diseases of the skin the Nitrate is employed to destroy parasitic fungi, 
to cause exfoliation of the epidermis and for stimulant effect upon indolent 
ulcers and sores. Lunar caustic is used to destroy warts and other small growths, 
to arrest capillary hemorrhage, and for other similar purposes. Solutions of 
various strengths are useful in some forms of eczema, relieve the itching in 
prurigo and lichen, and are said to prevent pitting in variola. It is a very 
efficient application in pemphigus, if used in a 4 per cent, solution to the sur- 
face of the derma, after removing the epidermis over the blebs and cleansing 
their bases of all secretion. Chilblains may be painted with a strong solution 
to relieve the irritation, and in lupus, psoriasis, erythema and ringworm, solu- 
tions of this salt have been applied with satisfactory results. In erysipelas 
a concentrated solution, 20 grains to the drachm, was formerly applied on the 
inflamed surface and over the healthy skin beyond, to the extent of two or three 
inches, after washing and drying the part, with the object of checking the spread- 
ing inflammation or at least rendering it less severe; but this procedure has 
been superseded by other methods of treatment. For application to the skin 
a solution in Spirit of Nitrous Ether is recommended. This solution deposits 
a light-colored precipitate but itself does not turn black like the simple alcoholic 
solution. It blackens the skin however in a shorter time than any other solu- 
tion. 

In general surgery the moulded stick (lunar caustic) is much employed to 
cut down exuberant granulations in suppurating wounds, and to stimulate the 
healing of indolent ulcers, sores and sinuses. Bedsores may often be pre- 
vented by painting the red but unbroken skin with a 2 to 4 per cent, solution. 
Cysts and hydroceles may be cured by the injection of a strong solution into 
them after evacuating their contents, the result being the exciting of an adhesive 
inflammation which obliterates the sac. 

The internal use of Silver Nitrate is almost wholly confined to the treat- 
ment of affections of the gastro-intestinal tract. Its astringent and tonic actions 
are sometimes very efficient in cases of weak and irritable stomach accompanied 
by great depression of spirits, morbid apprehensions and want of courage. It 
is employed in persistent vomiting, in chronic gastric catarrh, in hematemesis, 
and in gastric ulcer. When given for stomach affections it should be admin- 
istered when the viscus is empty. Chronic gastritis has been treated with 
benefit by irrigating the stomach with solutions of various strengths, from 2 
to 4 grains gradually increased to 20 grains in 6 drachms of water, immediately 
followed by a 3 to 5 per cent, solution of common salt. The Nitrate has often 
proved of value in chronic inflammation of the large and small intestine, espe- 
cially where there was ulceration of the intestinal mucous membrane. It has 
done good service as an internal remedy in acute dysentery, and in chronic 
dysentery a solution of 20 to 30 grains to the pint of distilled water as an injec- 



1 56 ARGENTUM. 

tion into the colon has given satisfactory results in many cases, and is considered 
one of the most valuable methods for the treatment of that affection. As an 
internal remedy it has rendered good service in cholera infantum after the acute 
symptoms abated, and has given marked relief to the pain in catarrh of the 
biliary ducts. Its employment in spinal sclerosis, glosso-labio-laryngeal paral- 
ysis and similar affections has not proved very successful, but it is said to be 
one of the few remedies which are of any service in locomotor ataxia. It was 
formerly used as a nerve tonic in epilepsy, but has been superseded by other 
agents which are less objectionable and more efficient. It has cured epilepsy 
where the bromides have failed, and it is an established fact that patients who 
have been subjected to a course of silver medication which has produced a de- 
posit of the metal in the tissues possess a remarkable degree of immunity from 
various minor nervous ailments. It may be inferred that a remedy which is 
deposited in the tissues may interfere by its presence with the chemical activity 
of adjacent atoms, preventing their explosive union (Murray). 

Several silver compounds have been introduced as substitutes for the Nitrate, 
with the view of obtaining greater penetrative local action, as the latter salt is 
decomposed by the proteids and chlorides of the tissues and possesses only limited 
powers as an antiseptic and astringent. These compounds are marketed under 
various trade-names (see pages 151 and 152), and are used with satisfaction 
as local applications in gonorrhea, conjunctivitis, otitis media, laryngitis, pharyn- 
gitis, dysentery, erysipelas, empyema of the antrum, cystitis, and other inflam- 
matory and suppurative affections. Protargol has probably been the most 
popular, though Neissen states that the results of 870 cases of gonorrhea treated 
therewith show that the average duration of the disease is not lessened by this 
agent more than by other recognized methods of treatment. Collargol has been 
used internally, by inunction, and by intravenous injection. It is said to cause 
marked and rapid leucocytosis, to be completely excreted within a month, to 
be incapable of producing argyria, and to have inhibitory action in the blood 
on bacteria. It has been used with benefit in skin and venereal diseases, local 
suppurations, and septic disorders; also in diphtheria, scarlet fever, pneumonia, 
pericarditis, and typhoid fever. 

The Oxide is the least irritant of the silver salts and does not discolor the 
skin so quickly as the nitrate, but eventually the same result follows its con- 
tinued administration. It has been employed with more or less success in gas- 
tric neuralgia, irritable dyspepsia, pyrosis, gastric and pulmonary hemorrhages, 
dysmenorrhea, menorrhagia and other uterine affections, also to check profuse 
sweating, to relieve vomiting even in severe gastritis, and to control diarrhea 
depending on reflex nervous irritation. As an ointment, 5 to 10 grains to the 
drachm of lard, it is employed for application to venereal sores and to the ure- 
thra in gonorrhea. 

A course of silver medication should be regulated by suspending the remedy after 5 or 
6 weeks' use, then promoting elimination by purgatives, diuretics and baths. To prevent 
the general discoloration Potassium Iodide may be given conjointly with the silver, and 



UtNICA. 157 

baths of Sodium Hyposulphite used frequently. The dark line .11 the margin of the gums is 
removable by a course of the Acid Tartrate of Potassium. Argyria lias been produced in 

three months and after the use of 5*s-j of the nitrate. 



ARNICA, Arnica, — is the dried flower heads of Arnica Montana, Leopard's 
Bane, a perennial of the nat. ord. Composite, indigenous to the mountains of 
Northern Europe and Siberia, and said to have been found in the mountains 
about the headwaters of the Missouri and Columbia rivers. It has large orange- 
yellow flowers and a small, curved rhizome with several rootlets. It contains 
two alkaloids, Arnicine and Cytisine, the latter being probably identical with 
the active principle of Cylisus laburnum, the Laburnum; also Trimethylamine 
(CH 3 ) 3 N, an ammoniacal alkaloidal principle, which has been looked upon as 
the active ingredient. Arnica also contains Inulin, Capronic and Caprylic 
Acids, tannin, mucilage, resins, and two essential oils, one in the flowers, the 
other in the root. Dose, gr. v-xx, [av. gr. xv.] 

Preparations. 

Tinctura Arnicas, Tincture oj Arnica, — strength 20 percent. Dose, irjv-xxx, [av. njjxv.J 

Infusum Arnicae, Infusion oj Arnica (Unofficial), — Arnica flowers 20, to 100 parts 
of water, is thought by many observers to be the best form for local use, as it does not excite 
dermatitis, probably from containing none of the Volatile Oil. 

Trimethylamina, Trimethylamine, C 3 H 9 N (Unofficial), — is a thin, colorless, strongly 
alkaline liquid, boiling at 49 F., and at ordinary temperatures a colorless, inflammable gas. 
The Hydrochloride is the most stable salt, crystallizing in white or colorless prisms, nearly 
odorless, of pungent taste, very deliquescent, freely soluble in water and in alcohol. Dose, 
gr. ij-iij in syrup even- 2 hours. 

Trimethylamine has been obtained from Arnica flowers and those of several other plants, 
from Ergot, Hops, Codeine, Cod-liver Oil, and decomposing albuminous substances, such 
as human urine, herring-pickle, and the residue left in making sugar from beets. It is some- 
times incorrectly named Propylamine, a term also applied to an impure trimethylamine, but 
in reality an allied and isomeric compound. 

Incompatiblcs. 
Incompatible with Arnica preparations are: Acids (mineral), Ferrous Sulphate, Lead 
Acetate, Zinc Sulphate. 

Physiological Action and Therapeutics. 
Arnica is irritant, stimulant, depressant, antipyretic, diuretic and vulnerary. 
It irritates the gastro-intestinal tract, and in some persons the local use of al- 
coholic preparations of the flowers will excite erysipelatous inflammation of 
the skin, though those of the root have not been observed to do so. In small 
doses internally it increases the action of the heart, raises the arterial tension 
and stimulates the action of the skin and the kidneys. Large doses produce 
a transient excitement, followed by depression of the circulation, respiration, 
and nerve-centres; headache, unconsciousness, and even convulsions being 
induced, the body-temperature lowered, the pupils dilated, and muscular par- 
produced. A toxic dose paralyzes the nervous systems of animal and or- 
ganic life, causing collapse and death. Cytisine is a powerful central emetic, 
and in large doses paralyzes the motor nerves. Its direct action on the circu- 



158 



ARSEXUM. 



lation is slight ; toxic doses cause a gradual lowering of arterial pressure, and 
death by respiratory paralysis. 

Arnica is a popular remedy with those who patronize the so-called homeo- 
pathic school of practice, but like many other agents which the homeopathists 
claim to have given to medicine, it is a remedy much older than homeopathy, 
and was investigated originally by regular physicians, notably by Van der Kolk 
in the sphere of mental affections. Externally, the tincture in water has a popular 
reputation in sprains and bruises, though an infusion is better for local use. 
Ecchymoses are rapidly dispersed by its administration internally as well as 
externally; and for internal bruises from shock or concussion its internal use 
has proven very efficacious. The aqueous preparation applied locally promotes 
the rapid union of cut surfaces. 

Internally, besides its value as previously noted, Arnica is employed effec- 
tively in typhus and typhoid fevers as a stimulant and antipyretic; also in de- 
lirium tremens, rheumatism and rheumatic gout, hemorrhages, epistaxis, hemop- 
tysis, amaurosis, concussion of the brain, chronic dysentery and paralysis of 
the bladder, it has rendered good service. In idiopathic mania, after the first 
excitement has diminished. Arnica, in aqueous preparation internally, has 
given great satisfaction. It has often checked an exhausting diarrhea after 
many other remedies have failed. 

Trimethylamine is an active escharotic and a gastro-intestinal irritant. It lowers the 
rate and force of the heart, decreases the body-temperature, and diminishes (though some- 
times increases) the excretion of urea. The Hydrochloride is a powerful antipyretic in doses 
of gr. ij every 3 hours. It has been found useful in acute rheumatism and gout, relieving 
pain, reducing temperature, and diminishing the frequency of the pulse. In chronic rheu- 
matism, as a liniment (1 part to 3 of Glycerin), it is said to give relief equal to that produced 
by any anodyne. It has been used with benefit in chorea, moderating the spasmodic move- 
ments when not suspending them entirely. 

ARSENUM, Arsenic, As. — The metal Arsenum exists in many minerals, 
and occurs in the free state, as a sulphide, and in combination, especially with 
iron, nickel, and cobalt. It is represented in medicine by its Trioxide and 
Iodide, Sodium Arsenate, and Potassium Arsenite, which are official; also by 
several unofficial compounds. The Trioxide (arsenous acid) is obtained by 
roasting native arsenides and condensing the fumes in a horizontal chimney. 

Official Compounds and their Preparations. 

Arseni Trioxidum, Arsenic Trioxide, (Arsenous Acid), As 2 3 , — is a heavy, white solid, 
occurring as an opaque powder, or in semi-transparent masses having usually a striated 
appearance, soluble in 30 to 80 of water at 59 F., the solubility varying with its physical 
condition, also soluble in 15 of boiling water, in alkalies and their carbonates, in hydrochloric 
acid and in glycerin. It is volatilized at 424. 4 F. without melting, and when thrown on 
ignited charcoal it emits an alliaceous odor. It floats when sprinkled on water, though its 
weight is about 3J times that of the corresponding bulk of the fluid on which it rests. 
Dose, gr. & - t's- [av. gr. &.] 

Liquor Acidi Arsenosi, Solution oj Arsenous Acid, — is a 1 per cent, solution in HC1 
and Distilled Water. Dose, njjij-vj, thrice daily in water after meals, [av. njjiij.] 

Liquor Potassii Arsenitis, Solution of Potassium Arsenite (Fowler's Solution), — is a 
1 per cent, solution, prepared by boiling together Arsenous Aci, 1, Potassium Bicarbonate 



ARSENUM. ijg 

imp. Tincture of Lavender 3, and Distilled Water to 100. Dose, utiij-vj, [av. ii^iij.J 
in water thrice daily after meals. 

Sodii Arsenas, Sodium Arsenate, i\a,IIAs<>, I 7 1 1 L . < > , is a salt of the second oxide, 
Irseiiic Acid, AsjOj. Occurs in colorless prismatic crystals, of feebly alkaline taste and 

reaction, soluble in (.of water at 50 F., very soluble in boiling water, hardly soluble in ale -oliol. 
gr. .' i. [av. gr. ,',,.] 

Sodii Arsenas Exsiccatus, Exsiccated Sodium Arsenate, an amorphous, odorless, white 
powder, very poisonous. [I) >se, gr. fo—H's [ av - S r - :'"■) 

Liquor Sodii Arsenatis, Solution oj Sodium Arsenate, (Pearson's Solution), — is a 1 per 
cent, solution of the dried Arsenate in Distilled Water. Dose, njfij-vj, [av. njjiij.] in water 
after meals. 

Arseni Iodidum, Arsenic Iodide, Asl 3 , — occurs in glossy, orange-red crystalline masses 
or scales, gradually losing iodine by exposure to the air, soluble in 7 of water and in 30 of 
alcohol at 50° F.; is gradually decomposed by boiling water and by boiling alcohol, and is 
completely volatilized by heat. Dose, gr. 5 V~i> t av - g r - tV] 

Liquor Arseni et Hydrargyri Iodidi, Solution of Arsenic and Mercuric Iodide, (Dono- 
Solution), — has Arsenic Iodide and Mercuric Iodide, of each 1 part in 100 of Distilled 
Water. Dose, njjj-v [av. itRjss], in water after meals. 

Unofficial Arsenum Compoinids. 

Cupri Arsenis, Cupric Arsenite, — occurs in the various cupro-arsenical pigments used 
for wall-paper coloring and as insect-poison, viz. — Scheele's green, Mineral green, Paris green, 
etc. Is highly poisonous. Dose, gr. T J C daily, in divided doses. 

Liquor Arseni Bromidi, Solution oj Arsenic Bromide, Clemens' Solution, — is properly 
a Liquor Potassii Arsenatis et Bromidi, and contains 1 per cent, of the arsenic salt. It is 
prepared by boiling together Potassium Carbonate and Arsenous Acid, oj of each in §x 
of distilled water, until a clear solution is formed; when cold 5ij of Bromine and 5-rij of 
water are added, and the mixture is allowed to stand until all color disappears, when it is 
ready for use. Dose, njfj-v, thrice daily in water after meals. 

Solutions of the Bromides of Arsenic and Gold (Arsenauro), of Arsenic, Gold and 
Mercury (Mercauro), of Arsenic, Gold and Calcium (Calcauro), and of Arsenic, Gold and 
Manganese (Manganauro), are described under the title Aurum. 

Atoxyl, — is the trade-name of an Amido-benzene compound of Arsenum, containing 
38 per cent, of arsenic oxide, and occurs as a colorless, odorless, and almost tasteless powder, 
soluble in ith its weight of warm water. Dose, hypodermically, gr. T V-J at first, gradually 
increased up to gr. iij. 

Cacodylic Acid, D imethyl-arsenine Hydrate, — is an organic arsenical compound con- 
taining the equivalent of 71 per cent, of arsenic oxide. Its Sodium, Magnesium, and Ferric 
salts have been used internally and intravenously. Dose, of Sodium Cacodylate, gr. J-j; 
twice daily after meals. 

Arrhenal, Disodic-methyl Arsenate, — is soluble in £ its weight of water, insoluble in 
alcohol, and is said to act with greater therapeutical effect than the cacodylates, especially 
in chronic malaria. Dose, gr. J-j, thrice daily. 

Incompatibles. 
Incompatible with Arsenous Acid and the Arsenites are: Hypophosphorous Acid and 
the Hypophosphites in acid solution, Dialyzed Iron, Iron salts and salts of the other heavy 
metals, Lime-water, Magnesia, Potassium Iodide, Silver Nitrate, Sulphides, Tannic Acid 
and Vegetable astringent decoctions and infusions. With the Iodide as for other iodides 
(see under Iodum). 

Tests for Arsenic. 
The principal tests are simple and should be known by every physician. (1) Reinsch's 
Test, — Hydrochloric Acid and a clean strip of Copper are boiled with the suspected fluid; 
a dull steel-colored deposit of copper arsenide will appear on the copper if arsenic is present. 
(2) Marsh's Test, — Zinc and diluted Sulphuric Acid are placed in a flask with the suspected 
liquid to produce nascent hydrogen, and the gas issuing from the tube is ignited, and a clean 
porcelaine plate is brought into contact with the flame. If arsenic is present the gas will 
contain hydrogen arsenide (arsin) and on the plate will be formed a steel-blue mirror of 
arsenum, which is distinguished from that formed by antimony by being soluble in a solution 
of potassium hypochlorite (bleaching-powder). 



160 ARSENUM. 

Physiological Action. 

Arsenic Trioxide, applied to the skin denuded of its epidermis, acts as a pain- 
ful escharotic, producing violent inflammation and resulting in a slough which 
forms a barrier to its absorption. If applied in dilute solution over a large 
surface, it will be absorbed, and may produce the systemic effects described 
below. 

In small doses it is a stomachic and general tonic, promoting the appetite 
and digestion, increasing the cardiac action, the respiratory power, and the in- 
testinal secretions; stimulating peristalsis, exalting mental activity and the 
sexual appetite, and producing a fair skin and a rotund form. When tolerance 
of the drug is established, large doses are used with impunity, as by the arsenic 
eaters of Styria, who can swallow at once as much as 5 grains with safety. They 
are careful, however, not to take any water into the stomach at the same time, 
so that the dose is slowly absorbed, and probably eliminated rapidly. Not all 
those who begin its use can acquire tolerance of it, but those who do so seem 
to continue it without injury, and live to an old age, undergoing great exertion 
without exhaustion, and being enabled to ascend steep mountains withont 
difficulty of respiration. 

In full medicinal doses, continued for some time, it causes itching and edema 
of the eyelids, ptyalism, nausea and vomiting, diarrhea or dysentery, epigastric 
pain and soreness, feeble and irritable heart, dyspnea, disordered sensibility, 
herpes zoster, urticaria, eczema and other skin eruptions, jaundice and albu- 
minuria. In large doses it is a powerful irritant to the gastro-intestinal and 
bronchial mucous membranes. Toxic doses may produce either symptoms of 
gastro-enteritis, or those of profoundly narcotic character. In the first and 
most usual form of acute arsenical poisoning, there is burning pain in the throat 
and stomach extending over the abdomen, vomiting, thirst, bloody stools, strang- 
ury, suppressed, albuminous or bloody urine, rapid and feeble heart, great 
anxiety, cold breath, finally exhaustion and collapse, — a group of symptoms 
much resembling cholera. The autopsy shows erosions, ecchymoses, and soft- 
ening of the gastro-intestinal mucous membrane, congestion of the lungs and 
bronchi, and fatty degeneration of the liver, kidneys and cardiac muscle. The 
poison is found in the urine, saliva, tears, sweat, etc., and may be detected 
even in the parenchymatous tissues. In the nervous form of poisoning by 
arsenic, profound coma and insensibility come on suddenly without any gastro- 
intestinal symptoms. 

Arsenical preparations are generally classed as alteratives, but they are 
valuable tonics and antiseptics, and possess antiperiodic powers second only 
to those of quinine. 

Chronic Arsenical Poisoning may occur from the inhalation of arsenical 
vapors or dust arising from wall-papers or other substances containing the 
poison. The quantity necessary to produce symptoms of poisoning when in- 
haled seems to be very small. The most prominent symptoms are, at first in- 



ARSENUM. I Cm 

creased appetite, next colicky pains, mucous or dysenteric stools, irritation of 
the eves, coryza, a short, dry cough, and a white and silvery tongue, all accom- 
panied by great bodily prostration. 

The long-continued use of arsenic may induce peripheral neuritis, the chief 
symptoms of which when so caused are — severe darting pains in the limbs, 
paralysis of the muscles of the extremities, especially the extensors of the hands 
and feet, ataxic gait, herpes zoster, and rapid muscular atrophy. In several 
cases it has caused general brown pigmentation of the skin, and may give rise 
to the same pigmentation of psoriasis patches. After death from chronic poison- 
ing, in addition to the gastro-intestinal and nervous lesions, there is found wide- 
spread fatty degeneration, affecting most of the organs, but particularly the 
liver, kidneys, stomach and muscles, including the heart. 

To avoid arsenical poisoning during a course of the drug full doses ("ivj 
of Fowler's solution) should be used at the commencement, and always taken 
on a full stomach. The dose should then be steadily reduced. Susceptible 
persons often tolerate it better if a few drops of laudanum are administered 
with each dose. It is quickly absorbed, and slowly eliminated, chiefly by the 
kidneys and the skin, its excretion continuing for about 60 hours, hence it should 
be administered at infrequent intervals of time. 

Therapeutics. 
Externally, Arsenic has been employed in the form of paste as a depila- 
tory, and as an escharotic in cancers, but is excessively painful. Most of the 
secret "cancer cures" have arsenous acid for their basis. Internally, it is used 
as a tonic and astringent to the intestinal canal, as a tonic and antispasmodic 
in nervous diseases, and for its action on tissue change. It is of especial value 
in irritative dyspepsia, gastralgia, pyrosis, gastric ulcer or cancer, regurgitation 
of food without nausea, diarrhea coming on immediately after taking food, 
vomiting of drunkards and chronic alcoholism. It has proven of signal ser- 
vice in the commencement of phthisis, also in catarrhal pneumonia, probably 
by causing fatty degeneration of the exudation in the alveolar cavities, thus 
breaking it up and quickening its absorption. It is often very serviceable in 
chronic bronchitis with copious expectoration, in acute catarrh, hay fever, whoop- 
ing-cough, asthma, chorea, epilepsy, angina pectoris and other spasmodic 
nervous disorders. In many forms of neuralgia it frequently gives prompt 
and permanent relief, especially in cases due to malarial poisoning. As an 
antiperiodic, it has high rank, being, however, of particular value in chronic 
malarial poisoning, and as an adjunct to quinine in the intervals between the 
paroxysms of intermittents. Anemia and chlorosis are remarkably benefited 
by it, and in rheumatic arthritis and chronic rheumatism it is sometimes of 
great service. In chronic scaly and papular skin diseases its value is very great, 
but it is not serviceable in acute forms, and the more chronic the cutaneous 
affection the more likely it is to be amenable to Arsenic. Epithelioma may 



1 62 ASAFCETIDA. 

be retarded by small doses long continued, and it has certainly been useful 
in delaying the progress of other cancers, particularly scirrhus of the stomach 
and uterine carcinoma. Hypodermically its solutions have been extremely effi- 
cient in histrionic spasm, local chorea of the head and neck, obstinate cases of 
general chorea, and in lymphadenoma. 

The so-called Bromide of Arsenic, in the form of Clemens' solution, has 
rendered good service as a remedy for diabetes mellitus of hepatic origin. Cupric 
Arsenite has been highly praised as a remedy for typhoid fever, in which it is 
given for its qualities as an intestinal antiseptic and a general stimulant. The 
Cacodvlates have been used with benefit in anemia, chlorosis, chorea, chronic 
bronchitis, pulmonary tuberculosis, inoperable carcinoma, and other affec- 
tions for which arsenic is indicated. The Sodium Cacodylate is considered by 
Murrell more toxic than the ordinary arsenical preparations, and only to be 
used with the greatest caution. It is said to increase the menstrual flow, and to 
promote the growth of the hair. The amido-benzene compound of arsenic 
named Atoxyl is claimed to be 40 times less toxic than Fowler's solution, and 
to afford the means of giving a large dose of arsenic without ill-effects. It has 
been used with satisfaction in dermatological practice, preferably by hypodermic 
administration, and in small doses at first, gradually increased up to 3 grains. 

ASAFCETIDA, Asafetida, — is a gum-resin obtained by incision from the 
living root of Ferula fcetida, a perennial herb of the nat. ord. Umbelliferae, native 
of Persia and Afghanistan. It occurs in whitish tears embedded in a grayish 
sticky mass, of alliaceous odor and taste, soluble in alcohol to at least 60 per 
cent., and when triturated with water it yields a milk-white emulsion. Its 
principal constituent is a Sulphuretted Volatile Oil, consisting chiefly of AIM 
Sulphide, C H 10 S; it also contains a gum and a resin, with ferulaic, malic, 
acetic, formic and valerianic acids. Dose, gr. ij-viij, [av. gr. iv.] 

Preparations. 

Tinctura Asafoetidae, Tincture 0} Asafetida, — strength 20 per cent. Dose, itrx-xxx 
[av. nnxv.] 

Emulsum Asafoetidae, Emulsion of Asafetida, (Milk of Asafetida), — strength 4 per cent, 
in water. Dose, oij-oj, [av. oiv.] 

Pilulae Asafoetidae, Pills of Asafetida, — each pill has gr. iij of Asafetida with gr. j of 
Soap. Dose, j-iv pills, [av. ij.] 

Mistura Magnesiae et Asafoetidae, Mixture of Magnesia and Asafetida, Dewee? Car- 
minative (Unofficial), has of Magnesium Carbonate 5, Tinct. Asafoetidae 7, Tinct. Opii 1, 
Sugar 10, Aqua Dest. q. s. ad 100 parts. Dose. 3ss — §ss. 

Spiritus Ammoniae Fcetidus (Unofficial), — Asafetida ij, Liquor Ammonias Fortior 2, 
Alcohol 20 parts. Dose, 5ss-j. 

Physiological Action and Therapeutics. 
Asafetida is a powerful antispasmodic, a stimulant to the brain and nervous 
system, a stimulating expectorant, also tonic, laxative, diuretic, diaphoretic, 
emmenagogue, aphrodisiac and anthelmintic in action. Its odor and taste are 



w i EPIAS -ASPIDIUM. [63 

extremely nauseous and persistent. In small doses continued it causes im 
paired digestion, alliaceous eructations, acrid sensation in the fauces, gastral 
gia, flatulent distention, fetid Flatulence, burning urination, diarrhea and ten 
esmus. Full doses produce various nervous or hysterical phenomena, with 
nausea, vomiting and purging. The Volatile Oil diffuses into the blood and 
tissues, and is excreted in the urine, sweat, and breath. By its action the cir- 
culation is stimulated, the arterial tension raised, the power of the cardiac 
motor ganglia is increased and the cardiac inhibition relaxed. Asafetida also 
stimulates the brain even to pleasant intoxication, and produces a subjective 
sensation of warmth without any rise of body-temperature. It stimulates the 
nervous system, the secretions and excretions, the menstrual flow and the sexual 
appetite. In Asia it is used as a condiment with food, and though at first it is 
nauseous to most people, a taste for it may be readily acquired. 

The disgust which is generally felt for Asafetida makes its use very restricted, 
though a valuable medicine. The Emulsion is extremely serviceable in the 
flatulent colic of infants, and as an enema in infantile convulsions. There is 
no better remedy in hysteria and hypochondriasis with indigestion and flatu- 
lence; in constipation with amenorrhea of anemic subjects, due to ovarian and 
intestinal torpor; in bronchial affections, cough of habit, chronic catarrhs, and 
flatulent indigestion. It has been highly praised in the treatment of habitual 
abortion. 

ASCLEPIAS, Pleurisy Root (Unofficial), — is the root of Asclepias luberosa, a plant of 
the nat. ord. Asclepiadaceae and a native of the Eastern and Southern States. Two other 
species of Asclepias are used in medicine and were formerly official. 

An Infusion or Decoction may be made in the proportion of §j of the powdered root 
to a quart of water, and given in teacupful doses every 2 or 3 hours. 

Asclepias contains two resins, a peculiar principle, tannic and gallic acids, albumin, 
pectin, gum, various salts and a volatile, odorous, fatty matter. It is emetic and cathartic 
in full doses, also diaphoretic and expectorant, as well as depressant to the action of the 
heart, and probably slightly sedative and astringent. It is a popular remedy in the Southern 
States for pleurisy (hence its common name), and has been used in medicine for catarrh, 
pneumonia, phthisis, diarrhea, dysentery, rheumatism, gastralgia, and to promote the eruption 
in L-xanthematous fevers. It is undoubtedly a powerful diaphoretic. 

ASPIDIUM, — is the rhizome of Dryopteris Filix-mas, Male Fern, and of 
Dryopteris marginalis, Marginal Shield Fern, plants of the nat. ord. Filices, 
the former found in most parts of the world, the latter indigenous to N. America. 
The active principles are Filmaron, Albaspidin, and Filicic Acid, named in the 
order of their value as anthelmintics. It also contains several other principles, 
a green, fatty oil, a volatile oil, resin, tannin, etc. Dose, 3SS-3JSS [av. 5J.] in 
a single dose fasting, or in divided doses at short intervals, followed by a pur- 
gative. 

Oleoresina Aspidii, Oleoresin of Aspidium, — is an acetone extract and deposits Filicic 
Arid on standing. It should be well shaken before being used. Dose, gr. xx- 5 j, [av. gr. xxx.] 
in capsules, repeated every 3 hours for 2 or 3 doses. 

Aspidium is an efficient vermicide against tapeworm, particularly the un- 
armed variety (bothriocephalus latus). The Oleoresin is the best form the 



164 AURA.VTIUM. 

patient having fasted for the previous day, or used only a milk diet, 33 may then 
be given in 4 doses \ hour apart. This may be repeated the next morning 
and followed by three drops of croton oil in emulsion. This is one of many 
methods. Cusso may be combined with it advantageously. A formula for a 
mixed treatment by Aspidium, Pomegranate and Pumpkin-seed is given under 
the title Granatum. 

Filmaron is said by Jacquet to be equally effective as an anthelmintic, and 
much easier to take than aspidium. In no case were unpleasant concomitant 
symptoms noted. Animals injected with poisonous doses of filmaron intra- 
spinally and intravenously soon developed convulsions, and shortly after par- 
alysis. Death took place with the heart in diastole. Animals given the drug 
by the mouth developed hemorrhagic gastroenteritis and died without convul- 
sions. Dose, gr. xv-xxx, dissolved in chloroform, mixed with Castor Oil 3vj- 
3j, and diluted in beer foam, followed an hour later by more castor oil in beer 
foam. 

AURANTIUM, Orange, — occurs in two official varieties of fruit and prepa- 
rations of their flowers, Citrus vulgaris, the Bitter Orange, and Citrus Auran- 
tium, the Sweet or Portugal Orange, both trees of the nat. ord. Rutaceas, culti- 
vated in almost all warm countries. Other varieties are described under Limon. 
The official titles are — 

Aurantii Amari Cortex, Bitter Orange Peel, — the dried rind of the unripe 
fruit of Citrus vulgaris, characteristics well known. It contains a Volatile Oil 
isomeric with oil of turpentine, C 10 H 10 , and a bitter crystalline principle, named 
Hesperidin or Aurantiin. 

Aurantii Dulcis Cortex, Sweet Orange Peel, — is the fresh outer rind of 
the ripe fruit of Citrus Aurantium. It contains a Volatile Oil differing from 
that of the bitter orange, and less of the bitter principle. 

Official Preparations. 
■ Fluidextractum Aurantii Amari, Fluidextract oj Bitter Orange Peel. — Used as flavor- 
ing. Dose, njx- oj, [av. njjxv.] 

Tinctura Aurantii Amari, Tincture oj Bitter Orange Peel, — strength 20 per cent. Dose, 
5j-ij, [av. 5j] A flavoring preparation. 

Tinctura Aurantii Dulcis, Tincture oj Sweet Orange Peel, — strength 20 per cent. Dcse, 
3j-ij, [av. oj-] A flavoring preparation. 

Syrupus Aurantii, Syrup oj Orange, — Tincture of Sweet Orange Peel 5, Magnesium 
Carbonate 1, Citric Acid 5, Sugar 82, Water to roo. Dose, 3j-ij- Used for flavoring. 

Syrupus Aurantii Florum, Syrup oj Orange Flowers, — Sugar 85, Orange-flower Water 
to 100. Dose, 3j-ij- A delicate flavoring agent, but having to some persons an extremely 
sickish taste. 

Spiritus Aurantii Compositus, Compound Spirit oj Orange, — Oil of Orange Peel 
20, Oil of Lemon 5, Oil of Coriander 2, Oil of Anise \, Alcohol to 100. Dose, as for alcohol. 

Aqua Aurantii Florum Fortior, Stronger Orange-flower Water, — is water saturated 
with the volatile oil of fresh orange flowers. Dose, indefinite [av. oij-] for flavoring. Used 
to prepare — 

Aqua Aurantii Florum, Orange-flower Water, — consists of equal volumes of the pre- 
ceding and Distilled Water, mixed immediately before use. Dose, indefinite, [av. oiv] 



AURUM. 165 

Oleum Aurantii Corticis, Oil of Orange Peel, — a volatile oil, obtained by expression 
from the fresh peel of either orange. Is soluble in about 4 times its volume of alcohol, and 
i- .in ingredient of the official Spirit of Orange and also of Spiritus Myrciiu (Bay Rum). 
Dose, gtt. j-v, [av. njiij.] 

Elixir Aromaticum, Aromatic Elixir, (Simple Elixir), — has of the Comp. Spt. of 
Orange 1.2, Purified Talc 3, Syrup 37 J, Alcohol and Distilled Water to 100. A flavoring 
vehicle. Dose, 5j- 3j, or more. 

Orange is aromatic and tonic, also more or less bitter, but has little action 
except a mild stimulant influence on the nervous system due to its volatile oil. 
Persons much exposed to its fumes are liable to cutaneous eruptions and various 
nervous disorders. The oil may produce violent colic and convulsions in chil- 
dren, one case being reported in which death resulted from eating the rind. 
Its use in medicine is confined to flavoring purposes, though the preparations 
of the bitter orange may be used as gentle tonics and stimulants to the digestion, 
but thev are usually combined with more energetic agents. 



AURUM, Gold, Au, — is represented by only one official salt, the Gold 
and Sodium Chloride, but triturations of the metal itself may be prepared, 
according to the general pharmacopceial formula for such preparations. The 
unofficial solution of Gold and Arsenic Bromide is a very efficient preparation. 

Auri et Sodii Chloridum, Gold and Sodium Chloride, — is a mixture composed of equal 
parts of dry Gold Chloride, AuCl 3 , and Sodium Chloride, NaCl; and occurs as an orange- 
yellow powder, of saline and metallic taste, slightly deliquescent in damp air, very soluble 
in water, partly soluble in alcohol, and contains not less than 30 per cent, of pure gold Dose, 
gr. j',j-i [av. gr. fa] once or twice a day. The Ph. Ger. gives the maximum single dose 

r. }, and the maximum daily dose as gr. iij, but these doses are too high. 

Incompatible with this salt are: Alkalies, Alkaloids, Arsenites, Hypophosphorous Acid, 
Ferrous and Mercurous salts, Organic substances, Oxalic Acid, Potassium Iodide, Sulphurous 
Acid, Thymol, Vegetable infusions. 

Unofficial Preparations. 

Auri Pulvis, Powdered Gold, — may be obtained by triturating gold leaf with ten times 
ts weight of sugar of milk or potassium sulphate until brilliant particles are no longer visible 
in it, and then washing the diluent away with boiling water. A Trituration of Gold may 
be prepared in the same manner, retaining the sugar of milk, as directed by the pharmacopoeia 
nder the title Triturationes. Dose of powdered gold is gr. ^-gr. j, or a little of it may 
be applied by friction to the sides of the tongue. 

Auri Chloridum, Gold Chloride, — also called the perchloride or terchloride of gold, 
AuCl 3 , the "potable gold" of the alchemists, — occurs in needle-shaped prisms of a deep 
orange color, very deliquescent and freely soluble in water, in alcohol and in ether. Dose, 
.. in pill or solution, preferably the latter. The commercial salt so named, and 
much used by photographers, is not the pure chloride but a crystallized double salt of gold 
and -odium, containing s,o per cent, of metallic gold. 

Auri Bromidum, Gold Bromide, AuBr 3 , — occurs as a yellowish-gray, friable mass, 
which is insoluble in water but soluble in ether, and contains 55 per cent, of Bromine. Dose, 
S r - h~i> but against migraine the minimum quantity should be used twice daily an hour 
before meals. 

Auri et Sodii Bromidum, Gold and Sodium Bromide, AuBr 3 NaBr.2H 2 0, — may be 
used hypodermically in solution, 2 parts to 100 of distilled water, the dose of which is njviij 
increased to njxxxij, respectively representing £ and f of a grain. 

Liquor Auri et Arseni Bromidi, Solution of Gold and Arsenic Bromide (Barclay), — 
is marketed under the trade-name "Arsenauro," and contains gr. fa of each salt in TtJJx. 
Dose, irpv-xv in water, thrice daily after meals, or hypodermically. 

This solution may be prepared as follows: (1) Take of Nitric Acid 3j and of Hydro- 



166 AURUM. 

chloric Acid 5iij. mix them and dissolve in the mixture 21 grains of pure Gold, then evaporate 
to dryness in a water-bath. Dissolve the resulting Chloride of Gold in distilled water 5j, 
and add slowly a solution of 35 grains of Ammonium Bromide in 3iv of water. Shake 
with Squibb's ether until all the gold is taken out, separate in a separating funnel, and treat 
the ether solution with fused calcium chloride to remove all water. Distil off the ether, and 
dissolve the remaining Gold Bromide in 3iv of water to make Solution No. 1. (2) Dissolve 
48 J grains of Arsenous Acid in 5iv of distilled water by the aid of heat, and when cold add 
5j of Bromine and let the mixture stand for 24 hours. Then drive off the excess of bromine 
by boiling in a sand-bath until the solution is colorless, which gives Solution No. 2. (3) Mix 
the two solutions and add sufficient water to make 1 quart. 

Liquor Auri, Arseni et Hydrargyri Bromidi, Solution oj Gold, Arsenic and Mercury 
Bromide (Barclay), — is marketed under the trade-name " Mercauro," and contains gr. ,' 2 
of each bromide in njjx. Dose, njv-xv in water, thrice daily after meals, or hypodermically. 

Similar solutions of the bromides of gold, arsenic and calcium (" Calcauro") and of the 
bromides of gold, arsenic and manganese (' ' Manganauro"), are on the market and may be 
used in like doses. 

Physiological Action. 

The action of the salts of gold upon the human organism is analogous in 
many respects to that of mercury, causing local irritation and escharotic effects 
when applied in substance or in strong solution. In continued medicinal doses 
given internally they produce a condition of general erethism which closely 
resembles the mercurial fever, and is accompanied by salivation but without 
tenderness or ulceration of the gums. The Chloride is one of the most active 
salts, being, according to Chrestien, even more toxic than corrosive sublimate. 
Locally, it produces irritant and caustic effects, and imparts a yellow stain 
to the skin, which later on turns violet and even black, from reduction of the 
metal therein. In overdoses it causes gastric pain and inflammation, also 
ulceration of the gastro-intestinal mucous membrane, and otherwise acts as a 
corrosive poison; toxic doses produce a violent gastro-enteritis with such nervous 
phenomena as convulsive tremor, cramps, priapism, insomnia and insensibility 
(Magendie). 

The salts of gold, administered in small medicinal doses, increase the appe- 
tite and the digestive power and stimulate the functional activity of the secret- 
ing organs, especially the skin and the kidneys. They also stimulate the gen- 
erative apparatus, causing diaphoresis, and diuresis, exciting the menstrual 
flow in women and the sexual appetite in men. The observations of several 
competent physicians have established the power of these salts to excite the 
vascular and muscular systems and to produce fever, to increase the urine and 
the sweat, to cause salivation without stomatitis, a sense of heat in the stomach, 
headache and diarrhea, to promote menstruation, excite the genitalia, and pro- 
foundly affect the nervous system. In large or continued doses they cause 
dryness of the tongue, redness of the pharynx, gastric and intestinal colic, nausea 
and vomiting, and even erosion of the gastric mucous membrane. The Bro- 
mide, though containing only 55 per cent, of bromine, is found to be many 
times more active, weight for weight, than the ordinary bromides. Admin- 
istered in doses of from £ grain to 3 grains per kilogramme of body-weight, it 
depressed the cortical motor centres to such a degree that the strongest elec- 
trical stimulation thereof failed to produce an epileptic seizure (Shtcherbak). 



AURUM. 167 

Therapeutics. 

The literature of gold shows that it is one of the most ancient medicines. 
Pliny, in the first century, recorded its use as a recognized remedy for several 
conditions for which it is still employed, including lichenoid eruptions, fistula, 

hemorrhoids, warts, putrid ulcers, and sores emitting an offensive smell. In 
the finely divided metallic state it was employed as a panacea by the Arabian 
phvsicians and by the alchemists. During the 17th and 18th centuries it was 
"highly esteemed as an antisyphilitic, also for leprosy, dropsies, epilepsy, the 
pest, fevers, amenorrhea, sterility and uterine diseases. During the first quarter 
of the present century it was in high repute among the European physicians as 
a remedy for syphilis and for scrofula. 

Mitchill (1S1S) administered gold salts for sj - philis in the New York Hospital, with 
excellent results. In his opinion "the muriate of gold will effect all that is achieved by the 
muriate of quicksilver, with incomparably less inconvenience to the patient, who gets well 
under the former without the hazard of a sore mouth or a salivation, and with very little 
wear and tear of constitution." Trousseau (1851) said that the happy results of gold in 
the treatment of venereal diseases are incontestable; and von Schroff of Vienna (1868) 
gave it great praise for the restoration of a case of syphilis in which the strongest mercurials 
had failed to avert destruction of the nasal bones or the deep, spreading ulcers of the skin. 
Phillips (1894) said that its efficacy is best seen in the later developments of syphilis, such 
as ulceration of the nose and larynx, cutaneous syphilides, hard nodes, etc., also that it may 
especially be employed in long-standing cases with chronic periostitis and when mercury 
has already been given to saturation. Still it has never obtained general professional favor 
in the United States or in England until recently. Professor Barton, of Jefferson Medical 
College, Philadelphia (1827), pronounced the following judgment upon it in his lectures on 
materia medica. "On the whole view of what has been said in favor of gold, I am not in- 
clined to attach great importance to it as a remedy. It is well enough in its proper place 
and for its proper purposes, for which it is more useful than as a medicine. Plenty of it 
would doubtless cure many diseases of mind and body." Such has been the general opinion 
since the above words were printed, but of late years a number of compounds of gold with 
other elements (chlorine, bromine, iodine, arsenic and mercury) have been employed as 
medicines with considerable satisfaction. 

Dr. Piffard of New York found that Gold is unquestionably useful in the 
later stages of syphilis, and said that its best effects are obtained with very 
small doses, gr. ^ or less, continued for not more than one or two weeks at 
a time. Several other observers have given it great praise as a remedy in con- 
stitutions which are broken down by the combined influence of syphilis and 
mercury, for syphilis in strumous subjects, and for the various manifestations 
of scrofula. Under its use the auric fever may develop, and the local affections 
for which it is administered may assume an aggravated intensity, and even 
new ones appear; but these phenomena do not call for the suspension of the 
remedy, for the disease retrogrades rapidly in a few days after they appear 
(Trousseau); and on lessening the dose pyrexia subsides and good effects are 
more conspicuous (Phillips). 

Strumous affections have been frequently reported cured by the internal 
and local use of auric preparations, including scrofulous ulcers, lupus, ozena, 
enlarged and indurated cervical glands, and hypertrophy of the tongue with 
induration thereof. Gold has been credited with many cures of cancer of the 
uterus, mammae and tongue, but it is probable that such have really been cases 



1 68 AURUM. 

of scrofulous ulceration. Squamous skin diseases, the "dartres" of the older 
writers, are, next to syphilis, the most successful field for the action of gold. 
In cutaneous diseases it is used locally as well as internally. Dropsy is one 
of the affections in which it was anciently recommended, and in which modern 
therapeutists have found it efficient, especially ascites due to chronic hepatic 
disease or to induration of the abdominal organs, also post-scarlatinal dropsy 
and ovarian dropsy. 

Many disorders of the female generative organs have proved amenable to 
gold when persistently employed. Amenorrhea due to ovarian torpor and 
chronic metritis with scanty menstruation are often benefited thereby, while 
sterility dependent on these states or due to coldness, is more certainly cured 
by the auric preparations than by any other merely medicinal means. The 
tendency to habitual abortion may be averted by the use of the Chloride, 
which is also beneficial for mental symptoms of hysterical character, especially 
when connected with uterine disease. Many competent clinicians have highly 
commended gold in suicidal melancholia, in hypochondriasis accompanying 
hepatic or testicular disease, in decline of the sexual power in men, and as a 
tonic for low-spirited, pining boys with undeveloped testes. 

Sclerosis of the internal organs, especially the liver and kidneys, may be 
retarded by the persistent use of the Gold and Sodium Chloride in doses of gr. 
tv~tu thrice daily. Nervous dyspepsia, characterized by a red and glazed 
tongue, epigastric pain increased by food, and relaxation of the bowels after 
eating, is greatly benefited by the same salt in equally small doses. Catarrh 
of the duodenum and bile-ducts, and jaundice therefrom, also vertigo and 
vertiginous sensations connected with gastric disorders or due to cerebral an- 
emia, are often removed by a course of treatment with the salts of gold. The 
Bromide has been employed in doses of from gr. £ to gr. \ with decided benefit 
in obstinate cases of hysteria and epilepsy. Goubert used it successfully for 
migraine, epilepsy, chorea and exophthalmic goitre, in daily doses of gr. \ to \, 
continued until its characteristic headache was produced. He claimed for it 
greater efficacy in epilepsy than is possessed by the other bromides, and said 
that, as compared with them, it is better tolerated and does not induce depres- 
sion and emaciation or the other pronounced symptoms of bromism. 

A combination of Gold and Arsenic (Auri Arsenas) was introduced by 
Chrestien and extensively employed by Massart in cancer and phthisis, with 
sufficient success to merit the approval of the medical societies of Lyons and 
Toulouse. It is said to be particularly serviceable in scrofulous affections, 
especially lupus, and to exercise a highly beneficial influence on anemia and 
chlorosis. A solution of the Bromides of Gold and Arsenic has been success- 
fully employed for several years by Dr. Barclay and others in the various dis- 
eases of which sclerosis is the chief factor, such as cirrhosis of the liver and lungs, 
interstitial nephritis, atheroma and calcareous degeneration of the arteries, 
senile degenerative changes and neurotic disease, fibroid phthisis, and loco- 



B \i s \\u U PERI vi \\r\i. t6g 

motor ataxia; also in cervical adenitis, arthritis deformans, syphilitic neuralgia 
and iritis, miliary tuberculosis, epilepsy, chronic neurtisi, sciatica, chronic mus- 
cular rheumatism and neurasthenia. Arsenauro is the trade-name of this solu- 
tion, which has been the subject of extended reports from many competent 
observers, some of whom claim to have obtained from the use of this combi- 
nation results which neither of its constituents are capable of when adminis- 
tered alone. It is held to have marked alterative power upon the glandular 
system and upon all non-malignant scleroses; to be not only a blood-maker 
but a blood-builder, increasing the number of the corpuscles and improving 
their quality, and also increasing the amount of hemoglobin therein. It is 
eliminated by the kidneys and produces no irritation when administered either 
by the mouth or hypodermically. A similar solution of the Bromides of Gold, 
Arsenic, and Mercury, named Mercauro, is on the market, and is highly praised 
in the treatment of the late manifestations of syphilis, particularly those affecting 
the nervous system. 

A M>-called Bichloride-oj-Gold Cure for inebriety has become highly notori- 
ous through extensive advertising and other commercial methods, but from the 
most reliable information obtainable it is reasonably certain that the only prepa- 
ration of gold which plays a prominent part therein is the gold coin which passes 
from the patient's pocket to that of the manager of the "institute." The phys- 
iological symptoms produced by the remedy employed are those of strychnine 
and atropine, the administration of which hypodermically several times daily 
for three or more weeks is decidedly dangerous. In many cases cardiac failure 
has occurred soon after the completion of the treatment, and in a large num- 
ber of instances insanity or other serious psychoses have developed immediately 
after the subjects had been through one of these so-called "cures." 

BALSAMUM PERUVIANUM, Balsam of Peru,— is a balsam obtained 
from Toluijera Pereirce, a Central American tree, of the nat. ord. Leguminosse. 
It occurs as a thick, brown-black liquid, its odor reminding of benzoin and 
vanilla, soluble in 5 of alcohol, almost insoluble in water, which extracts from 
it only some cinnamic acid and cinnamein. It is not a true balsam, as it con- 
tains no volatile oil. Its composition is: Cinnamein (benzyl cinnamate, C 16 - 
H u 2 ) 60 per cent., Cinnamic Acid 6 per cent., Resins 30 per cent.; also ben- 
zoic acid and other bodies. Dose gr. x-xxv [av. gr. xv.] in emulsion. There 
are no official preparations. 

Incompatible with Balsam of Peru are: Ferric salts, Iodoform, and Hydrogen Peroxide. 

The action of Balsam of Peru is that of its several constituents, namely, 
antiseptic, stimulant to the circulation, and sedative to the nervous system; 
acting chiefly on the mucous membrane, it is tonic and expectorant, diuretic and 
diaphoretic. In large doses, it causes gastralgia, nausea and vomiting, colic and 
diarrhea. It closely resembles in physiological action its congeners, Styrax 
and Benzoin. 



I jo BA1SAMUM TOLUTANTTM — BARIUM. 

Balsam of Peru is used locally in chronic skin diseases of inflammatory 
type and sore nipples, to relieve itching, cleanse bed-sores, promote the heal- 
ing of wounds and ulcers, and to kill the acarus scabiei, being considered by 
some authorities the best of all applications in itch. Internally, it is used as 
a stimulant and disinfectant expectorant in chronic bronchitis and asthma, 
as well as in gonorrhea, gleet, leucorrhea, and other discharges from mucous 
membranes. 

BALSAMUM TOLUTANUM, Balsam of Tolu,— is a balsam obtained from Toluijera 
Bahamian, a tree of the nat. ord. Leguminosse, a native of Venezuela and New Granada. 
Its composition and properties are similar to those of Balsamum Peruvianum, except that 
it is of lighter color, more agreeable odor, and contains a volatile oil, Tolcne, in the proportion 
of about i per cent. Dose, gr. x-xx [av. gr. xv.] 

Tinctura Tolutaria, Tincture oj Tolu, — contains 20 per cent, of the Balsam dissolved 
in alcohol. Dose, njjxx— xl(av. itjfxxx.] 

Syrupus Tolutanus, Syrup oj Tolu, — has of the Tincture 5 per cent., with Sugar 82, 
and Water to 100. It is much used in cough mixtures, and covers the taste of Chloral Hy- 
drate well. Dose, 5j-vj (av. 5iv.] 

Balsam of Tolu has similar action to that of Balsam of Peru, but being more agreeable 
in flavor it is more used internally than the latter. It is chiefly employed as a pleasant ex- 
cipient in cough mixtures, and is a constituent of the Compound Tincture of Benzoin. 

BAPTISIA, Wild Indigo (Unofficial), — is the root bark of Baptisia tinc- 
toria, a plant of the nat. ord. Leguminosas, native in North America. It con- 
tains an alkaloid and a resin, neither of which have been examined critically. 
The so-called Baptisin is an impure resinoid, obtained by precipitation from 
the alcoholic extract with water. 

Unofficial Preparations. 
Extractum Baptisias, Extract oj Baptisia, — Dose, gr. j-x. 
Fluidextractum Baptisiae, Fluidextract oj Baptisia, — Dose, irjjij-xx. 
Tinctura Baptisias, Tincture oj Baptisia, — Dose, ttjjv-xxx. 
Baptisin, — the resinoid. Dose, gr. j-v. 

Baptisia has a bitter and acrid taste; in small doses it is laxative, in large 
ones violently emeto-cathartic, and may excite severe gastro-intestinal inflam- 
mation. It is a decided stimulant of the liver, and increases the secretions of 
the glandular appendages of the gastro-intestinal mucous membrane. It has 
considerable power as an antiseptic. 

Baptisia has been used locally in decoction or cataplasm to obstinate and 
painful ulcers, for threatening or existing gangrene and gangrenous sores. In- 
ternally, it is a useful remedy in amenorrhea, typhoid and typhus fevers, variola, 
scarlatina, and epidemic dysentery. In the common continued fever, or in 
the first stage of typhoid, it will be found of service in drop-doses of a fresh 
tincture, repeated hourly. 

BARIUM, Ba., — is one of the alkaline metals, and is characterized by its 
strong affinity for oxygen. Several of its salts are official only as test-solutions, 
but the Chloride has important physiological actions which may obtain for 
it a permanent place in practical medicine. 



BE] 1 \IH>\\ \. 171 

Barii Chloridum, Barium Chloride, HaCI, |- 211,0, (Unofficial), — occurs in colcn 
translucent tables or lamellae, soluble in 3 of water, insoluble in absolute alcohol. Dose, 
ijr. ss-ij, in water, thrice daily after meals. 

Incompatibles. 
Incompatible with Barium sails are: Carbonates, Chlorates, Oxalic Acid, Oxalates, 
Phosphoric Acid, Phosphates, Sulphuric Acid, Sulphates, Tannic Acid, Tartaric Acid, 
Tartrates. 

Physiological Action and Therapeutics. 
Barium salts in overdoses act as irritant poisons, causing salivation, thirst, 
vomiting, purging, dyspnea, and a slow pulse. Toxic doses paralyze the cen- 
tral nervous system and the heart, which is arrested in systole. In medicinal 
doses the Chloride stimulates the cardiac muscle, like Digitalis causing the 
contractions of the ventricles to become slower and more forcible. It con- 
stricts the arterioles by action on their muscular coat, raising the blood-pressure, 
stimulates the intestinal muscular fibres, and increases peristalsis, in these 
respects acting like Ergot. Applied locally to voluntary muscles it prolongs 
their contraction, like Veratrine. It was formerly used as a remedy in glandular 
affections and nervous diseases, and has been found efficient in mitral insuffi- 
ciency, irregular heart, hemorrhages, and atony of the bladder and of the in- 
testine. The Sulphide is occasionally used as a depilatory. 



BELLADONNA, Deadly Nightshade.— The Atropa Belladonna is an her- 
baceous, perennial plant, of the nat. ord. Solanaceae, having dark-purple, bell- 
shaped flowers, and glossy, purplish-black berries about the size of cherries. 
It is indigenous in the mountainous districts of central and southern Europe 
and Asia, and is cultivated in Europe and the United States. It contains the 
official alkaloid Atropine, C 17 H 23 N0 3 , which may be decomposed into Tropine 
and Tropic Acid, — also the alkaloids Belladonnine, Hyoscyamine, Hyoscine, 
and Atropamine, in varying quantity, all existing as malates in the plant. It 
also contains the usual vegetable constituents, as albumin, gums, etc., and a 
coloring principle named Atrosin. The official titles are as follows: — 

Belladonnae Folia, Belladonna Leaves, — ovate and tapering, brownish- 
green above, grayish-green below, of slight odor- and bitter, disagreeable taste. 
Stramonium leaves are more wrinkled, Hyoscyamus leaves are more hairy. 
Dose, gr. ss-jss [av. gr. j], gradually increased. 

Belladonnae Radix, Belladonna Root, — occurs in cylindrical, tapering, 
wrinkled pieces, £ to 1 inch thick, nearly odorless, taste bitter and acrid. Dose, 
gr. ss-j [av. gr. f], cautiously increased. 

.Allied Plants are Hyoscyamus, Stramonium, Duboisia, and Scopola, containing alkaloids 
which are closely allied to Atropine, both chemically and physiologically. 

Preparations 0} the Leaves. 
Extractum Belladonnae Foliorum, Extract oj Belladonna Leaves. — Dose gr. T ' ff to i, 
[av. gr. I}. 

Tincrura Belladonnae Foliorum, Tincture oj Belladonna Leaves, — 10 per cent. Dose, 
3J-XV, [av. nRviij.] 



172 



BELLADONNA. 



Emplastrum Belladonnae, Belladonna Plaster, — has of the above extract 30 per cent., 
mixed with Adhesive Plaster. It may produce the physiological action of the drug. 

Unguentum Belladonnae, Belladonna Ointment, — has of the above extract 10, Diluted 
Alcohol 5, Benzoinated Lard 65, Hydrous Wool-fat, 20. 

The Extract is a constituent of Pil. Laxativae Comp., and PH. Podophylli, Belladonna- 
et Capsici. 

Preparations oj the Root. 

Fluidextractum Belladonnae Radicis, Fluidextract oj Belladonna Root. — Dose, rrgss— ij 
[av. nrj.] 

Linimentum Belladonnae, Belladonna Liniment, — has of Camphor 5, dissolved in 
Fluidextract of Belladonna Root to 100. 

Atropine and its Derivatives. 

Atropina, Atropine, C 17 H 23 N0 3 , — white, acicular crystals, odorless, of bitter taste and 
alkaline reaction; very soluble in alcohol and in chloroform, also in 130 of water at 59 F. 
Is decomposed by prolonged contact with caustic alkalies and is resolvable into Trophic 
and Tropic Acid. [Av. dose, gr. T ^. ] 

Atropinae Sulphas, Atropine Sulphate, (C 17 H 23 N0 3 ) 2 H 2 S0 4 , — a white powder of bitter 
taste and neutral reaction, soluble in 0.4 of water and in 6.2 of alcohol at 50 F. Dose gr. 

,,; [av. gr. T 57j]. 

Oleatum Atropinae, Oleate 0} Atropine, — a 2 per cent, solution of the alkaloid in Alcohol 
2, Oleic Acid 50, and Olive Oil to 100. 

Homatropinae Hydrobromidum, Homotropine Hydrobromide, C 16 H 21 N0 3 HBr, — is 
the hydrobromide of an alkaloid obtained by the condensation of tropine and mandelic acid. 
It is soluble in 6 of water, ^^ OI alcohol, insoluble in ether, Dose, gr. tsoTbtj [ av - S r - T5?-] 
It is used by ophthalmologists as a mydriatic, its effects passing off much sooner than those 
of Atropine. Homatropine slows the heart, Atropine quickening it. 

Incompatibles. 

Incompatible with Belladonna or Atropine are: Alkaloidal precipitants, Alkali Hydrates 
or Acids with heat, Tannic Acid, Vegetable decoctions or infusions. Physiologically incom- 
patible are: Aconitine, Bromal Hydrate, Chloral Hydrate, Hydrocyanic Acid, Jaborandi, 
Morphine, Muscarine, Physostigmine, Phytolacca, Pilocarpine, Quinine. 

Physiological Action. 
The effects of Belladonna are those of its alkaloid Atropine, the dominant 
actions of which are stimulant to the vaso-motor centre and the cerebral cortex, 
and paralyzant to the terminal nerve-organs. It stimulates the central nervous 
system, especially its higher divisions, including the respiratory and vaso-motor 
centres [Strychnine affects the lower divisions], and paralyzes the terminal 
nerve-organs of the involuntary muscles, the intestines, the secretory glands, 
and the inhibitory apparatus of the heart. By stimulating the vaso-motor 
centre it greatly raises the arterial pressure; by depressing the vagus cardiac 
terminations it increases the rate but not the force of the heart, [Digitalis slows 
the rate and increases the force], and at the same time it raises the body tem- 
perature. If the dose be sufficient the blood pressure becomes progressively 
lowered by depression of the cardiac muscle and the muscles in the capillary 
walls, the temperature falls, but the rapid pulse continues to the last. The 
respiration is stimulated by small doses but is depressed by large ones, which 
paralyze the respiratory centre and the motor nerves of the respiratory mucles. 
Death occurs by asphyxia combined with cardiac failure. Excepting the vaso- 



BELJ UH>\\ \. 173 

motor and respiratory spinal centres the spinal cord is affected hut slightly, 
though very large doses may produce convulsions and paralysis. The motor 
nerves are directly depressed withoul any apparent stimulation, the sensory 
nerves are but slightly affected, though they are depressed by its local appli- 
cation. The voluntary muscles are unaffected, the involuntary are paralyzed 
by the action of the drug on their nerve terminations. All the secretions of 
the body are checked by the paralysis of the nerve-endings in the secretory 
glands, except the urine, which is sometimes increased. 

A small dose of Belladonna or Atropine causes dryness of the mouth and 
throat and some slight disorder of vision. Under larger doses the dryness is 
more intense, the fauces reddened, the pupils are dilated, the vision disordered, 
the pulse becomes very rapid, and a bright red flush, resembling that of scar- 
let fever, appears on the face and neck and may spread over the whole body. 
The intellect is not affected, but some giddiness and confusion of thought may 
be experienced, and sometimes spectral illusions occur. Large doses produce 
a talkative, wakeful delirium, which is often wild, the patient being violent 
and uncontrollable; a very large dose may cause a fatal stupor with complete 
muscular relaxation, or severe convulsions ending in coma and paralysis. Con- 
gestion of the lungs, the membranes and substance of the brain and cord, and 
the retina, are usually found after death. There is suppression of urine after 
a toxic dose, though medicinal doses sometimes increase its flow. 

The pupils are dilated by either the local or systemic use of the drug, which 
stimulates the end-organs of the sympathetic and paralyzes those of the motor 
oculi, thus increasing the power of the radiating iris fibers and lessening the 
action of its circular ones. Atropine applied locally also paralyzes accom- 
modation and increases the intraocular pressure. The least quantity of atropine 
which will affect the pupil is variously stated at from the one-two thousandth 
to the one-seven hundred thousandth of a grain, the latter amount being that 
given by Donders. 

Atropine is rapidly absorbed and quickly eliminated, the latter process 
being complete within two hours. Its excretion is performed by the kidneys, 
and the urine of an atropinized animal will dilate the pupil of another animal. 
Birds and herbivorous animals are affected very slightly, and pigeons seem to 
be entirely unaffected by it. Children bear proportionately larger doses than 
adults. 

Therapeutics. 
Belladonna is one of the most valuable agents in the materia medica, rank- 
ing high in its efficacy and its wide range of usefulness. It is employed in direct 
conformity with its physiological action, to relieve pain, relax spasm, stimulate 
the circulation, decrease secretion, and check local inflammation. Atropine 
is used for the same purposes, also to antagonize the effects of certain poisons,, 
to dilate the pupils, and to paralyze the accommodation of the eye. These 
agents are efficiently administered in rheumatic torticollis, lead colic, spasmodic 



174 



BELLADONNA. 



colic, spasmodic dysmenorrhea, laryngismus stridulus, whooping cough, asthma, 
constipation, irritability of the bladder, and many other spasmodic affections. 
They are of little value in relieving pain unconnected with spasm, though they 
have been used with benefit in the pain of inflammation, particularly that of 
rheumatism, gout, neuralgia due to peripheral disturbance, sciatica, cancer, 
and pelvic affections. The sedative action of Atropine on the vagus has been 
successfully utilized in cholera infantum and other forms of cholera, on the 
theory that the gastro-enteric branches of the nerve are powerfully excited 
by the toxin of the disease. It is of great value in sudden collapse occurring 
in acute disease, and characterized by failure of arterial tension, subnormal 
temperature and excessive sweating; also in shock when the loss of temperature 
is chiefly due to vaso-motor paralysis. As a vaso-motor contractor it has been 
highly commended in pneumonia, congestion of the lungs, cerebral and spinal 
hvperemia, congestive headaches, encephalitis, meningitis, and myelitis. Bella- 
donna is often a valuable remedy in recent cystitis from chill, incontinence of 
urine in children, acute corvza, sore throat with fever, acute tonsillitis, epileptic 
and puerperal convulsions, spermatorrhea, and involuntary seminal emissions. 
In scarlet fever it is indicated when the rash is imperfectly developed, the pulse 
feeble, and the general condition adynamic, also in typhus fever when the pupils 
are contracted, and in erysipelas of superficial and non-vesicular character. 
The prophylactic power of Belladonna against scarlet fever was at one time 
believed in by many practitioners, strenuously denied by others, and is now 
generally discredited. The Ointment is an efficient application in mastitis, 
rectal ulcer, anal fissure, boils, carbuncle, and other superficial inflammations. 
Beside the affections already mentioned, Atropine is used internally or 
hypodermically as a hemostatic remedy in metrorrhagia and phthisical hemop- 
tysis; also in ptyalism due to mercury and pregnancy, for the night-sweats 
of phthisis, in colliquative diarrhea, and as an antagonist to all the effects of 
Muscarine, and to some of the effects of Morphine, Physostigmine, Hydro- 
cyanic Acid, Ether, and Chloroform. It is synergistic to many of the effects 
of Morphine, and in poisoning thereby it should be used in very small doses, 
chiefly as a respiratory stimulant. Most of the unsuccessful cases treated by 
it were instances of overdosing with the antagonist, thereby superinducing 
atropine-narcosis upon the morphine-narcosis. In many cases of apparent 
death from ether or chloroform, the hypodermic injection of Atropine has saved 
life when other methods had failed. A solution of gr. iv to the 3 is used locally 
by ophthalmologists to dilate the pupils, paralyze accommodation, and contract 
the vessels of the eye, as in iritis, phlyctenular keratitis, and perforating ulcer of 
the cornea. It is contraindicated whenever there is increased intraocular tension, 
and should not be used in persons over 40 years of age, or in gouty or rheu- 
matic subjects, in whom its instillation may light up a latent or incipient glau- 
coma. 



BENZOIN! M. 175 

BENZOINUM, Benzoin, is a balsamic rosin obtained from Styrax Ben 
zoin, a tree of the nat. ord. Styracese, native in Sumatra and Siani, by incision 
of its liark. It occurs in agglutinated tears or a brown, mottled mass, is soluble 
in alcohol and solution of potassa, and is composed of Resins ( So per cent., Ben- 
zole Acid 10 to 20 per cent., and a trace of Volatile Oil. Some varieties yield 
also Cinnamic Acid. Dose, gr. v-xx, [av. gr. xv. |. Benzoin is an ingredient 
of Adeps Benzoinatus, Benzoinated Lard. 

Preparations. 

Tinctura Benzoini, Tincture oj Benzoin, — has of Benzoin 20 parts, Alcohol 100. Dose, 
ijfx-xx, [av. iivxv.] 

Tinctura Benzoini Composita, Compound Tincture oj Benzoin (Friar's Balsam), — 
has of Benzoin 10, Aloes 2, Storax 8, Balsam of Tolu 4, Alcohol to 100. Dose, irjx-xl, 
[av. njxxx.] 

Benzoic Acid and its Salts. 

Acidum Benzoicum, Benzoic Acid, HC ; H 5 2 , — occurs in light, feathery plates and 
needles, and is obtained from Benzoin by sublimation, or prepared artificially, chiefly from 
Toluol. It is soluble in 500 of water, and in 2 of alcohol at 59° F., but its solubility in water 
is aided by Borax, one part of each being soluble in 100 parts. It is a constituent of Tinctura 
Opii Camphorata. Dose, gr. v-x [av. gr. vijss] in wafers. 

Ammonii Benzoas, Ammonium Benzoate, — is soluble in 5 parts of water and in 28 of 
alcohol. Dose, gr. v-xxx, [av. gr. xv.] 

Lithii Benzoas, Lithium Benzoate, — soluble in 4 parts of water and in 12 of alcohol. 
Dose, gr. v-xxx, [av. gr. xv.] 

Sodii Benzoas, Sodium Benzoate, — is efflorescent on exposure to air, soluble in about 
2 parts of water and in 45 of alcohol. Dose, gr. v-xxx [av. gr. xv.] 

Unofficial Derivatives. 

Acidum Cinnamicum, Cinnamic Acid, C 9 H 8 2 , — occurs in the balsams, in styrax, 
and in some benzoin resins. It occurs in fine needles or thick prisms, which are soluble in 
hot water and in alcohol. Dose, gr. j-x, hypodermically. 

Sodii Cinnamas, Sodium Cinnamate, — occurs as a white, crystalline powder, soluble 
in water. Dose, gr. j-x, in 5 per cent, sterilized solution, internally or hypodermically. 

Incompatible s. 
Incompatible with Benzoin are Alkalies, Acids, Water; with the Benzoates are Acids, 
Ferric salts. 

Physiological Action and Therapeutics. 

The action of Benzoin is that of Benzoic Acid, which is antiseptic, anti- 
pyretic, analgesic, diaphoretic, and diuretic. A solution of 1 in 1000 prevents 
the development of bacteria, and one of 4 in 1000 is fatal to most of them. Taken 
internally it causes slight epigastric heat, increases the pulse-rate, and stimu- 
lates the action of the skin and kidneys, the salivary glands, and the bronchial 
mucous membrane. It is principally excreted by the kidneys, partly as hip- 
puric acid by combination with glycocoll, and in part unchanged. Benzoin 
is irritant to the fauces, and the powder excites sneezing and coughing when 
inhaled. 

Benzoin is principally used as a stimulating expectorant, especially in the 
chronic bronchitis of the aged, and by atomization in laryngeal affections. 
The compound tincture, 3j to 5J in a pint of boiling water, is a useful sedative 
inhalation for the irritation and cough of subacute laryngitis and tracheitis. 



176 BERBERIS. 

It has been used beneficially in chlorosis and some uterine disorders. The 
compound tincture is a good local application (1 part to 4 of glycerin and water) 
for sore nipples and chaps of the hands and lips. For use as a cosmetic, either 
tincture is mixed with 20 parts of water, and employed to remove freckles, and 
for other skin affections, especially urticaria. The tinctures are excellent appli- 
cations to foul-smelling wounds, and form the basis of all the proprietary prepa- 
rations sold for that purpose. • 

Benzoic Acid and its salts are generally considered to be efficient agents for 
rendering an alkaline urine acid. They are valuable remedies in chronic cystitis, 
not only neutralizing the alkalinity of the urine, but also stimulating and dis- 
infecting the vesical mucous membrane. Phosphatic calculi are said to have 
been dissolved by the long-continued use of Ammonium Benzoate. 

Sodium Benzoate has been largely used as a substitute for the salicylates 
in the septic diseases, being equally antiseptic and antipyretic. Though slower 
in action, its effects are more permanent, and it is capable of being used in larger 
doses (3ij-iij daily). In diphtheria and scarlet fever it has been highly effi- 
cient, and in acute rheumatism, typhoid and the malarial fevers it has rendered 
good service. In phthisis, its use by inhalation to the extent of y^nnr of the 
body-weight daily has seemed to be of value. It has proved very efficient in 
whooping-cough. 

Lithium Benzoate is used in gout and the uric acid diathesis, with the object 
of forming the very soluble urate of lithium in the system, also on the theory that, as 
benzoic acid is converted into hippuric acid at the expense of nitrogenous material 
which would otherwise become uric acid, the latter product will be lessened. 

Cinnamic Acid resembles benzoic acid in its action. It increases leuco- 
cytosis, and promotes the excretion of uric acid in a marked degree. Sodium 
Cinnamate has been used internally and by intravenous injection in pulmonary 
tuberculosis with excellent results. 



BERBERIS, Berberis, {Barberry), — is the root of several species of the nat. ord. Ber- 
beridaceae, the one generally used being the Berberis aquijolium, or Oregon grape, which 
grows on the Pacific slope of the United States. Its value is probably due to its alkaloid, 
Berbyine, C 20 H 17 NO 4 , a yellow, crystalline body, soluble in hot water and alcohol, but not 
in ether, which is found also in several other plants, as Hydrastis, Coptis, Podophyllum. 
Mcnispermum, Calumba, Xantho.xylum, etc. Dose, gr. x-xl [av. gr. xxx.] 

Fluidextractum Berberidis, Fluidextracl 0} Berberis, — Dose, njjx-xl [av. njfxxx.] 

Berberina, Berberine (Unofficial), — Dose, gr. j-x. It usually occurs in commerce as 
Hydrastin, which is a Berberine Hydrochlorate prepared from Hydrastis. 

Berberis is an astringent bitter, a tonic and stomachic in small doses, but in large doses 
it is cathartic, producing watery diarrhea with abdominal pain. It is believed to possess 
considerable alterative powers. It has been successfully used as a local application in con- 
junctivitis, and internally as a remedy for intermittent, remittent and typhoid fevers, diarrhea 
and dyspepsia. As an alterative and tonic it is useful in syphilitic and strumous affections, 
and in pain, soreness and burning sensations along the biliary or urinary tracts with a ten- 
dency to gravel or gall-stones it will be found a useful remedy. 

Berberine has some antiseptic and antiperiodic value, but in large doses it is a gastro- 
intestinal irritant. The Hydrochlorate is a useful injection in gonorrhea, in which it act? 
by virtue of its antiseptic and astringent powers. Alkaloidal precipitants and soluble Tar- 
trates are incompatible with Berberine salts. 



BISMUTH UM. 177 

BISMUTHUM, Bismuth, Hi. -This metal is represented in medicine by 

six official sails and several unofficial ones, the most important of which are the 
following: — 

Official Salts 0/ Bismuth. 

Bismuthi Citras, Bismuth Citrate, BiC 8 H a 7 , — a white, amorphous powder, odorless 
and tasteless, insoluble in water or alcohol, soluble in Water of Ammonia. Used only for 
pharmaceutical purposes. Dose, gr. j-iij |av. gr. ij.] 

Bismuthi et Ammonii Citras, Bismuth and Ammonium Citrate, — is a combination 
of the citrate with aqua ammonia", and has no definite chemical composition. Small, pearly 
scales, very soluble in water, sparingly in alcohol. Dose, gr. j-v, [av. gr. ij.] 

Bismuthi Subcarbonas, Bismuth Subcarbonate, — a white or yellowish-white powder, 
of somewhat varying chemical composition, tasteless and odorless, insoluble in water or 
alcohol. Dose, gr. v-xx [av. gr. vijssj, in powder or emulsion. 

Bismuthi Subnitras, Bismuth Subnilratc, — a heavy, white powder, of somewhat varying 
chemical composition, odorless and almost tasteless, of slightly acid reaction; insoluble in 
alcohol, almost insoluble in water. Dose, gr v-xx, [av. gr. vijss.] several times a day, in 
powder, pill, or milk; often combined with opium, morphine or belladonna. 

Bismuthi Subgallas, Bismuth Subgallate ^Dermatol), — fine, odorless, saffron-yellow 
powder, insoluble in all ordinary solvents. Dose, gr. v-xx [av. gr. iv.] 

Bismuthi Subsalicylas, Bismuth Subsalicylate, — should yield not less than 80 per cent, 
of pure bismuth oxide; almost insoluble in water, insoluble in alcohol. Dose, gr. v-xv [av. 
gr. vijss.] 

Unofficial Bismuth Salts. 

Bismuthi Subiodidum (Oxyiodidum), Bismuth Subiodide, — a brick-red, heavy, amor- 
phous powder, insoluble in water, insoluble in any reagent without decomposition. Used 
locally as an antiseptic dusting powder, and internally in doses of gr. jss-iij. 

Bismuthi Oleas, Bismuth Oleate, — a pearly-gray, soft, bland substance. [See under 
Acidum Oleicum]. 

Airol, Bismuth Oxy-iodo-gallate, — is a patented combination of Bismuth Subgallate 
and Iodine, occurring as a bulky, gray powder, odorless and tasteless, insoluble in water 
or alcohol. It is used as a dusting powder for ulcers and wounds, or mixed with Yaselin 
or Lanolin as an ointment. Calomel is incompatible with it. 

Eudoxin, Bismuth Tetra-iodo-phenol-phtalein, — is a bismuth salt of Nosophen and 
contains about 53 per cent, of Iodine and 14 per cent, of Bismuth. It occurs as a reddish- 
brown, odorless and tasteless powder, insoluble in water. It is said to be an efficient internal 
antiseptic for gastric and intestinal affections. Dose, for children, gr. j-iij; for adults, 
gr. iij-viij. 

Orphol, Bismuth Bela-naphtholale, — contains from 50 to 70 per cent, of Bi 2 3 also Beta- 
naphthol; is a reddish-brown powder, insoluble in water, and recommended as an intestinal 
antiseptic and astringent. Dose, gr. v-xx, up to a daily quantity of gr. xv for children and 
gr. xlv for adults, given w T ith honey or milk. 

Xeroform, Bismuth Tri-brom-phenol, — is a patented preparation which contains about 
50 per cent, of Bi 2 3 and occurs as a yellow, insoluble powder, having a faint odor of carbolic 
acid. It is almost non-toxic and unirritating to mucous surfaces. It is an excellent surgical 
and intestinal antiseptic, and has been used locally with benefit in chancroids, buboes, foul 
ulcers, infected wounds, burns, eczema and other skin diseases. It has been given internally 
with satisfactory results in cholera, intestinal catarrh and the summer diarrhea of children, 
also for chronic urticaria and certain forms of infantile eczema. Dose, gr. vij-xv, three times 
a day. 

Incompatibles. 

Incompatible with Bismuth and Ammonium Citrate are Acids; with Bismuth Subnitrate 
are Alkali Carbonates and Hydrates, Calomel, Hypophosphites, Gallic Acid, Iodides, Sali- 
cylic Acid, Sulphur, Tannic Acid; with the Subcarbonate as with the carbonates (see under 
Carbo); with the Subgallate, Acids. 

Physiological Action. 
The action of the insoluble Bismuth salts is chiefly a local one,, they being 
sedative to the end-organs of the nerves, though a minute quantity passes into 
r 3 



178 BISMUTHUM. 

the blood and acts as a tonic, promoting constructive metamorphosis by increas- 
ing the appetite and digestion. They are also feebly astringent, and produce 
constipation after a time, coloring the stools and tongue a dark clay color, from 
thoir conversion in part into the sulphide. Toxic effects when occurring are 
as< ribed to Arsenic, with which the commercial preparations were formerly 
contaminated; but it has been shown that the Bismuth salts possess toxic powers 
of their own, and that the symptoms of bismuth-poisoning may develop when 
these preparations are applied as a dressing to a large, denuded surface, or 
taken internally in large doses for a long period of time. A black line alonjj 
the margins of the gums, headache, nausea, vomiting, pale face, elevated tem- 
perature, rapid pulse, edema of the lower extremities, diarrhea, and an odor 
of urine on the breath, are some of the symptoms observed in such cases. Black 
and gangrenous sloughs may occur in the intestines, and the urine may contain 
albumin. 

The insoluble Bismuth salts are used internally in many forms of disordered 
digestion, gastralgia, vomiting and diarrhea, especially in children, but large 
doses are necessary for efficiency. The best vehicle for them is milk. Locally 
they are used with advantage in acne rosacea, stomatitis, nursing sore mouth, 
eczema, intertrigo, ulcers, conjunctivitis, coryza, gonorrhea, gleet and leucorrhea. 
The Subnitrate is regarded by many practitioners as almost a specific in cholera 
infantum, given in hourly doses of 3 to 6 grains: also in the diarrhea of phthisis, 
in dysentery and intestinal ulceration, it is highly efficient, in doses of 15 grains 
every hour or two. Externally, it is employed as a dusting powder, either pure 
or mixed with starch (1 to 5); as a drying application for the nasal, pharyn- 
geal and laryngeal mucous membranes; in suspension as an injection in gonor- 
rhea (4 to 10 per cent.); and with vaselin (10 to 15 per cent.) as an ointment 
in eczema, also for burns and wounds. 

The Bismuth and Ammonium Citrate being soluble, is more rapid in action, 
but also more astringent and irritant than the other salts, though it is prob- 
ably precipitated in the stomach by the hydrochloric acid of the gastric juice. 
It is serviceable in diarrhea without irritation of the intestinal mucous mem- 
brane, but rather with relaxation thereof. The Subsalicylate when pure is 
well borne by the stomach, and can be used for longer periods than the sub- 
nitrate. It has been especially serviceable in the diarrhea of phthisis, in that 
of typhoid fever, and in chronic gastric and intestinal disorders, also as an in- 
ternal antiseptic in dilatation of the stomach. 

The Subgallate, also known as Dermatol, is one of the many substitutes 
for Iodoform. It has great stability, as well as valuable drying and bactericidal 
qualities, and is an excellent vulnerary for wounds and burns. It has proven 
useful in the treatment of moist cezema, ulcers, and other affections of the eye, 
diseases of the middle ear and dental caries. It occasionally produces der- 
matitis, and Dr. Cantrell holds that it is decidedly irritating, is a stimulant rather 
than an astringent, does not check but rather increases discharge, and does not 



BR0M1 m 179 

fulfil the claims made for it. Efforts are made to show value for it as an internal 
remedy in fermentative dyspepsia ami gastric catarrh. It is efficient lv employed 
internally for diarrhea in doses of 10 or 20 grains ever) two or three hours. 

The Oleate is credited with mildly astringent and emollient properties, .and 
has been used with benefit in pustular affections of the skin and in acne. The 
Subiodide is an exceedingly valuable agent in the treatment of burns, wounds, 
ulcers, and similar affections as a substitute for Iodoform. It is remarkably 
efficient as a stimulant of granulation in wounds, and is odorless, non-irritant, 
and highly antiseptic. 

BROMUM, Bromine, Br, — is a non-metallic element found in sea-water 
and in the mother-liquid of certain salt-works, usually in combination with 
other substances. It occurs as a dark, brownish-red, volatile liquid, evolving 
an irritant vapor of peculiar and suffocating odor. It is soluble in 30 of water 
at 59 F., very soluble in alcohol, ether, chloroform and carbon disulphide. 
On exposure to air or heat it is completely volatilized. It destroys the color 
of solutions of litmus and indigo, and imparts a yellow color to solution of starch. 
It is used only by inhalation and locally as an escharotic. 

Acidum Hydrobromicum Dilutum, Diluted Hydrobromic Acid, — is com- 
posed of absolute Hydrobromic Acid, HBr, 10 per cent., and Water, 90 per 
cent., and occurs as a clear, colorless and odorless liquid, of pungent and acid 
taste. It is produced by decomposing Potassium Bromide with Sulphuric acid 
and distilling. Dose, r^xx-gij [av. 3j.] well diluted. 

Bromides and their Preparations. 

Potassii Bromidum, Potassium Bromide, KBr, — colorless, cubical crystals, soluble in 
1.6 of water and in 200 of alcohol. Dose, gr. ij- 3j, [av. gr. xv], well diluted. 

Sodii Bromidum, Sodium Bromide, NaBr, — colorless, monoclinic crystals, soluble in 
i .2 of water and in 13 of alcohol. Dose, gr. ij- o j, [av. gr. xv], well diluted. 

Lithii Bromidum, Lithium Bromide, LiBr, — a white, granular, deliquescent salt, very 
soluble in water and in alcohol. Dose, gr. ij— xl, [av. gr. xv], well diluted. 

Ammonii Bromidum, Ammonium Bromide, NH 4 Br, — colorless, prismatic crystals, 
soluble in 1.5 of water and in 30 of alcohol. Dose, gr. ij— xl [av. gr. xv], well diluted. This 
Bromide is well borne by children in comparatively large doses if epileptic from reflex causes. 
A child one year old can tolerate gr. v every 4 hours (Barton). 

Calcii Bromidum, Calcium Bromide, CaBr 2 , — a white, granular, deliquescent salt, very 
soluble in water and in alcohol. Dose, gr. ij- oj, [av. gr. xv], well diluted. 

Strontii Bromidum, Strontium Bromide, SrBr 2 (H 2 0) 6 , — colorless, hexagonal crystals, 
very deliquescent, very soluble in water and in alcohol; insoluble in ether. Dose, gr. ij-xxx 
[av. gr. xv], well diluted. 

Zinci Bromidum, Zinc Bromide, ZnBr 2 , — a white, granular, deliquescent powder, very 
soluble in water and in alcohol. Dose, gr. J-iij [av. gr. ij], well diluted. 

Syrupus Ferri Bromidi, Syrup 0} Iron Bromide (Unofficial), — is a syrupy liquid con- 
taining 10 per cent, of Ferrous Bromine, FeBr 2 , prepared by acting on Iron Wire 35 parts 
with Bromine 75, adding Sugar 600 and Water up to 1000 parts. A translucent, pale-green, 
odorless liquid of sweet, ferruginous taste and neutral reaction. Dose, oss-j. 

Arsenic Bromide is described on page 159, Aurum Bromide on page 165, Ethyl 
Bromide on pages 87 and 90, and Camphora Monobromata under Camphora. 

Derivatives of Bromine. 
Bromoformum, Bromojorm, (Tri-bromo-methane), CHBr 3 — is prepared by the action 
of sodium hypobromite on acetone, or by the action of bromine upon a solution of equal 



1S0 BROMUM. 

parts of caustic potash and methyl alcohol. A clear and colorless liquid, of pleasant odor 
and sweet, agreeable taste; slightly soluble in water, readily soluble in alcohol and in glyc- 
erin. Dose, njj-v [av. njriij ]. If it has color it should be rejected as unsafe by reason of 
decomposition. 

Bromipin (Unofficial), — is a combination of bromine with the fatty acids of Sesame 
oil, and occurs as a yellowish liquid containing 10 per cent, of Bromine. Dose, 5j-iv thrice 
daily, in emulsion, warm milk or capsules. 

Incompatibles. 
Incompatible with Bromine are: Alkali Hydrates, Arsenites, Ferrous salts, Hypophos- 
phites, Hydriodic Acid, Mercurous salts; with Bromojorm are: Caustic Alkalies, Aqueous 
liquids; with the Bromides are: Acids, Alkaloids, Antimony salts, Bismuth salts, Chlorine- 
water, Chlorates and Chromates in acid solutions; Salts of Copper, Lead, and Silver; Mer- 
curous salts, Nitric Acid, Spirit of Nitrous Ether if acid. 

Physiological Action. 

Bromine is an active and painful escharotic. It sets free ozone, and is there- 
fore antiseptic, disinfectant and deodorant. A solution of i in 500 is germicidal 
in moist air and with an exposure of not less than three hours. Its vapor is 
irritant to the eyes and the respiratory tract, causing cough, hoarseness and 
dyspnea. Internally it acts as a corrosive poison, producing violent gastritis, 
depression, and collapse. 

The Bromides are powerful depressants to the nervous system and the cir- 
culation, the Potassium salt being the most active in this respect. They lower 
the activity of the cortical motor area, and that of the brain as a whole, and 
are powerful hypnotics. The excessive use of Potassium Bromide produces 
degeneration of the cortical cells, beginning at the periphery of the dendrons. 
They lower the reflex excitability of the spinal cord, and impair the functions 
of the peripheral nerves and the sensory apparatus, causing anesthesia of the 
skin and mucous membranes. They depress the muscular system, by direct 
action on the muscles themselves, as well as by their action on the nerves sup- 
plying them. The Potassium salt is directly paralyzant to the heart, lessening 
the force and frequency of its contractions, and finally stopping it in diastole. 
They lower the arterial tension and the body temperature, depress the sexual 
appetite and power, cause pallor and emaciation, a coated tongue and disordered 
digestion, a fetid breath, acne on the face and upper extremities, somnolence, 
dysphagia, sluggish reflexes and defective coordination; and if long continued 
may even impair the mental faculties, producing hallucinations in some cases, 
in others melancholia with suicidal tendency; also incompetence of the sphincters 
and paralysis, beginning at the periphery and extending to the centres. They 
sometimes cause maniacal excitement, as in the case of a physician who com- 
mitted suicide in a frenzy caused by bromidizing himself for sea-sickness. The 
general result of their action is termed Bromism, and is heralded by the acne 
and lowered faucial sensibility. It is probably due to the sedative influence of 
these agents on the sympathetic system, causing general anemia of the brain, 
spinal cord, sexual organs, and skin. It is believed that a previous prolonged 
use of opium or morphine renders the organism extremely susceptible to the 
action of the bromides. 



HRUMUM. ISI 

Bromides are rapidly absorbed and slowly eliminated by the kidneys, skin, 
saliva, intestinal and bronchial mucous membranes, and the milk. They irri- 
tate the mucous membranes at the points of elimination, and increase the quan- 
tity of the urine and the excretion of the chlorides and the nitrogenous con- 
stituents, but decrease the elimination of the phosphates. 

Hydrobromic Acid is more irritant to the stomach than the bromides, but 
after absorption it has the same action as these agents on the nervous system 
and the circulation. 

Dr. Hammond mentions several cases of fatal bromide-poisoning in one of the last chap- 
if his treatise on Nervous Diseases, and several cases of poisoning by Potassium Bromide 
have been published by Dr. Greenless. The first was that of an epileptic who took 75 grains 
.i day for three weeks, when stupor, coma, and extreme prostration and death followed. 
The post mortem showed intense congestion of the meninges. In another case, an epileptic, 
the same amount of potassium bromide, 75 grains a day, was given, and in ten days coma 
and death followed. Both the brain and meninges were congested and the kidneys were 
in the advanced stage of cirrhosis. The other cases were less prominent and clearly resulted 
from bromism due to long use of the drug. In some cases of inebriety large doses of bromides 
produce stupor and prostration, from which recovery is slow, and is followed by continued 
prostration. 

Differences in Action between the Bromides. 

Potassium Bromide is the most toxic to the heart and the muscular system, and is the 
least hypnotic. It contains 66 per cent, of Bromine. 

Sodium Bromide is the least toxic, but the most hypnotic, and acts more energetically 
on the circulation. It contains 78 per cent, of Bromine. 

Ammonium Bromide resembles the Potassium salt in action, except that it exerts less 
influence on the heart and on the muscular system, and is somewhat more stimulating. 

Lithium Bromide contains the most Bromine, 02 per cent., and resembles the sodium 
salt in action. It has proved better than the others in some cases of epilepsy, and is by 
several authorities considered the best hypnotic of the series. 

Calcium Bromide is an efficient hypnotic, but otherwise much less active than the other 
bromides. 

Strontium Bromide is said to be less apt than the other bromides to produce the bromic 
acne and the other results of bromism. 

Zinc Bromide, in large doses, is violently irritant. It is supposed to combine the tonic 
effects of zinc with the sedative action of the bromides. 

Ferrous Bromide is not official. It is supposed to combine the actions of iron and the 
bromides, and to produce the effects of a sedative chalybeate tonic. It is not an eligible 
chalybeate. 

Therapeutics. 
The Bromides are used as sedatives to the nervous system, to lower reflex 
activity, to produce sleep, to subdue excitement of the genital apparatus, and 
to antagonize cerebral excitement when not inflammatory in character. In 
epilepsy their power of lowering the excitability of the cerebral cortex makes 
them the most valuable remedies for diminishing the number of the attacks, 
though they rarely cure the disease. They are greatly abused in many in- 
stances, and should usually be restricted to those cases in which motor irrita- 
bility is more marked than psychic irritability, and where the disease is not 
due to gross organic lesions. They should not be used in anemic or adynamic 
cases, and should never be continued for any length of time without the daily 
supervision of a competent physician. Their dosage in this disease is usually 
much heavier than is necessary, instead of 40 to 60 grains and more thrice 
daily, less than one-half these qualities give equally good results, particularly 



1 82 KROMUM. 

if sodium chloride is withdrawn from the food, as the bromides act more efficiently 
in the absence of the chlorides. If opium be administered for 4 to 6 weeks be- 
fore a course of bromide treatment the latter will be more effective in smaller doses 
than otherwise. In various forms of insanity they are largely used, often to 
the detriment of the patient, causing a degree of mental dulness which simu- 
lates dementia, lowering nutrition and checking recovery. As hypnotics they 
arc valuable in the insomnia of overwork or worry, in nightmare and the night- 
screaming of children, and when there is no organic reason for the wakeful- 
ness, but they are useless in cases due to pain, and in delirium tremens. They 
are efficiently palliative in many spasmodic affections, as laryngismus stridulus 
and whooping-cough, also for the nervous symptoms of the climacteric period, 
and those complicating uterine disease. Tetanus has been cured by large doses 
of the bromides, and in strychnine poisoning they have proved efficient as an- 
tagonists, though too slow of action to be of much practical service. In diabetes 
of nervous origin, the Ammonium salt, long used, has proved curative by its 
sedative influence on the medulla; and in acute rheumatism it is an excellent 
alkali. In muscular rheumatism, rheumatic arthritis and myalgia, also in the 
uric acid diathesis and various affections due to undeveloped gout, the Lithium 
salt gives good results. Bromides are often very efficient in migraine, neuralgia, 
and hysteria, nervous erethism, infantile colic, cholera infantum, vomiting of 
cerebral origin, sea-sickness, cardiac irritability not due to anemia and other 
varieties of functional disease of the heart, seminal losses when plethora exists, 
and nymphomania. The Potassium salt is, by some writers, considered almost 
specific in subinvolution of the womb, also in uterine hemorrhage not due to 
a mechanical cause. 

Strontium Bromide is favorably knowm for its beneficial action in gastric 
affections, particularly in dyspepsia, acetic and lactic fermentation, flatulence 
from decomposition and vomiting of various origin, including the vomiting 
of pregnancy. In severe cases of the latter affection it proved entirely suc- 
cessful, administered in doses of gr. xv with meals, twice daily for a month. 
In epilepsy it has been employed with advantage, in doses of gr. xx thrice daily, 
gradually increased: and it has been used in the treatment of nervous and sick 
headaches, sea-sickness, insomnia and other conditions for which the bromides 
are considered suitable. It is said to be less productive of the bromic acne 
than any other bromide in general use. 

The Syrup of Iron Bromide has been reported by some observers as very 
efficient in chorea, and its usefulness therein is as strenuously denied by others. 
Hydrobromic Acid has been useful in hysteria, congestive headaches, neuralgia, 
and tinnitus aurium. It is considered less depressant than the bromides of 
potassium and of sodium, and is recommended as a substitute for those salts. 
Fothergill used it with benefit in reflex and spasmodic coughs, and in the cere- 
bral disturbance of simple continued fever. Used as a solvent for quinine it 
retards cinchonism, and prevents the headache due to the full action of quinine 
and iron. 



BRYONIA. 183 

The Bromides should be administered in plenty of water, two 01 three times a day after 
meals, and when given for any length of time Arsenic should be conjoined with them to 
prevent the bromic acne, and an occasional purgative to prevenl accumulation. The mixture 
of Potassium Bromide and Chloral, so much used in alcoholism, is dangerous in cases of 
weak or fatty heart, both drugs being active cardiac depressants. 

Bromipin may bo administered for a long time, it is said, without irritating 
the stomach, impairing the appetite, or producing bromism. It is highly praised 
by those who have used it, as supplying all the therapeutic efficacy of the bro- 
mides, with few or none of their drawbacks. 

Bromine is not much used in medicine. It is the most efficient escharotic 
for chancre and hospital gangrene, and its vapor inhaled from hot water is 
useful in acute coryza and hay-fever. A solution of 8 minims to the ounce, 
used internally in doses of mj-iij every half-hour, together with inhalation 
of the vapor, has been successfully employed in severe cases of laryngeal diph- 
theria. 

Bromoform is an analogue of Chloroform, its inhalation producing anes- 
thesia of brief duration. Overdoses internally have caused deep narcosis in 
children tempted by its agreeable taste to the surreptitious ingestion of a greater 
than the prescribed quantity. It is an efficient palliative in whooping-cough, ad- 
ministered in daily doses of 5 to 20 minims in glycerin and alcohol solution. It 
aborts the paroxysms of coughing and reduces their number, but has little in- 
fluence otherwise on the regular course of the affection. Increasing doses must 
not be pushed very far for fear of toxic symptoms, and the drug must be abso- 
lutely colorless if pure. Inhalations of Bromoform have been used with some suc- 
cess in the treatment of diphtheria, and it has been employed locally with bene- 
fit, as a deodorizer, disinfectant and analgesic, in ozena and in tuberculous and 
other ulcers of the larynx. 

BRYONIA, Bryonia, Bryony (Unofficial), — is the root of Bryonia alba 
and of Bryonia dioica, European perennial plants of the nat. ord. Cucurbitaceae. 
Its taste is acrid and bitter, but it is inodorous. The active principle is the 
glucoside Bryonin, C^HgoOj,,, which is intensely bitter, and soluble in water 
and in alcohol, but insoluble in ether. Dose, of the powdered root, gr. x-xxx. 

Preparations. 

Tinctura Bryoniae, Tincture of Bryonia (Unofficial), — a 10 per cent, solution of the 
root in alcohol. Dose, njrv-sss. 

Bryonin (Unofficial), — is a violent poison in doses of from 3 to 4 grains. Dose, as a 
drastic purgative, gr. $-j. 

Physiological Action and Therapeutics. 
Bryonia is a pure irritant, setting up local inflammation wherever applied, 
with febrile phenomena. It has a vesicant action on the skin, and is violently 
irritant to the serous and mucous membranes. Taken internally, it has caused 
fatal gastritis; introduced into the pleura, fatal pleuritis has resulted with fibrin- 
ous effusion. It has a specific determination to serous and synovial mem- 



1 84 BL'CHU. 

I>ranes, especially the pleurae, and is irritant to muscular fibre and to the bron- 
chial mucous membrane, causing dry, continuous, shaking cough, with sore- 
ness behind the sternum. It produces cerebral congestion, with frontal head- 
ache, vertigo and epistaxis; also hepatic and renal congestion, burning pain 
and tenderness in the hepatic region with bilious disturbance amounting some- 
times to severe jaundice, vesical tenesmus, and depression of the action of the 
heart. It is a drastic purgative and a powerful diuretic. 

Bryonia is a very old medicine, its most ancient reputation having been in 
epilepsy, hysteria and mania, conditions in which it is now superseded by other 
agents. It is a most valuable drug in the second stage of serous inflamma- 
tions, after Aconite has reduced the pyrexia, especially in pleurisy, pleuro-pneu- 
monia and pericarditis, to limit the extent of the effusion and to promote its 
absorption. For this purpose small doses frequently repeated are required. 
Also, in rheumatic fever, after the swelling of the joints has been reduced by 
other means, Bryonia is extremely efficient for the pain and stiffness. It is one 
of the best remedies for a "cold-on-the-chest," with dry, shaking cough, sore- 
ness, or shooting pains. It has been used with success in common, continued 
or "gastric" fever, relapsing fever, congestive headaches increased by stooping, 
bilious headache with vomiting, gastralgia with pyrosis and soreness of the 
epigastrium, constipation, cholera infantum during dry, hot weather, conges- 
tion of the liver, croup, and threatened mammitis. Pains of shooting or tearing 
character, increased by movement, are often quickly relieved by this drug. 
In dropsies it is used as a drastic purgative and diuretic to remove the accumu- 
lated fluid. 



BUCHU, Buchu, — is the dried leaves of Barosma belulina, a S. African 
shrub of the nat. order Rutaceae. They contain a Volatile Oil, which is probably 
the active principle, and gives them a peculiar and penetrating odor, resembling 
that of peppermint; also Barosmin, a bitter extractive, and resin, gum, lignin, 
etc. Dose, of the leaves, gr. xv-xl [av. gr. xxx.] 

Preparations. 
Fluidextractum Buchu, Fluidextract of Buchu, — Dose, njxv-xl [a v. njxxx.] 
Infusum Buchu, Infusion of Buchu (Unofficial), — oj to the pint. Dose, oss-ij. 

Incompatible with Buchu are: Ferrous Sulphate, Infusion of Galls. 

Physiological Action and Therapeutics. 

Buchu in small doses causes a sense of heat in the stomach, which is grad- 
ually diffused over the body. It increases the pulse-rate, stimulates the appe- 
tite, and produces slight moisture of the skin. It increases the flow of urine 
which becomes of darker color and strongly aromatic odor, and deposits a brown- 
ish sediment. In large doses it causes vomiting, purging and strangury, with 
a burning sensation at the stomach. 

Buchu is of especial value in chronic affections of the genito-urinary mucous 



CACTUS GRANDIFLORUS CAFFEINA. 185 

membrane, on which the volatile oil acts topically, being eliminated by the 
kidneys. It is a useful remedy in pyelitis, cystitis and urethritis; also in lithiasis, 
in chronic bronchitis, and in affections of the prostate gland. It is recommended 
in atonic dyspepsia, chronic rheumatism and affections of the skin, also for dropsy, 
hut it is not SO actively diuretic as to be very efficient in the latter condition. 
The Infusion makes an excellent vehicle for saline diuretics. 

CACTUS GRANDIFLORUS, Night-blooming Cereus (Unofficial),— is a native of 
tropical America, and has long had a local reputation as a remedy for dropsy, hut was brought 
into notice as a cardiac remedy by Or. Rudini. Its active principle, Cactine, a supposed 
alkaloid, has been physiologically studied by Dr. Myers, who finds it possessed of very de- 
rided stimulant action upon the heart, the arterial tension and the spinal motor centres. 
Therapeutically, this drug has been employed as a cardiac stimulant in the functional dis- 
orders of the heart connected with anemia, neurasthenia, dyspepsia, tobacco-poisoning, 
exophthalmos, sexual exhaustion and low fevers, also in pseudo angina pectoris. It docs 
not prolong the diastole, as Digitalis does, and on this account it has been especially recom- 
mended in complicated aortic regurgitation. A tincture is prepared, oivof the fresh stems 
to a pint of strong alcohol, the dose of which is itjxx— xxx every 4 hours. Dose of Cactine, 
gr. Ti Vtt — a\s» three or four times a day. 

Pellotine, C n H 10 NO s (Unofficial), — is an alkaloid obtained from Anhalonium Williamsii, 
a member of the cactus family growing in Mexico. This alkaloid is a powerful hypnotic 
and also somewhat analgesic, though not possessing the pain-relieving power of morphine. 
It has the advantage of being capable of hypodermic administration, and has given relief 
to the pains of locomotor ataxia and peripheral neuritis. The dose is about gr. j for an 
adult. Mescaline, another alkaloid, seems to be the cause of the exaltation produced by 
drinking the fermented liquor Mezcal prepared from this plant. 

CADMIUM, Cd., — in its physiological action resembles both Antimony and Zinc, its 
salts being escharotic, astringent, depressant, and emetic; in overdoses acting as irritant 
poisons, with cerebro-spinal symptoms such as convulsions and coma. They are never used 
internally, but for external employment the important ones are — 

Cadmii Sulphas, Cadmium Sulphate (Unofficial), — transparent oblique prisms, efflo- 
rescent, and very soluble in water. Used externally in a solution of gr. ss-iv ad oj aq. destil., 
or as an ointment (1 to 40 of fresh lard). 

Cadmii Iodidum, Cadmium Iodide (Unofficial), — large, white, pearly crystals, soluble 
in water and alcohol. Used as an ointment, 1 to 8 of lard. 

The Sulphate has been used almost exclusively as a stimulating astringent in gonorrhea 
and conjunctivitis. Corneal opacities are absorbed under the use of a solution of gr. ij to 
the 5, and in gonorrhea a mild injection (gr. J ad oj) is very beneficial. An ointment of 
the Iodide has been usefully employed for enlarged glands, chronic joint affections, cutaneous 
diseases, nodes and chilblains. Alkalies, Carbonates, Chromates, Phosphates, and Sulphides, 
are incompatible with the soluble Cadmium salts. 

CAFFEINA, Caffeine, (Theine, Trimethyl-xanthine) C 8 H 10 N 4 O 2 + H 2 0, — 
is a feebly basic proximate principle, obtained from the dried seeds of Coffea 
arabica, or the dry leaves of Thea sinensis, and found also in other plants. It 
occurs in colorless, silky crystals, which are soluble in 80 of water and in 33 of 
alcohol. The commercial Caffeine is usually obtained from old tea leaves. It 
contains more nitrogen than almost any other vegetable principle. Dose, 
gr. ss-iij [av. gr. j ]. Caffeine is an ingredient of the Compound Powder of 
Acetanilide (see page 59). 

The coffee-plant is a small tree of the nat. ord. Rubiaceas, 15 to 30 feet high, 
native of Arabia and Abyssinia, but cultivated in various parts of the world. 
Its -eeds contain the alkaloid Caffeine (partly free, partly as a tannate), also 



1 86 CAFFEINA. 

tannic and caffeic acids, sugar, legumin, etc. By roasting them, part of the 
caffeic acid is converted into methylamin, the sugar is changed into caramel, 
and several volatile substances are formed, which give to coffee its peculiar 
aroma and some of its stimulant qualities, and are collectively known as Caffeone, 
one of them being called Cafjeol. 

Allied Plants are — Thea sinensis, the tea-plant, which contains Caffeine and Theophyl- 
line; Thcobroma cacao, containing Theobromine, a principle allied closely to caffeine; Stercutia 
acuminata, the Kola-plant, the nut of which contains Caffeine and small quantities of Theo- 
bromine; Paullinia sorbilis, the seeds of which (Guarana) contain Caffeine and Theobro- 
mine; Ilex Paragicayensis (Mate) contains a very small quantity of Caffeine; Erythroxyion 
Coca, contains the alkaloid Cocaine, which is allied to caffeine in action, but is more 
powerful. 

Theobromine, Dimethyl-xanthine, C 7 H s N 4 2 , — is closely allied to caffeine, both chemi- 
cally and physiologically. 

Theophylline, Dimethyl-xanthine, C 7 H 8 N,0 2 , — is isomeric with theobromine, differing 
only in the arrangement of its formula and in some of its reactions. 

These bodies are derivatives of Xanthine, C 5 H 4 N 4 2 , which occurs as a waste product 
of metabolism in muscles and other organs, and appears also in urine and feces. 

Preparations. 

Caffeina Citrata, Cilrated Caffeine, — is a very uncertain mixture, and is not considered 
to be a definite compound. It is prepared by dissolving equal weights of Caffeine and Citric 
Ac id in double the quantity of hot distilled water, evaporating the solution to dryness and 
powdering the product, which is white, odorless, of acid taste and acid reaction, soluble in 
about 3 parts of water, precipitated as Caffeine on. further dilution with water, and redis- 
solved with about 25 parts of water. Dose, gr. j-v [av. gr. ij.] 

Caffeina Citrata Effervescens, Effervescent Citrated Caffeine, — composed of Caffeine 4, 
Citric Acid 19 \, Sodium Bicarbonate 57, Tartaric Acid 30, triturated, dried and powdered. 
Dose, gr. xxx-5 jss [av. 5 j-], in a glassful of water, as an effervescing drink. 

Fluidextractum Coffeae Viridis (Squibb), Fluidextract of Green Coffee (Unofficial), — 
is intended as a substitute for the fluid extract of Guarana. Dose, 3ss-ij. 

Analogues of Coffea. 

Guarana, — is a dried paste consisting chiefly of the crushed seeds of Paullinia Cupana, 
a climbing plant of the nat. ord. Sapindaces, growing in Brazil. It occurs in brown cakes or 
sticks, having an odor of chocolate, and a bitter, ^astringent taste, partly soluble in water 
and in alcohol. It contains Caffeine and Theobromine, also tannic acid, gum, albumin, 
starch, and a fixed oil. The specimens found in commerce are untrustworthy, unequal in 
quality and expensive (Squibb). Dose, gr. xv-xlv [av. gr. xxx.] 

Fluidextractum Guaranae, Fluidextract of Guarana, — is made with Diluted Alcohol. 
Dose, njjxv— xlv [av. iijxxx.] 

Diuretin, Sodio-theobromine Salicylate (Unofficial), — occurs as a colorless powder, of 
sweetish, saline and alkaline taste, soluble in J its weight of water, and should contain 46$ 
per cent, of Theobromine. Being a very unstable compound, it should not be prescribed 
in combination with other drugs, and when dispensed it should be well sealed from contact 
with the air, from which it rapidly absorbs carbonic acid, thereby undergoing decomposition. 
If ordered under its chemical name the cost should be less than $ that of the same article 
under its proprietary title (Squibb). Dose, gr. x-xv, in powder or aqueous solution, several 
times a day, as a diuretic. 

Agurin (Unofficial), — is a combination of Sodium Acetate and Sodium Theobromate, 
and is said to contain 60 per cent, of Theobromine. It occurs as a colorless and odorless 
powder, of alkaline reaction, soluble in water. Dose, gr. v-xv or more, thrice daily in wafers, 
as a diuretic. 

Theocin (Unofficial), — is the trade-name of Theophylline (see above), and occurs as 
a white, crystalline powder, soluble in 180 of cold water and in 85 of water at ioo° F. Dose, 
gr. iv, thrice daily, as a diuretic. 

Incompatibles. 

Incompatible with Caffeine are: the same substances as for the alkaloids generally (see 
page 6). Physiologically incompatible are Chloral Hydrate, Morphine, Physostigmine. 

Incompatible with Diuretin arc: Acids, Bicarbonates, Borates, Chloral Hydrate, Ferric 
Chloride, Phosphates, Phenol, Phosphoric Acid, also the incompatibles for salicylates (see 
under Salicixum). 



caffe1na. 1s7 

Physioj ogical Action. \ 

Caffeine is in general terms at first a stimulant and subsequently a pa- 
ralyzant to the nerve-centres in the cerebrum, medulla and cord. In small 
doses it quickens the action of the heart and raises arterial tension; stimu- 
lates the cerebral functions, by increasing the supply of blood to the brain; 
and increases the respiration rate and the secretion of urine. Larger doses\ 
(gr. v-viij) often over-stimulate the cerebral circulation, causing great heaviness 1 
of the head, flashes of light before the eyes, tinnitus aurium, insomnia, restless- I 
ness, and even delirium, the pulse becoming rapid, feeble, irregular and inter- / 
mittent, and the general body-temperature elevated, though that of the periph- 
ery may be lowered. Large doses depress the heart and respiration, and 
lower the blood-pressure; in the smaller animals it exalts the reflex excitability 
of the cord, producing tetanic convulsions, and in lethal doses paralyzes the 
cardiac muscle as well as its motor ganglia, but causing death by paralysis of 
respiration. It powerfully affects muscular fibre, both voluntary and involuntary 
kinds, throwing it into a state of tetanic contraction resembling rigor mortis. 
Caffeine is a reliable hydragogue diuretic, acting by stimulation of the secret- 
ing apparatus in the kidney, as well as by generally raising the arterial tension 
(Brunton). The action of caffeine on the kidneys is two-fold; during the first 
stage it causes a fall of general blood-pressure and constriction of the renal 
vessels; during the second stage, which persists much longer than the first, 
the blood-pressure returns to its normal height and the kidney undergoes great 
expansion (Murrell). If administered in sufficient quantity it would doubt-, 
less prove fatal to man, but its lethal dose for him would be large. Zenetz has 
recently published the details of three cases of sudden death during the use 
of full doses of caffeine, in all of which the heart was found at the autopsy to J 
be so firmly contracted that it was cut with difficulty. He infers therefrom 
that caffeine may cause sudden arrest of the heart in systole. 

Caffeine is excreted as such very slightly and slowly by the kidneys. In 
its passage through the body it largely loses its methyl groups, most of it being 
transformed into xanthine, which probably breaks up into urea. 

Theobromine and Theophylline act similarly to Caffeine on the kidneys, 
heart, and muscular tissue, but have little effect on the central nervous system. 
In large doses Theobromine is fatal to small animals. 

Coffee is a cerebro-spinal stimulant, a stomachic tonic, and a laxative. It 
is decidedly diuretic, and is somewhat antiperiodic. The green bean produces 
very different effects from those of the roasted one, exhibiting the action of 
Caffeine alone, unmodified by that of the empyreumatic products. A tincture 
of green coffee, besides being an efficient diuretic, has marked anti-lithic powers, 
and promotes the elimination of the poison of gout from the system. Coffee 
when freshly roasted and ground is deodorant, antiseptic, and germicidal, an 
infusion of J per cent, inhibiting the growth of many pathogenic organisms, 
and those of 10 per cent, killing anthrax bacilli in 3 hours, cholera spirilla in 



l88 CAFFEIXA. 

4 hours, and other bacteria in 2 to 6 days. Infusions of green coffee do not 
;ess this antiseptic action, which is probably due to the empyreumatic prod- 
ucts developed by the process of roasting. 

As a beverage, if used with moderation Coffee assists digestion, promotes 
itinal peristalsis, allays the senses of fatigue and hunger, lessens tissue- 
waste and consequently decreases the formation and excretion of urea. Used 
to excess it disorders digestion, and causes functional disturbances of the nervous 
system, shown by headache, vertigo, mental confusion, and palpitation of the 
heart. It increases secretion, blunts sensation, exalts reflex excitability, increases 
mental activity, and may produce insomnia and great nervous restlessness. It 
first briefly stimulates the heart and raises arterial tension, but soon de- 
presses both. The wakefulness is usually preceded by a short period of 
drowsiness. 

The brief stimulation of the intellect, consequent on drinking a cup of good 
coffee, cannot be obtained from an infusion of raw coffee, and is probably due 
to the volatile constituents developed in roasting. Cajjeone opposes Caffeine 
in its action on the circulation, as it quickens the pulse and lowers arterial ten- 
sion. Its action, however, is of brief duration, and soon gives way to the in- 
fluence of the principal constituent. The Tannin is the ingredient which en- 
ables it to produce dyspepsia, and is most abundant in those infusions which 
are kept a long time on the stove before being served. 

Tea (Thea sinensis, nat. ord. Ternstromiaceae), is one of the most refresh- 
ing and stimulating members of the group. Used to excess, it powerfully 
affects the stability of the motor and the vaso-motor nerves, the action of the 
heart, and the digestive function, producing flatulent dyspepsia, tremulousness 
of the limbs, pallor of the surface, irregular cardiac action and feeble impulse, 
hallucinations, nightmare, anorexia, headache, nausea and vomiting, obstinate 
neuralgias, especially of the supra-orbital and occipital nerves; also constipa- 
tion and a pain in the left side are not infrequent. The condition of chronic 
tea-poisoning is termed Theism, and is very often seen among women of the 
lower class in cities, who do not indulge in alcoholic beverages, but freely accept 
the dominion of the "cup that cheers" and worse than inebriates. Tea con- 
tains much more tannin than coffee, and that used as a beverage by the poorer 
classes is little more than a decoction of tannin, and a fruitful source of dyspepsia 
and other forms of gastric disorder. 

Cocoa (Theobroma Cacao, the Chocolate-tree, nat. order Sterculiaceae), 
pronounced Ko-ko, — is more nutritious than any other of the group, containing 
a large quantity of fat, Oleum Theobromatis (cacao-butter), which makes it 
difficult of digestion to many persons. The various preparations of this agent 
are made from the seeds, after the oil has been expressed from them. They 
are ground in a mill, mixed with rice, barley, sugar, flour, etc., and put up in 
powdered form, called Cocoa, — but when flavored with vanilla and pressed into 
a cake the product is named Chocolate. The thin husks which envelop the seeds 



CUT FIN A. I,Sq 

are known as Shells, and are used to make a beverage similar to but 
milder than COCOa or chocolate. [Compare the article entitled THEOBROMATIS 
Oi.itm.] 

Coca, or Cuca (Erythroxylon Coca, nat. ord. Linese), is probably more sus- 
taining than either tea or coffee and less of a direct stimulant, at least as used 
by the Peruvian natives. Its habitual and excessive use produces a very serious 
train of nervous symptoms. [Compare the article entitled Coca.] Its alkaloid, 
Cocaine, is allied in action to Caffeine, but is more powerful, and its proportion 
in the leaves of the plant varies greatly in the different samples which occur in 
commerce. 

Kola (Cola acuminata, nat. ord. Sterculiacere), is the nut or seed of the 
Kola plant, a handsome tree growing 30 to 60 feet high in the tropical forests 
of Africa and in the West Indies. It contains both Caffeine and Theobromine, 
the former in larger proportion than any member of the group except Guarana; 
also Tannic Acid and a glucoside substance named Kolanin, which, in the pres- 
ence of a ferment, splits up into free caffeine and glucose, its yield of caffeine 
being 3 per cent. The Kola nut is highly valued by the negroes as a stimulant 
beverage and food and as an aphrodisiac, the latter quality being ascribed to the 
essential oil, which is not present in the dried nuts. It improves the appetite 
and the digestion, and promotes cheerfulness of the spirits and inclination to 
exertion. It is becoming a fashionable stimulant under the commercial methods 
which are employed in pushing the sale of the various preparations on the market. 

Guarana (Paitllinia Cupana of Brazil, nat. ord. Sapindaceae), contains 
an alkaloid — Guaranine, in the proportion of 5 per cent., which is identical 
with Caffeine. It is especially noted for relieving a nervous headache, for 
which purpose the official fluid extract may be used in doses of ir^xx, three or 
four times daily, when the basis of that preparation happens to be of good 
quality. 

Mate (Ilex Paraguayensis, nat. ord. Aquif oliacese) , is supposed to be inter- 
mediate as to its effects between tea and coffee. It contains a very small quan- 
tity of Caffeine, about 1 per cent., also a little tannin. 

The qualities possessed in common by these substances, and for which 
they are so universally esteemed by mankind, are three-fold. They all retard 
the retrograde metamorphosis of the body-tissues (tissue- waste), thereby en- 
abling the work of the individual to be done upon a smaller supply of reparative 
material (food), and with less fatigue. Furthermore, when used in modera- 
tion, they are more or less stimulating to the mental processes, and sedative 
to the nervous system. 

This similarity of action they owe to the possession of principles, which are so closely 
related to each other that until very recently they have been considered identical both by 
chemists and pharmacologists. The divergence from each other, in the finer shades of their 
action, depends most probably on the existence in each of differing aromatic and volatile 
principles, which modify the action of the alkaloid in some degree. Other principles are 
developed in them by the various processes of preparation (roasting, drying, etc.), which have 
some part in determining the general action of the beverages containing them. 



I go CAFFEINA. 

Therapeutics. 

Although without a very extensive range of usefulness, Caffeine is a valuable 
stimulant in many forms of nervous and cardiac depression, and has proved 
especially efficacious in headaches of neuralgic or nervous type, the pain being 
general over the head; gr. j of Caffeine every half hour, or the fluid extract 
of Guarana, in 20-minim doses every 2 or 3 hours. In choleraic diarrhea, and 
that of phthisis, it checks outward osmosis by stimulating the depressed nerv- 
ous apparatus. In cervico-brachial neuralgia, Caffeine may be used hypo- 
dermically in doses of gr. ss, increased to gr. ij. In lithemia and gout, a tinc- 
ture of the green bean has marked diuretic and antispasmodic powers, and is 
very useful in these conditions. In the insomnia of chronic alcoholism gr. £ 
of Caffeine hypodermically is often efficient. For adynamic fevers, it max- 
well be used in place of alcoholic stimulants. In intermittents Coffee has a 
curative reputation among the inhabitants of the Philippines, xx-hich is corrob- 
orated by the Dutch physicians. In asthma, Coffee is valuable for the par- 
oxysm if not used habitually. In opium narcosis, Caffeine hypodermically, 
or better still, strong black coffee by the mouth, xvill antagonize the increasing 
torpor of the nervous centres. 

Although Caffeine is an efficient diuretic in cardiac and renal dropsies, 
there are many objections to its use for this purpose. It sometimes acts as 
a purgative as xvell as a diuretic, and although at first it produces copious diu- 
resis, tolerance is soon established and it loses its diuretic power. Moreover, 
it is a poxverful cardiac stimulant, and in many persons it exerts a very marked 
excitant action upon the central nervous system. Lastly, and as a minor dis- 
qualification, it sometimes sets up considerable smarting in the penis and pro- 
duces a mild form of urethritis (Murrell). Its tendency to produce tetanic con- 
traction of muscular tissue and its possible influence to arrest the heart in systole 
should be kept in mind when it is being administered for any prolonged period. 

Caffeine is contained in many proprietary preparations of which Acetanilide is the active- 
ingredient (see page 60). Its office therein is that of a corrigent, to antagonize the depressant 
action of the latter drug upon the heart. A double citrate of caffeine and antipyrine, named 
Migranin, is described on page 141. 

Kola is a useful agent in gastric catarrh and in the dyspepsia of alcoholic 
subjects, as an adjunct to other treatment. After an alcoholic debauch it xvill 
do much toxvard restoring the nervous system to its normal condition. It xvill 
counteract the depressing effects of tobacco, and has been employed xvith bene- 
fit in asthma of both the nervous and cardiac forms. As it contains a good 
deal of tannin, it is especially efficient in atonic diarrhea, and in gastrointes- 
tinal irritation xvith looseness of the boxvels, a restricted diet and Kola-wine 
are frequently all that is needed. As an aphrodisiac it deserves high rank, 
though it acts in this respect not so much by stimulating the sexual appetite as 
by enabling the organism to escape the sense of exhaustion and extreme de- 
bility xvhich neurotic patients are apt to complain of. 



CAJUPUTI OLEUM CALCIUM. lot 

Guarana is chiefly employed in the treatment of nervous sick-headache (migraine) 
administered in half-drachm doses of the fluid extract when the attack is developing. It 
has been used in the diarrhea of phthisis, in convalescence from acute diseases, and generally 
in conditions requiring toni< treatment. 

Diuretin has been employed with marked benefit in both cardiac and renal dropsy, in 
hepatic cirrhosis, and in various diseases of the heart and kidneys accompanied by edema. 
The author has seen a large pleuritic effusion disappear rapidly under its use, the fluid having 
re-accumulated after having been once removed by tapping the pleura] cavity. It should 
be administered in aqueous solution, avoiding acids or acid vegetable juices, which are chemi- 
cally incompatible, as they precipitate the alkaloid in the form of a thick white sediment. 

Agurin is less irritant to the stomach than Diuretin, and is equally active as a diuretic. 
1 \. client results are recorded from its use in engorgements and dropsies of various origin, 
renal, hepatic, and cardiac. It is said to be an excellent antistenoeardic remedy, serving to 
both suppress and prevent the paroxysms. 

Theocin (Theophylline 1 ) has not so great a stimulant action on the heart as Caffeine, 
but is a much more powerful diuretic than either Caffeine or Theobromine. It may give 
rise to some gastric irritation, and is said to not irritate the kidneys to any harmful extent. 

CAJUPUTI OLEUM, Oil of Cajuput — is a volatile oil distilled from the leaves of 
Melaleuca Leucadendron, a tree of the nat. ord. Myrtacea?, native of the Molucca Islands. 
It is a bluish-green or colorless liquid, of camphoraceous odor and neutral reaction, freely 
soluble in alcohol. It should yield not less than 55 per cent, by volume of Cineol. Dose, 
tn;v-x [av. njviij]. 

Cajuput Oil resembles Oil of Turpentine, and has similar action to that of the other 
volatile oils, being a stimulant carminative, somewhat diuretic and diaphoretic, antiseptic, 
parasiticide and anthelmintic. Externally used it is irritant to the skin. Swallowed, it pro- 
duces a sense of warmth in the stomach and accelerates the pulse. 

It is not much used internally, though it has been given with benefit in flatulent colic, 
dropsy, hysteria, chronic rheumatism, scrofula, and syphilis, also in elephantiasis and other 
cutaneous disorders. Externally, as a strong, stimulating rubefacient, it is efficient in chil- 
blains, muscular rheumatism and nervous headaches. 

CALAMUS, Sweet Flag, — is the rhizome of Acorus Calamus, a plant of the nat. ord. 
Aracese, native in Europe and North America, having an aromatic odor and pungent taste. 
Only the unpeeled root should be used, peeled or bleached calamus being almost inert. It 
contains a volatile oil and Acorin, which is a nitrogenous, bitter principle, also benzoic acid, 
starch, etc. Dose, gr. x-xx [av. gr. xv.] 

Fluidextractum Calami, Fluidextract 0} Calamus, — is made with Alcohol and Water 
as a menstruum. Dose, itjx-xx [av. n!>xv.] 

Calamus is an aromatic bitter, and a stomachic tonic, increasing the appetite and stimu- 
lating digestion. It is one of the constituents of the preparations termed "bitters," and 
is chewed as an appetizer. 

CALCIUM, Ca, — is the metal characteristic of Lime, Chalk, and all cal- 
careous substances, and although itself unofficial it is represented by several 
official salts and preparations. Lime (Calx) and Chalk (Creta) are respec- 
tively the Oxide (CaO) and the Carbonate (CaCO a ) of Calcium, the carbonate 
occurring in the native forms called chalk, marble, lime-stone, oyster-shells, 
etc., which are converted into lime by heating to full redness (calcination), 
thereby driving off carbonic acid and leaving the oxide behind. The latter, 
in this form, is known as "burnt lime" or "quicklime"; and, by the addition 
of J to I its weight of water, combines with one molecule of H 2 to form Cal- 
cium Hydroxide, Ca(HO),, or "slaked lime," the process being termed "slak- 
ing" and being accompanied by the evolution of a high degree of heat. 

Lime is one of the four alkaline earths, the other three being Baryta, Magnesia, and 
Strontia. As such, however, it never occurs naturally, though in combination with various 
acids it is found in all the three kingdoms of nature; its base, the metal Calcium, being a 



IQ2 



CALCIUM. 



widely distributed element, forming the basis of all calcareous and cretaceous substances. 
Besides the forms mentioned above, Calcium occurs as a sulphate (gypsum), also as a phos- 
phate in bones, shells and various organic tissues, and as a silicate and a fluoride in certain 
minerals and vegetables. 

Official Salts oj Calcium. 

Calx, Lime, Calcium Oxide, CaO, — is Lime prepared by burning white marble, oyster- 
shells, or the purest varieties of native Calcium Carbonate. Occurs in hard, white masses, 
gradually resolving to a white powder in the air, odorless, of sharp, caustic taste and alkaline 
reaction, soluble in 750 of water and 1600 of boiling water, insoluble in alcohol. Not used 
internally except in solution. 

Calcii Carbonas Praecipitatus, Precipitated Calcium Carbonate, CaCO s> — a fine im- 
palpable, white powder, odorless and tasteless, insoluble in water or alcohol, but soluble 
in mineral acids or acetic acid with effervescence. Creta (chalk) is native Calcium Car- 
bonate. Dose, gr. v-.xxx [av. gr. xv.] 

Calcii Chloridum, Calcium Chloride, CaCl 2 , — hard, colorless masses, deliquescent, 
of sharp, saline taste, soluble in 1 J of water and in 8 of alcohol. Dose, gr. iij-x [av. gr. vijss], 
in solution. This salt should not be confounded with Chlorinated Lime. 

Calcii Sulphas Exsiccatus, Exsiccated Calcium Sulphate, {Dried Gypsum) — contains 
about 5 per cent, of water. A fine, white powder, without odor or taste, insoluble in alcohol, 
soluble in 410 of water at 59° F., in 388 of water at ioo° F., and in 451 of water at 212 F. 
Used in the preparation of Calx Sulphurata. 

Calcii Sulphidum, Calcium Sulphide, is described under Sulphur; Calcii Bromidum, 
Calcium Bromide, under Bromum; Calcii Hypophosphis, Calcium Hypophosphilc. Calcii 
Phosphas Praecipitatus, Precipitated Calcium Phosphate, and Calcii Lactophosphas, 
under Phosphorus. 

Preparations oj the Oxide. (Lime.) 

Liquor Calcis, Solution of Calcium Hydroxide, Lime-water, — contains not less than 
0.14 per cent, of Calcium Hydroxide, Ca(HO) 2 . A clear, colorless liquid, of saline taste 
and alkaline reaction. Dose, 5ss-j [a v. oiv.] 

Syrupus Calcis, Syrup oj Lime, Syrup oj Calcium Hydroxide, — contains 6i per cent, 
of Lime, and 40 of Sugar, the latter aiding the solvent power. Dose, njfx-oj, [av. njjxxx.J 
Is an antidote to poisoning by Oxalic Acid and Phenol. 

Linimentum Calcis, Lime Liniment, (Carron Oil) — contains equal volumes of Lime- 
water and Linseed Oil, mixed by agitation. For local use. 

Calx Chlorinata, Chlorinated Lime, is described under Chlorum; and Calx Sulphu- 
rata, Sulphurated Lime, under Sulphur. 

Preparations oj the Carbonate. (Chalk.) 

Creta Praeparata, Prepared Chalk, CaC0 3 , — is native Calcium Carbonate, freed from 
most of its impurities by elutriation; a white, amorphous powder, odorless and tasteless, 
insoluble in water or alcohol. Dose, gr. x-xxx [av. gr. xv.] It is a constituent of Hydrargy- 
rum cum Creta, and also of the following: 

Pulvis Cretas Compositus, Compound Chalk Powder, — has of Prepared Chalk 30, 
Acacia 20, Sugar 50 parts. Dose, gr. v-oj [av. gr. xxx.] 

Mistura Creta?, Chalk Mixture, — has of the preceding 20 parts, Cinnamon Water 40, 
Water to 100, rubbed together and made fresh as required. Dose, 5 j-o j [a v. 5'v.] 

Testa Praeparata, Prepared Oyster-shell (Unofficial), — contains animal matter inti- 
mately mixed with the Carbonate of Calcium. Dose, gr. x-xx or more. 

Allied Substances. 

Substances allied to Chalk, and derived from the animal kingdom, are — Crabs'-eyes, 
which are concretions obtained from the stomach of the craw-fish, Coral, Cuttle-fish Bone, 
Egg-shell and Oyster-shells (Testa, see above) ; all of which are mainly composed of Calcium 
Carbonate, but also contain the phosphate and sulphate of calcium and other metallic salts 
in small quantity, as well as organic material. In the past special virtues have been ascribed 
to these substances, and even now some authorities maintain that the animal carbonates 
derange the stomach less than the mineral ones, and are to be preferred for infants and deli- 
cate persons. 

Incompatibles. 

Incompatible with the Carbonate are Acids, Alum, Ammonium Chloride, Sulphates, 
Tartar Emetic, and other metallic salts; with the soluble Calcium Salts are Alkalies, Car- 
bonates, Citrates (with heat), Oxalates, Phosphates, Tartrates. 



calcium. iq3 

Physiological Action. 

Lime, in its unslaked form (quick-lime), has a great affinity for water and 
readily combines with sulphur, thereby decomposing and destroying organic 
matter. Upon the skin its action is irritant and superficially caustic, but more 
severe on the mucous membranes, and if inhaled or swallowed it may produce 
dangerous local inflammation, followed by ulceration. In weak solution it has 
an astringent and sedative effect both locally and internally, and acts as an ab- 
sorbent and an antacid. Chalk possesses the astringent and antacid qualities 
of lime without its irritant properties. 

Calcium Chloride is a very diffusible salt, and in small doses has remark- 
ably alterative action, being apparently a powerful antagonist to the condition 
known as the strumous diathesis. Full doses produce symptoms of muscular 
poisoning similar to those caused by potassium salts, with lowered tempera- 
ture, a slow pulse, and a tendency to cardiac paralysis. It inhibits intestinal 
peristalsis, and increases the coagulability of the blood, thereby acting as a hemo- 
static. It increases the amount of the urine, and promotes the excretion of 
urea. In large doses it is an irritant poison. It has a great affinity for water, 
and is used in pharmacy to abstract water from other substances, as in the 
preparation of absolute alcohol and ether. In solution it is used as a test for 
tartrates, citrates and oxalates. 

Calcium Salts play an important part in the circulation and in most of the 
other functions of the body. The heart or any other muscle, deprived of cal- 
cium, will no longer contract. These salts have a remarkable influence on 
the nutrition of plants and animals, the Phosphate being as essential to the 
nourishment of the organs of locomotion (cartilage, bone, tendon and muscle) 
as iron is to the blood or phosphorus to the nerve tissue. They possess high 
coagulating power on the blood; their deficiency gives rise to lymphatic and 
osseous disease, and their absence results in emaciation and finally death. They 
are excreted almost entirely by the intestines, a very small portion being ab- 
sorbed, and but little of that passes out by the kidneys. Their absence from 
water renders the latter flat and insipid to the taste, but if present in excess 
(above 20 grains of the carbonate to the gallon) the water containing them is 
believed to be one of the factors of goitre. The Sulphate, in even so small a 
proportion as 6 grains to the gallon, is unwholesome, as it is liable to irritate 
the bowels and produce constipation and diarrhea' alternately, according as its 
astringent or irritant effect predominates. 

Therapeutics. 
Lime may be used as a caustic and depilatory, but is better known as an 
agent for hastening decomposition, which it does by its great affinity for water, 
the resulting hydrate absorbing many of the products. Chlorinated Lime is 
an excellent antiseptic and disinfectant, but as it owes its energy entirely to its 
power of evolving chlorine it will be described under the title Chlorum. Lime- 
14 



I ( ;4 CALCIUM. 

water is a favorite remedy for vomiting, especially in children, and is added 
to milk, to increase its digestibility. A mixture of milk and lime-water will be 
retained by the stomach when no other food can be borne. Lime-water is an 
efficient agent in acid dyspepsia, mucous enteritis and typhoid fever, as an 
astringent and antacid. Locally, it is well employed as an enema against thread- 
worms, as a mouth wash for aphthae, and as a lotion for cracked nipples, eczema- 
tous eruptions, and many mucous and purulent discharges. For such pur- 
poses it may be mixed with oil or glycerin, and if a few drops of carbolic acid 
be added the efficacy of the mixture is much increased. The Liniment is best 
known by the name Carron Oil, from the foundries at Carron, where it is ex- 
tensively used. It is one of the best applications for burns and scalds, and 
makes a good dressing for the face in smallpox, and for cases of eczema affecting 
a large area of the skin. The vapor of slaking lime, or lime-water in the form 
of spray, have been usefully employed as inhalations in diphtheria. Lime- 
water is a good injection into the bladder in vesical calculus, in which its benefit 
is probably due to its astringent and soothing effects on the inflamed vesical 
mucous membrane, blunting its sensibility, and preventing the further growth 
of the stone by neutralizing the free acid of the urine. The Syrup contains more 
lime in solution than lime-water does, and may be used instead of the latter 
when a strong preparation is indicated. It is one of the antidotes in poisoning 
by carbolic and oxalic acids, while lime in any form (wall-plaster, whiting, etc.) 
is the best antidote for any mineral acid. 

Chalk is the basis of all dentifrices, and may be used as a dusting-powder 
on ulcers, burns and excoriations of the skin. Chalk-mixture is a common 
remedy for diarrhea, and is usually employed in combination with other as- 
tringents, also with opium and aromatics. It is particularly serviceable for 
the diarrheas of children with sour-smelling stools and other symptoms of gastro- 
intestinal acidity. 

One of the curiosities of medical history is the fact that in 1739 the British Parliament 
gave the sum of £5,000 to Mrs. Johanna Stephens for divulging the nature of a certain 
lithontriptic remedy. This, she stated, consisted of calcined egg-shells and soap, with various 
aromatic bitters, a combination which had previously been recommended by Barbette for 
the same purpose. The nauseousness of this compound suggested to Whytt the use of lime- 
water as a substitute, and the latter was found to be efficacious in many instances. Calcium 
salts are believed to prevent the formation of uric acid calculi by binding the phosphates of 
the food and blood, and thereby lessening the excretion of phosphoric acid, the disodium 
phosphate holding uric acid in solution, though the monosodium phosphate precipitates it. 
The carbonate is. the salt preferred for this purpose, given in doses of gr. xv-xx thrice daily 
in plenty of water. 

Calcium Chloride is used with benefit as an internal remedy in the various 
manifestations of the strumous diathesis. It often causes the resolution of 
glandular enlargements, and the calcification of tubercular deposits, aids the 
cicatrization of ulcerating cavities, and has proved curative in eczema and lupus. 
It "is praised in phthisis, also in chorea, and for the colliquative diarrhea of 
strumous children. As it inhibits intestinal peristalsis it is a rational and use- 
ful remedy for the diarrhea of hysteria and other forms of nervous excitability. 



C \i i:\in I. \ CAMBOG] \. 195 

It Is used as a hemostatic in uterine hemorrhages and hemophilia. In solution 
as a fomentation it is said to hasten the maturation of boils. 

The therapeutics of the other salts and combinations of calcium are described 

under the titles of their more active ingredients, Bromum, Chlorum, Phosphorus 
and Sulphur. 

CALENDULA, Marigold, — is the florets of Calendula officinalis, the common Garden 
Marigold, a plant of the nat. ord. Composite, frequently cultivated for ornament. The 
tincture 1 ;o per cent.) is also official, and is exclusively used as a local application to promote 
the healing process in wounds, ulcers, burns and other breaches of tissue. Extravagant 
views of its powers as a vulnerary arc promulgated by the so-called "homeopathic surgeons," 
and serve as one of their excuses for professing an exclusive position in the art of surgery. 
Dose of Calendula, gr. x-xx [av. gr. xv]. 

CALUMBA, Calumba, — is the root of Jateorhiza palmata, a plant of the 
nat. ord. Menispermaceae, native in southeastern Africa, but cultivated in the 
East Indian Islands. It contains the alkaloid Berberine (see under Berberis, 
page 176), a bitter principle named Calumbin, also Calumbic Acid and Starch, 
but no tannin. Dose, gr. v-xlv [av. gr. xxx.] 

Preparations. 
Fluidextractum Calumbas, Fluidextract oj Calumba. — Dose, njrv-xlv [av. itgxxx.] 
Tinctura Calumbae, Tincture of Calumba, — 2 in 10. Dose, 3 ss— i j , [av. 3j-] 
Incompatible with Calumba preparations are: Mineral Acids, Ammonia, Cinchona 

infusion, Galls infusion, Ferric salts, Lead Acetate, Lime-water, Mercuric Chloride, Silver 

Nitrate, Tartar Emetic. 

Physiological Action and Therapeutics. 

Calumba is one of the simple bitters, a group of vegetable agents which con- 
tain no volatile oil, have no astringent property, and no effect upon the general 
system, but markedly affect the stomach as stimulants. This group includes 
also Chirata, Cornus, Gentian, and Quassia. They stimulate the nerves of 
taste, increase the flow of saliva, excite the gastric circulation and the flow of 
gastric juice, and thereby increase appetite, aid digestion, and promote the 
constructive metamorphosis. As they also increase the production of the gas- 
tric mucus, their long-continued use will set up gastric catarrh and impair diges- 
tion, though they are the least irritant of all the stomachic tonics. 

As Calumba contains no tannin, it may be administered with the salts of 
iron, and is often prescribed with the sub-carbonate. It is useful in atonic 
dyspepsia with pain after eating, in the convalescent stage of disease to pro- 
mote appetite and digestion, in diarrhea and dysentery, vomiting, sea-sickness, 
cholera morbus and cholera infantum. An Infusion of Calumba with Ginger 
and Senna is effective in flatulence, and the same preparation is a good vehicle 
for the administration of acids and alkalies, tonics, aromatics, and mild ca- 
thartics. Having little or no irritant quality, it is an excellent tonic in the hectic 
fever of phthisis. 

CAMBOGLA, Gamboge, — is a gum-resin, obtained from Garcinia Hanburii. a Siamese 
tree of the nat. order Guttiferas. It contains 73 per cent of Gambogic Acid, a resinous sub- 



I 9 6 CAMPHOR A. 

stance, also 25 per cent, of gum and 2 of water. It is partly soluble in alcohol and in ether. 
The only official preparation is the Pil. Cathartics Co. (described under Colocynthis), 
each pill containing gr. \ of Gamboge. Its dose, as a cathartic, is gr. ij-v, — as a diuretic, 
gr. i at short intervals, [a v. gr. ij.] 

Gamboge is an irritant purgative, decidedly diuretic, and its powder is sternutatory. 
Its catharsis is accompanied by vomiting and colic, and the stools produced are watery, 
but not so much so as generally believed. It has no cholagogue action. Full doses are 
liable to produce violent gastro-enteritis, and incautiously used (as in Morrison's pills) it 
has caused death. On the other hand, large doses have been given continuously in some 
cases, without producing any dangerous symptoms. 

Gamboge was formerly much used as a hydragogue cathartic and diuretic in dropsies, 
but its irritant qualities have caused it to be superseded by other agents (elaterium, digitalis, 
etc.). However, for dysentery, especially when in young subjects, very small doses (gr. ^5) 
at short intervals, up to gr. J in 24 hours, have proven to be remarkably efficacious. 

CAMPHORA, Camphor, C w H 16 0, — is officially described as the dextro- 
gyrate modification of the saturated ketone obtained from Cinnamomum Cam- 
phora, a tree of the nat. ord. Laurineae, and purified by sublimation. It occurs 
in white, translucent, waxy masses, of penetrating odor and pungent taste, 
lighter than water, in which it is sparingly soluble (1 to 1300), but dissolves 
readily in alcohol, ether, chloroform, benzin, and oils. The camphor-tree is 
indigenous to China, Japan, Formosa and other parts of Eastern Asia. Borneo- 
camphor has the formula C 10 H 18 O, bears the same relation to Japanese cam- 
phor as alcohol bears to aldehyde, and is heavier than water. Dose, gr. j-iij 
[av. gr. ij.] 

Derivatives of Camphor are — Camphor-cymol, which is obtained by its 
distillation with zinc chloride; Camphoric and Camphretic Acids, which result 
respectively from its lesser or greater oxidation; and Safrol, also contained 
in Sassafras oil, but obtained in much larger quantities from Camphor oil, a 
waste by-product in the manufacture of crude camphor. An artificial Camphor 
is made by synthesis from oil of turpentine. 

Official Preparations. 

Aqua Camphorae, Camphor-water, — Camphor 8, Alcohol 8, Talc 15, Distilled Water 
to 1000. Used externally or as a vehicle internally. Dose, 3j~iv, [av. oij-] 

Spiritus Camphorae, Spirit 0} Camplior, — 10 per cent, in Alcohol. Dose, irjv-xx 
[av. tij-xv] 

Linimentum Camphorae, Camphor Liniment, — Camphor 20, Cotton-seed Oil 80. 

Ceratum Camphorae, Camphor Cerate, — has of the Liniment 10, White Wax 35, White 
Petrolatum 15, Benzoinated Lard 60. Used for itching skin-affections. 

Camphora Monobromata, Monobromated Camphor, C I0 Hi 5 BrO,- — colorless, prismatic 
needles or scales, of mild camphoraceous odor and taste, and neutral reaction; almost in- 
soluble in water, slightly in glycerin, freely in alcohol, ether, oils, etc. Dose, gr. j-v [av. gr. ij], 
in emulsion. 

Acidum Camphoricum, Camphoric Acid, C 8 H 14 (COOH) 2 , — is a dibasic acid, obtained 
by the oxidizing action of nitric acid on camphor. Occurs in white, acicular/odorless crystals, 
of feebly acid taste; insoluble, or nearly so, in cold water, readily soluble in hot water, alcohol, 
ether and fatty oils. Dose, gr. x-xx [av. gr. xv], dry on the tongue. 

Camphor is an ingredient of Linimentum Saponis, and Tinctura Opii Camphorata. 

Unofficial Preparations. 

Rubini's Tincture of Camphor, — is a saturated solution in alcohol, oj in oji. of 
which the dose is from 4 to 10 drops, njvij have caused toxic symptoms in an adult. 

Raspail's "Eau Sedative," — contains Aq. Ammonia? oij, Sodii Chloridum oij. Cam- 
phorated Spirit of Wine 5 iij, Water Oij. Used externally. 



CAMPHORA. K)7 

Camphora Carbolata is the name given to a mixture of t\ parts of camphor with one 
each of carbolic acid and alcohol. This preparation, mixed with olive oil, is a good non- 
irritating and antiseptic dressing for wounds and breaches of surface. 

Camphor-Chloral is a Quid obtained by triturating together equal parts of camphor 
and chloral hydrate. It dissolves morphine sulphate readily (gr. xx in 5'j), also many 
other salts of alkaloids. It is often a serviceable application in superficial neuralgia, and 
is said to allay spasmodic cough if painted over the larynx. 

Camphora Salicylata is obtained by heating together it parts of salicylic acid and 
14 of camphor. An ointment prepared therefrom has been used with satisfactory results 
in the treatment of phagedena, spreading syphilitic sores, epithelioma and lupus. 

Oleum Camphorata, Camphorated Oil, — strength 10 per cent., is used for hypodermic 
injection, in doses of H.U.w-5 j- 

Oxyphor, — is the trade name of an alcoholic solution, containing 50 per cent, of Oxy- 
camphor, a synthetic derivative of camphor, prepared by replacing one of the hydrogen atoms 
by the molecule hydroxy!, and unstable in the crystalline state. Dose, oss-ij. 

Iiicompatibles. 

Incompatible with Camphor preparations are: Butyl-chloral Hydrate, Chloral Hydrate, 
Chromic Trioxide, Dichlor-acetic Acid, Euphorin, Hydrochloric Acid, Menthol, Monochlor- 
acetic Acid. Naphtol, Phenol, Potassium Permanganate, Pyrocatechin, Pyrogallol, Resorcin, 
Salol, Salicylic Acid, Thymol, Urethane, Water; with Camphora Monobromata are: Chloral 
Hydrate, Kuphorin, Phenol, Pyrocatechin, Salol, Thymol. With Spirit 0} Camphor are 
A. aria, Aqueous fluids, Gelatin. 

Physiological Action. 

Camphor is antispasmodic, anodyne, antiseptic, diaphoretic, a stimulant 
expectorant, a cerebral excitant, a gastro-intestinal irritant, and a rubefacient. 
It has an acrid, hot taste, and irritates the skin and mucous membranes, in quan- 
tity exciting severe gastric inflammation with all the effects of an irritant poison. 
In medicinal doses it stimulates the vasomotor system and the cardiac motor 
ganglia, and lessens the influence of the pneumogastric, — thus increasing 
the circulation and raising arterial tension. It also stimulates respiration 
and mental activity, even producing intoxication; promotes diaphoresis, allays 
pain, and increases the menstrual flow and the sexual appetite, but its continued 
use depresses the generative function. "Camphora per nares castrat odore 
mares." 

Large doses cause gastro-intestinal inflammation, depress the heart and 
lower arterial tension, diminish the reflex function of the spinal cord, produce 
coldness of the surface, insensibility, coma, convulsions and perhaps death. 
Vs many as 200 grains have been taken without fatal result, yet 6 or 7 grains 
have produced extreme drowsiness and weakness of the pulse, 20 grains laid 
up an Alpine guide for a day, and §ss of the spirit caused profound symptoms 
of poisoning, including epileptiform convulsions and severe headache. The 
autopsy in one fatal case showed congestion of the cerebral meninges. It is 
eliminated by the bronchial mucous membrane, skin and kidneys, and has often 
caused dysuria. 

Monobromated Camphor resembles the bromides, but its action is not iden- 
tical with theirs. In mammals it produces muscular weakness passing into 
paralysis, lowered temperature and respiration, stupor and death. In some 



198 cannabis indica. 

cases its use by man has been followed by epileptiform convulsions. It is a 
nervous sedative and hypnotic, and a gastric irritant. 

" Therapeutics. 

Camphor was much used by the older physicians as an antispasmodic and 
is greatly valued still in China and Japan. It has a reputation for uncertainty 
of therapeutic action, but is usefully administered in cholera and choleraic 
diarrhea, summer diarrhea and that of infants, vomiting, gastralgia, cardiac 
depression, nervousness and nervous headache, nymphomania, capillary bron- 
chitis, typhoid and eruptive fevers, dysmenorrhea, afterpains, chordee, strangury, 
and catarrhal colds. Locally it is effective in myalgia, lumbago, toothache, 
gangrene, and other conditions where counter-irritation or a local anodyne is 
required. A solution in ether is a beneficial application in erysipelas. 

Subcutaneous injections of camphor in doses of gr. j dissolved in n^xv of 
olive oil are employed with excellent results in pneumonia, typhoid fever, and 
other conditions when collapse is imminent. In fibrinous pneumonia these 
injections produce a depression of about one degree in the temperature, and 
greatly ameliorate the general condition. They are also employed with benefit 
in the treatment of phthisis during the period of softening, rendering the patient 
more comfortable and prolonging life. Camphor administered in this manner 
is not well borne by young children, even in minimum doses. Its power of 
producing sedation of the nervous system and stimulation of the heart have 
been utilized in the treatment of tetanus, and may be efficiently employed in 
many acute affections. 

Monobromated Camphor is used as a nerve sedative and* hypnotic, but 
is not particularly efficient. It has been employed with advantage in whoop- 
ing-cough, neuralgia, chorea, hysteria, delirium tremens and epilepsy, but it 
is taken with difficulty and is liable to irritate the stomach. 

Camphoric Acid, in solutions of h to 6 per cent, strength, has been used with benefit 
as a topical agent in cystitis, also in coryza, acute bronchitis and other affections of the respira- 
tory tract. Internally administered it gives good results as an intestinal disinfectant, and 
has lately come into prominence as one of the most efficient agents against sweating from 
various causes, especially the profuse night-sweats of pulmonary tuberculosis. For this 
purpose it is best administered dry on the tongue, in dose of 10 to 30 grains, not more than 
two hours before the time for the expected sweating to occur, as it is quickly and abundantly 
eliminated by the urine. 

Oxy camphor is devoid of the stimulant action of camphor on the brain, medullary 
centres, and blood pressure, but markedly depresses the respiration by diminishing the 
excitability of the respiratory centre. The alcoholic solution named Oxyphor, (see page 
197), has been used with great satisfaction in asthma, dyspnea, and whooping-cough. 

CANNABIS INDICA, Indian Cannabis, {Indian Hemp),— is the dried 
flowering tops of the female plant of Cannabis sativa, grown in the East Indies ; 
a coarse, pubescent, somewhat viscid annual of the nat. ord. Moraceae. Its 
odor is peculiar and narcotic, its taste slightly acrid. 

Cannabis Americana, American Cannabis, (Unofficial), — is the same plant. 
Cannabis sativa, grown in the Southern States. 



CANNABIS CNDICA. l<;o 

The two varieties are specifically identical with each other, differing only 
in the degree of their action, that grown in India being the most powerful. 
They contain a resin named Cannabin, and a Volatile Oil, from the latter of 
which are obtained Cannabene, a light hydrocarbon, and Cannabene Hydride, 
a crystalline body. Cannabis should not be confounded with the so-called 
"Indian or Canadian Hem])," ApOCYNUM cwnabinum (see page 145). 

Preparations. 

Extractum Cannabis Indie*, Extract of Indian Cannabis. — Dose, gr. J-J [av. gr. !], 
if active, lloring's English Extract is one of the best. 

Fluidextractum Cannabis Indicae, Fluidcxtract of Indian Cannabis, — is an alcoholic- 
preparation which in mixtures must be thoroughly emulsified with Acacia, otherwise the 
resinous drug will separate and float to the top or adhere to the sides of the bottle. The 
Dose is put at njjj-v [av. rnjj], hut the author has frequently administered 3j of a good fluid 
extract without untoward results. Whatever may be the reason, it is a fact which he has 
often verified, that if the precipitate, formed when the alcoholic preparation is added to water, 
bo of a brownish hue, a dirty, yellow-brown, the sample will prove to be almost inert; — but 
if of a derided olive-green color, the preparation will be active. The activity will be found 
to increase almost in direct proportion to the decided green color of the precipitate. Samples 
from one manufacturer show this difference, often seen between two bottles in the same 
shipment. The active principle seems to be intimately connected with the chlorophyll or 
other coloring matter present, and to be destroyed therewith by whatever affects the latter. 

Tinctura Cannabis Indicae, Tincture of Indian Cannabis, — strength 10 per cent. Dose, 
njv-xxx [av. irjx]. The above remark on mixtures containing the fluid extract applies also 
to those containing the tincture of this drug. 

Similar preparations of Cannabis Americana are made by the manufacturers and may 
be used in larger quantities. The dosage of all preparations of hemp is uncertain, as speci- 
mens of the plant vary greatly in activity. The best rule is to begin with a small dose, gradu- 
ally testing the activity of the drug and the susceptibility of the patient by cautiously in- 
creased doses. 

Cannabin Tannate (Unofficial), — is a ye'lowish-brown permanent powder, insoluble 
in water and ether, slightly soluble in alcohol, having a not unpleasant odor and a bitterish, 
astringent taste. No formula has been published for it, but it is claimed to be the tannate 
of a glucoside by Merck, of Darmstadt, who placed it on the market. Dose, as a hypnotic, 
gr. v-x. 

Preparations used in tlie East. 

Churrus is an impure resin, prepared by rubbing the leaves of the plant together and 
scraping off the adhering resin. 

Gunjah is the dried leaf and tops as sold in the bazaars for smoking purposes. 

Hashish, Bhang or Siddhi is a confection consisting of the leaves and small stalks 
coarsely broken and mixed with fruits and aromatics. It is employed in the preparation of 
various electuaries and beverages, and is also smoked with or without tobacco. 

Incompalibles. 
Caustic Alkalies are incompatible with preparations of Hemp. Water precipitates the 
resin from alcoholic preparations. 

Physiological Action. 
Cannabis Indica is antispasmodic, analgesic, anesthetic and narcotic, a 
cerebro-spinal stimulant and a powerful aphrodisiac. It increases intellectual 
and motor activity, stimulates the vaso-motor nerves, raising arterial tension, 
depresses sensation, and strengthens the energy of the uterine muscular fibre, 
but has no power to initiate uterine contractions. In large doses it causes a 
peculiar but generally pleasant form of intoxication, during which the particular 
traits of the individual are exaggerated, and the ideas follow each other so 



200 CANNABIS IXDICA. 

rapidly as to produce a sense of great prolongation of time, minutes seeming 
as if hours or even days. With this occurs increased sexual desire and uterine 
activity, also sensations of double consciousness and enormous dimensions. 
The sight and hearing are exalted, pupils dilated, anesthesia sets in, the reflexes 
are lowered by stimulation of inhibition, and if the dose be a heavy one a cata- 
leptic state is induced. Sleep or coma follows according to the size of the dose, 
but death has never been produced by this drug. 

After-effects are dullness, heaviness, vertigo, headache, confused thought, 
anesthesia of the skin, and marked diuresis, — but no nausea, no vital depression, 
no constipation. Repeated use of the drug causes mental weakness and sexual 
impotence, the results of over-stimulation. It is much used by the natives of 
Egypt, and is responsible for most of the crime and insanity seen in that country. 
A ravenous appetite is usually one of its early effects. 

Therapeutics. 

Cannabis Indica was formerly much employed as an anodyne and hypnotic, 
also as an anesthetic during surgical operations. It is now somewhat out of 
fashion. In migraine it is useful to prevent recurrence of the attack, and in 
neuralgia it is often very efficient. Uterine affections, such as chronic metritis, 
subinvolution, menorrhagia and dysmenorrhea, are greatly benefited by its 
anodyne quality and its power over the uterine muscular fibre. It is one of 
the best hypnotics in delirium tremens, and in traumatic tetanus and paralysis 
agitans large doses of this drug will lower the reflex activity. The tincture, 
in doses of 2 to 8 minims every 3 or 4 hours for children below ten years, of 
age, is highly praised in chorea minor and whooping-cough. Dysuria and 
retention of urine are often relieved by it, while in spasm of the bladder and 
other painful affections of that organ it will be found a most efficient remedy. 
It is useful in functional impotence, especially if combined with Ergot and 
Nux-vomica. In gonorrhea it lessens the discharge, relieves the inflammation, 
burning pain and restlessness, and allays chordee. The tincture of Cannabis 
Americana is the most useful in this affection, being fully as efficient as copaiba 
or sandal oil, and much more agreeable. It should, however, be prepared from 
the fresh plant, and be given in 3 to 5 drop doses 3 or 4 times daily after the 
subsidence of the acute symptoms. Full doses of the tincture of the Indian 
plant are extremely efficient in many cases of headache at the menopause, but 
should be used cautiously until the activity of the sample and the susceptibility 
of the patient are tested. 

Dr. Lees has called attention to the fact that aqueous preparations of this 
drug, which contain but little of the resin, are much used by the natives of India 
for intoxicating and stimulating purposes, which indicates that the volatile oil 
and not the resin is the active principle. He uses a strong aqueous extract, 
prepared without heat, which gives all the beneficial effects of the alcoholic 
preparations without the extreme exhilaration bordering on intoxication so often 



I \\ I'll \RIS. 20I 

produced by even medium doses of the latter. He finds that, in pulmonary 
affections generally, this Liquor Cannabis Indices acts favorably as an anodyne 
and hypnotic, while in phthisis pulmonalis it relieves the cough and aids the 
patient by its stimulant and exhilarating qualities to a degree which no other 
drug can accomplish. Lees has also used it with benefit in indigestion with 
constipation, and in many affections of children in which nervous symptoms are 
prominent. The adult dose is oss-j. 

Cannabin Tannate is considered by Fronmuller to be a very useful hyp- 
notic, not in any degree dangerous and neither disturbing the secretions nor 
leaving unpleasant after-effects. It has been used with benefit in acute mania. 

CANTHARIS, Cantharides, (Spanish Flies),— is the dried beetle, Can- 
tharis vesicatoria, an insect of the nat. ord. Coleoptera, about an inch long, 
of a shining green color, the powder being grayish-brown with green particles, 
odor very disagreeable. Contains Cantharidin, C 10 H 12 O 4 , the active principle; 
also a greenish volatile oil and peculiar fatty bodies. Dose, gr. J-j [av. gr. ss.] 

Preparations. 

Tinctura Cantharidis, Tincture of Cantharides, — 10 per cent. Dose, njjj— x [av. npv.] 

Ceratum Cantharidis, Cantharides Cerate, (Blistering Cerate), — Cantharides 32, Yel- 
low Wax, Rosin, of each 18, Lard 17, Liquid Petrolatum 15. 

Collodium Cantharidatum, Cantharidal Collodion, {Blistering Collodion), — Canthar- 
ides 60. Flexible Collodion 85, Chloroform to. 100. 

Emplastrum Picis Cantharidatum, Cantharidal Pitch Plaster, Warming Plaster, 
I Inofficial), — has of Cerate of Cantharides 8 parts, Burgundy Pitch to 100. 

Incompatib/es. 
Incompatible with Cantharidin are: Copper Sulphate, Lead Acetate, Mercuric Chloride, 
Silver Nitrate. 

Physiological Action. 

Cantharis applied to the skin is a rubefacient and vesicant, acting more 
slowly than mustard but much more severely. Internally it is irritant, caus- 
ing heat of stomach, gastralgia, nausea and vomiting, the circulation is stimu- 
lated, temperature elevated, the urine becomes scanty and irritating, is voided 
with difficulty and pain, and often contains blood and albumin. Afterwards 
the pulse falls, temperature and arterial tension are lowered, and depression 
ensues. A toxic dose produces severe gastro-enteritis, abdominal tenderness, 
tenesmus, mucous or bloody stools, pain in the stomach and lungs, dysphagia, 
ptyalism, strangury, priapism, hematuria, swollen genitals, abortion, muscular 
tremor, convulsions, coma and insensibility. The post-mortem shows evidences 
of violent metritis, gastro-enteritis and general peritonitis. Cantharis is aphro- 
disiac by causing vascular turgescence of the genital apparatus, but only in 
doses which produce dangerous symptoms. It is abortive only in toxic doses. 
In >mall doses it is diuretic and emmenagogue. 

Counter-irritation by rubefacients or blisters acts on disease probably through 
the nervous system. Its influence is explained by the theory that the periph- 



_>C2 CANTHARIS. 

eral extremities of the nerves supplying the skin of the part to which the agent 
is applied undergo some molecular change, which extends to the nerve centre 
and is thence radiated to centrifugal or trophic nerves, effecting various changes 
in nutrition and secretion over the areas to which they are distributed. In addi- 
tion to this method of action, neighboring parts are affected by direct exten- 
sion of the inflammation produced, and distant parts are also implicated by 
absorption through the vesicated surface of agents having special affinities for 
certain organs. 

A blister acts primarily as a stimulant to the body generally as well as to 
the organs in its vicinity, but if permitted to remain long enough to produce 
a large bleb, the result is depression proportionate to the amount of serum 
abstracted, the serum of the bleb containing nearly as much albumin as the 
blood itself. 

Therapeutics. 

As a counter-irritant and vesicant Cantharis is of great value in neuralgia 
if applied close to the emergence of the nerve from the spinal column, also in 
sciatica and neuritis, and in acute rheumatism around the affected joints. A 
blister at the nape of the neck controls many headaches, and one behind the 
ear will modify inflammatory affections of the eye. In pleuritic effusions a 
succession of small blisters (flying-blisters) will promote absorption of the pleural 
contents, and a blister applied to the perineum will often cure a rebellious gleet. 
Though valuable as a therapeutic measure in very many conditions, blistering 
is going out of fashion except in hospitals and among people who believe in 
heroic treatment. It is invaluable in subacute joint affections. 

As an internal remedy Cantharis must be employed in very small doses 
(itlj of the tincture) in order to be efficient. When so used it is an admirable 
agent in acute desquamative nephritis after the active inflammation and fever 
have subsided, to reduce the albumin and blood in the urine. Drop-doses are 
particularly useful in irritable bladder with frequent desire to micturate, so 
often observed in women, also in the incontinence of the aged and of children; 
and in cystitis, gonorrhea and gleet. The same dose thrice daily will generally 
abate chordee. In spermatorrhea, prostatorrhea, scanty menstruation, and 
menorrhagia in subjects of lax fibre and general want of tone, it is often very 
serviceable. Cutaneous squamae and vesicuhe are greatly improved by small 
doses frequently administered and gradually increased, and it is one of the best 
remedies for psoriasis. For alopecia areata it is of the utmost value as an ex- 
ternal application, and the tincture, largely diluted, is an ingredient of all the 
hair renewers in common use. In pleurisy, after effusion has taken place, 
it will be found admirable in i- to 2-drop doses every 2 or 3 hours, and in the 
after-prostration of diphtheria it proves a serviceable stimulant. One of the 
best applications to burns or scalds is a cloth dipped in a lotion of the tincture 
one part to thirty or forty of water. The same lotion is an efficient application 
to vesicular erysipelas and herpes zoster. 



CAPSICUM. 203 

CAPSICUM, Capsicum, (Cayenne Pepper), — is the dried, ripe fruit of 
Capsicum fastigiatum, a plant of the nut. ord. Solanaceae, native in tropical 
Africa and America. It contains Capsicin, which is a thick, red liquid, and 
is the active principle,- also a volatile alkaloid having the odor of Coniine. 
Dose of the powdered drug, gr. SS-ij |av. gr. j.] 

Preparations. 
Fluidextractum Capsici, Fluidc.xtract of Capsicum. Dose, njjss-ij [av. itgj.] 
Tinctura Capsici, Tincture of Capsicum, — 5 percent, strength. Dose, ttjv-xx [av. iniviij.] 
Oleoresina Capsici, Oleoresin of Capsicum, — extracted by acetone. Dose, gr. J— j 
[av. gr. ss.] 

Emplastrum Capsici, Capsicum Plaster, — prepared by applying a thin coating of 
( lleoresin of Capsicum to Adhesive Plaster so that each square 6 inches may contain about 
gr. iv of the oleoresin. An excellent warming plaster. 

Capsicum is an ingredient of the PiluLx Podophylli, Belladonna et Capsici (sec under 
Podophyllum). 

Incompatibles. 
Incompatible with Capsicum are: Alum, Ammonia, Alkaline Carbonates, Copper Sul- 
phate, Ferrous Sulphate, Galls infusion, Lead Acetate, Mercuric Chloride, Silver Nitrate, 
Zinc Sulphate. 

Physiological Action and Therapeutics. 

Capsicum is irritant to the skin and mucous membranes. Externally used 
for sufficient length of time it will produce vesication, internally in quantity 
it will excite gastritis. In medicinal doses it increases the saliva, excites a sen- 
tation of warmth in the stomach, promotes appetite and digestion, and produces 
easier and more copious alvine evacuations. It stimulates the action of the 
heart, is diaphoretic and diuretic, also decidedly aphrodisiac. It is a general 
stimulant to the nervous system, but in repeated doses produces a slight nar- 
cotic effect upon the brain. On the vascular system it acts like ergot, power- 
fully constringing the vessels by influencing the unstriped muscular fibre in their 
walls, either directly or through the vaso-motor nerves. 

Capsicum is an excellent stomachic tonic in atonic dyspepsia and "in that 
of chronic alcoholism with tremor and insomnia. In acute dipsomania and 
delirium tremens large doses are efficient in producing sleep and promoting 
appetite. It is the best substitute for alcohol and opium in attempts to cure 
those habits. It is well used in intermittents, chiefly as an adjuvant to more 
active drugs; in flatulent colic, especially when occurring in hysterical women 
and hypochondriacs; also in low fevers and cholera as a stimulant. It gives 
good results in functional impotence, in spermatorrhea from loss of tone, in 
chronic parenchymatous nephritis to check the waste of albumin, and is bene- 
ficial in chronic cystitis and in prostatorrhea. The tincture internally, and a 
plaster externally over the loins, are efficient in cases of renal congestion with 
habitual pain in the back and a trace of albumin in the urine. Locally the 
tincture diluted (3j to §viij) or the powder with honey, forms an excellent gargle 
for relaxed throat and its accompanying cough, relaxed uvula, inflammatory 
sore throat, and the cynanche of scarlet fever, but they must be used with cau- 
tion, as such applications are sometimes very irritating. 



204 CARBONEUM. 

The Capsicum plaster is a mild counter-irritant, of great value in lumbago 
and other muscular rheumatisms as a palliative application. 

CARBONEUM, Carbon, C— This element is widely distributed through- 
out all the kingdoms of nature. United with oxygen in the form of Carbon 
Dioxide, C0 2 , it occurs in the air and in many mineral waters, while as car- 
bonates, such as limestone,, it constitutes a large portion of the surface of the 
earth. Another compound with oxygen, Carbon Monoxide, CO, a highly poison- 
ous gas, is formed during the combustion of charcoal, but does not form salts. 
Two forms of Carbon are official, viz. : — 

Carbo Animalis, Animal Charcoal, — prepared from bone, occurring in 
dull black fragments or powder, odorless and nearly tasteless, insoluble in water 
or alcohol. 

Carbo Ligni, Charcoal, — prepared from soft wood, and very finely pow- 
dered; is black, shining, brittle, inodorous, tasteless and insoluble. Dose gr. 
x-xx [av. gr. xv.] 

Acidum Carbonicum, Carbonic Acid, Carbon Dioxide, C0 2 (Unofficial). 
The body which is commonly called Carbonic Acid, but should be called Car- 
bon Dioxide, is a colorless and odorless gas, of slightly sharp taste, soluble in 
its own volume of pure water at the ordinary temperature and pressure, much 
more soluble under increased pressure and lowered temperature of the water, 
also more soluble in water containing phosphates. In water it promotes the 
solution of phosphates and carbonates. Its aqueous solution gives an acid 
reaction, and is "sparkling" from rapid escape of the gas, especially when 
agitated. It is prepared by treating any carbonate (usually calcium carbonate 
in the form of marble-dust) with dilute hydrochloric acid; the resulting gas 
is passed into water under pressure, and the solution is thus obtained. 

Carbon Dioxide occurs in the atmosphere in the proportion of 0.4 volume in 1,000, 
also in all water in varying quantity. Certain sparkling waters contain it in the proportion 
of more than one-half their volume, Johannis having more than 90 per cent. It occurs also 
in all the liquids of the body, especially in the blood, originating in the oxidation processes 
which are constantly taking place in the tissues, and readily passing by osmosis through 
animal membranes. It is continuously produced by the action of the yeast-plant, and by 
all other fermentation processes, and accumulates in brewers' vats, old wells, some caves, 
grottoes and deep valleys, also in mines, forming the well-known "choke-damp" of miners. 
It is constantly evolved during respiration and in the burning of fuel. When the air of a 
room contains 0.6 volume of this gas per 1,000 it is considered vitiated. 

True Carbonic Acid, C0 3 H 2 , or Hydrogen Carbonate, is an organic acid which is not 
known in the separate state, but only in combination. It is supposed to exist in a solution 
of carbon dioxide in water. 

Carbon Monoxide, CO, — is the chief poisonous constituent of the vapors arising from 
burning coal or charcoal, and is contained in ordinary illuminating gas in the proportion of 
6 to 10 per cent., but higher in the "water-gas" now often mixed with the former and used 
for illuminating and heating purposes. Its limit of safety in the air is 0.5 volume in i,ooo; 
when it reaches 5 to 10 volumes in 1,000 (i to 1 per cent.) it is fatal. 

Preparations. 
Carbo Animalis Purificatus, Purified Animal Charcoal, — the bone-phosphate and 
calcium carbonate being removed by digesting with hydrochloric acid and washing. 

Carbonei Disulphidum, Carbon Di sulphide, CS 2 , — is a clear, colorless, diffusive liquid. 



' CARBONEUM. 205 

of strong, offensive odor, aromatic taste and neutral reaction; soluble in alcohol, ether, 
chloroform and oils, and in 535 of water; vaporizes at ordinary temperatures, and is highly 
inflammable. Dose, njiss-j. 

Aqua Carbonata, Carbonated Water, Soda-water 1 1 noi'i'i, ial), — is water highly charged 
with carbonic acid gas, the excess of gas being dissolved in the water by pressure, and escaping 
in bubbles when the pressure is taken off. h was official in the I'. S. P., 1870, under the 
title Aqua Acidi Carbonici, the formula requiring that the water be charged with five times 
its volume of gas, for which a pressure oi five atmospheres is required. Among the carbonated 
mineral waters arc — 

Selters, Nassau, Germany, 30 cubic inches ] 

Apollinaris, Neuenahr, Prussia, 47 I of ( '( ),, 

Old Sweet Spring, West Virginia, 1 1 | to the pint. 

Sweet Chalybeate Spring, Virginia 13 " 

There are 10 official Carbonates and 2 official Bicarbonatcs, which are severally described 
under their basic titles. 

Incompatible*. 
Incompatible with the Carbonates are: Acids, Acid salts, Alkaloidal salts, Bismuth Sub- 
nitrate; Salts of Aluminum, Antimony, Barium, Bismuth, Cadmium, Calcium, Chromium, 
Cobalt, Copper, Iron, Lead, Manganese, Mercury, Nickel, Silver, Strontium, Zinc; Urethane. 
Incompatible with Charcoal are all Oxidizers, as Potassium Chlorate, Potassium Permanga- 
nate, Chlorine, Hydrochloric Acid, etc. 

Physiological Action and Therapeutics. 

Charcoal is an efficient deodorant and disinfectant, as it absorbs and con- 
denses many gaseous bodies and vapors. It is evacuated unchanged by the 
bowel and exerts no specific action on the body. 

Charcoal is used in pharmacy for decolorizing vegetable principles, remov- 
ing alkaloids from infusions of plants, and making several preparations, as 
acidum sulphurosum, potassii iodidum, etc. Externally it is an efficient dis- 
infectant, absorbent and deodorant application to cancerous discharges, foul 
ulcers and gangrenous wounds. Having no odor it is not open to the charge 
of substitution of one smell for another. A small quantity added to water will 
keep it sweet for a long time. It is an excellent dentifrice if finely powdered. 
Internally, it is used for the same purpose, namely to absorb gases and offend- 
ing products of indigestion. In flatulent dyspepsia, gastralgia, pyrosis, diar- 
rhea, nausea of pregnancy, epidemic cholera, and constipation, it has warm 
advocates. When used internally for any time, an occasional purgative should 
be given to prevent its accumulation in the intestines. It has been proposed 
as an antidote for several alkaloidal poisons on theoretical grounds, but its effi- 
cacy in this respect is doubtful. 

Carbon Dioxide is highly antiseptic and preservative. DArsonval employs 
it, under 30 atmospheres pressure, for the sterilizing of orchitic extract. Beef 
will remain perfectly fresh and its taste unchanged for eight days if hung in a 
chamber filled with the gas. Externally, applied to the skin, mucous mem- 
branes or wounded tissues, the undiluted gas produces slight hyperemia, with 
prickling and a sense of heat, followed by a certain degree of local anesthesia. 
Internally, given by the stomach in aqueous solution, it is refreshing and quenches 
thirst, slightly stimulates the heart's action, quickens respiration and causes 
a brief sense of exhilaration. It increases somewhat the gastro-intestinal secre- 
tions and excites peristalsis, but diminishes the sensibility of the mucous lin- 



206 CARBONEUM. 

ing of the alimentary canal. Inspired, the gas is highly toxic, a proportion of 
i; per cent, in the air being irrespirable and fatal. Even a tenth of i per cent, 
produces headache, sleeplessness and depression; 2 per cent, causes throbbing 
headache, fulness and tightness across the temples and giddiness; and a larger 
quantity profoundly affects the nervous system, inducing fainting, muscular 
weakness, somnolence or insensibility, and coma or convulsions. The in- 
halation of the undiluted gas at first excites irritation and sometimes spasmodic 
closure of the glottis with consequent asphyxia, but in any case it soon arrests 
the respiration. It hinders the exhalation of the carbon dioxide normally ex- 
isting in the blood, and is itself absorbed in small quantity, inducing dyspnea, 
cyanosis, slow and labored pulse, and ultimately arrest of the heart's action. 
In toxic quantity it abolishes the functions of nerve and muscle by combining 
with the hemoglobin of the blood, rendering it incapable of carrying oxygen, 
and thereby stopping the process of oxidation in the tissues. The carbonic- 
oxide hemoglobin so formed is not a very stable substance, and persons deeply 
poisoned may be resuscitated by artificial respiration. 

The symptoms of Carbon Dioxide poisoning may be divided into three 
stages, which are the stages of Asphyxia. They are: (1) that of excitement, 
in which the blood pressure rises from excitation of the centres in the medulla 
by the venous blood; the vessels of the surface become dilated, the skin takes 
on the cherry-red color of carbonic oxide hemoglobin, and insensibility begins; 
(2) the convulsive stage, in which the respiratory movements become more vio- 
lent and spread to all the muscles of the body; (3) that of paralysis, in which 
the convulsions cease, the blood pressure falls, the respiration gradually fails, 
and finally the heart stops. The autopsy shows great venous congestion every- 
where, the right side of the heart distended with blood, the brain much con- 
gested, with exudation, and even extravasation of blood, into its substance. 

Carbon Monoxide causes the same symptoms as those above detailed for 
C0 2 , but being a more powerful poison its effects are produced with great in- 
tensity and are fatal in a short time. After death the muscles are rigid, and 
the skin shows the characteristic cherry-red color all over the body. Carbon 
monoxide gradually disappears from the blood when the body is exposed to the 
air, probably within eight days. 

Carbon Dioxide has been locally employed as a stimulant in ulcers and 
as an anesthetic in cancers, either by directing a stream of the gas upon the 
part or by the application of a yeast poultice. It has been applied to the eyes, 
ears, nose, vagina and rectum, in catarrhal inflammations of these parts, also 
to the bladder, for irritability of that viscus, and its application is beneficial 
when there is no acute inflammation present. It is injected into the vagina 
with good results in dysmenorrhea and in many other painful affections of the 
pelvic viscera, whether neuralgic in character or arising from organic disease. 
Diluted with 90 to 95 per cent, of air, its inhalation is serviceable in chronic 
laryngitis and pharyngitis, also in asthma, chronic bronchitis and chronic cough. 



CARDAMOMUM. 207 

Carbonated water, or Soda-water as it is popularly named, is a grateful 
leverage in warm weather, especially when flavored with syrups and fruit 
juices. It is a useful drink in febrile affections, as it relieves thirst, allays nausea 
and gastric irritability, and is both diaphoretic and diuretic in slight degree. 
It is an efficient remedy for vomiting and in the form of iced champagne is one 
of the numerous agents which have proven efficacious in the vomiting of preg- 
nancy. It forms an excellent vehicle for the administration of saline cathartics. 
the various carbonates and piperazin. The free use of carbonated mineral 
waters is of service in gout, especially when they contain the salts of lithium in 
solution. At many European spas the course of treatment is largely based on 
the use of carbon dioxide, administered in the forms of baths and inhalations 
as well as by the ingestion of the waters containing it. Bathing in the natural 
carbonated waters is sometimes beneficial in catarrh, gout, rheumatism, anemic 
amenorrhea and leucorrhea, the gas acting as a gentle stimulant of the cutaneous 
circulation and promoting slight diaphoresis. 

Carbon Disulphide is largely used in the arts, hence its effects are frequently 
observed. Persons exposed to its fumes are affected by headache, vertigo, 
over-excitement of the nervous system, emaciation, incoordination of move- 
ment, depression of all the special senses with impairment of sensation and 
motility and perhaps insanity. Inhaled directly, it excites violent coughing, 
and produces anesthesia characterized by great muscular rigidity. Being a 
powerful cardiac paralyzant, it is a dangerous anesthetic. In 3-drop doses it 
produces nausea and vomiting, with a sense of heat in the stomach and a weak 
and rapid action of the heart. It is a solvent for caoutchouc and many other 
substances. 

Carbon Disulphide has such a horribly offensive odor that it will never be 
used for any purpose for which another agent can be found. It relieves the 
pain of gastric cancer, and in ^-drop doses will alleviate nausea and vomiting, 
also gastralgia. Locally it has been used as a counter-irritant and a local 
anesthetic, for deafness due to want of nervous energy, in facial neuralgia and 
various local pains. 

CARDAMOMUM, Cardamom, — is the dried fruit of Elettaria repens, a plant of the 
nat. ord. Zingiberacea?, cultivated in Malabar. It contains about 4! per cent, of a Volatile 
Oil, C 10 H 16 , isomeric with Oil of Turpentine, the oil being the active principle; also a fixed 
oil, coloring matter, etc. It is an ingredient of Pulvis Aromaticus and of Fluidextractum 
Aromaticum (See under Cinnamomum), as well as of several compound preparations. 
Dose, gr. x-xx [av. gr. xv.] 

Tinctura Cardamomi, Tincture oj Cardamom, — 20 per cent. Dose, 5ss-jss [a v. oj-] 

Tinctura Cardamomi Composita, Compound Tincture of Cardamom, — has of Car- 
damom 25, Cinnamon 25, Caraway 12, Cochineal 5, Glycerin 50, Diluted Alcohol to 1000 
parts. Dose, 3ss-jss [av. 5j] 

Infusum Cardamomi, Infusion oj Cardamom (Unofficial), — may be made in the strength 
of oij to the pint, and used in wineglassful doses. 

Cardamom is aromatic, carminative and stomachic, and is used as an agreeable flavoring 
for bitter mixtures in dyspepsia and other gastric affections. It makes the best flavoring 
addition to saline solutions or mineral waters, and is particularly efficient to correct flatu- 
lence and griping when combined with purgatives. Acids, Ferrous Sulphates, and Mercuric 
Chloride are incompatible with the preparations of cardamom. 



208 CARDUl'S— CARYOPHYLLUS. 

CARDUUS (Unofficial), — the seeds of Cardials tnarianus, or St. Mary's thistle, an 
annual European plant of the nat. ord. Composite. A decoction ( 3ij ad Oj) is the prep- 
aration usually employed. It is an old remedy revived as a hemostatic, and reported as 
being very efficient in hemoptysis, uterine hemorrhage, melena and amenorrhea connected 
with derangement of the portal circulation. It has proved curative in congestion of the liver 
and simple jaundice, and in Germany it has long been popularly deemed efficacious in gall 
stones and liver affections generally. Dose of the decoction, 5j-3ss, of a tincture, npx-xx. 

Carduus Benedictus, the "blessed thistle," also called Cnicus benedictus and Cenlaurea 
beitedirta, is another plant of the same order, formerly held in high esteem as a popular "cure- 
all." It contains Cnicin, an amorphous bitter principle, which has been used as an anti- 
periodic in doses of gr. v-.\, but generally produces burning sensations and pharyngeal con- 
striction, with nausea, vomiting, colic, and diarrhea. It acts chiefly as a bitter tonic, resem- 
bling Calumba and Taraxacum most closely. 

CARUM, Caraway, — is the dried fruit of Carum Carvi, a European plant of the nat. 
ord. Umbelliferae. Its odor and taste are aromatic and agreeable. The active principle 
is the Volatile Oil, which is also official. Caraway is an ingredient of Tinctura Cardamomi 
Composita. Dose gr. x-xx [av. gr. xv.] 

Oleum Cari, Oil oj Caraway, — is the volatile oil distilled from Caraway, and is resolvable 
into Carvene, C 10 H„j, isomeric with Turpentine, and Carnal, C 10 H u O, isomeric with Thymol. 
It is an ingredient of Spiritus Juniperi Compositus. Dose, Ttjrj-v [av. ttjn'ij.] 

Infusum Cari, In fusion oj Caraway (Unofficial), — 3 j — Ij ad Oss. Dose, oss-ij. 

The Oil of Caraway is fatal to small animals, and in one case 5j produced cerebral 
congestion, delirium and rigors in man. The chief use of Caraway is as a flavoring agent, 
but it is efficient in the flatulent colic of children, and to prevent griping from the use of 
purgatives. 

CARYOPHYLLUS, Cloves, — are the dried flower buds of Eugenia aro- 
matica, a handsome evergreen tree of the nat. ord. Myrtaceae, cultivated in the 
East and West Indian Islands. They exude oil when scratched, have an aro- 
matic odor and a pungent, spicy taste, and are contained in Tinctura Lavan- 
dula; Composita, Tinctura Rhei Aromatica and Vinum Opii. They contain 
a heavy Volatile Oil, which is official; also Eugenin, C 10 H 12 O 2 , a crystalline 
body; Caryophyllin, C 10 H 16 O, a camphor; Caryophyllic Acid, and tannin, 
gum, etc. Dose, gr. j-vj [av. gr. iv.] 

Preparations. 

Oleum Caryophylli, Oil oj Cloves, — a volatile oil distilled from cloves, soluble in alcohol, 
and of sp. gr. 1.060. It consists of a light arid a heavy oil, the latter containing Eugenol, 
C 10 H 12 O 2 a phenol, and Caryophyllin, C I0 H ie O, which yields as a product of its oxidation, 
Caryophyllinic Acid, C 20 H 32 O 6 . Dose of the oil, TT^j-iv [av. njnij.] 

Infusum Caryophylli, Infusion oj Cloves (Unofficial), may be made of strength 1 to 
40, and used in doses of one to two fluid ounces. 

Eugenol, Eugenol, C 10 H 12 O 2 , — an unsaturated, aromatic phenol, miscible with alcohol 
in all proportions. Dose, irgj-v [av. npiij.] 

Physiological Action and Therapeutics. 
Cloves may be considered as a type of several agents yielding aromatic- 
oils, which as a rule consist of terpenes with camphors, resins, fatty and other 
acids, and are closely allied to phenol and benzoic acid, the balsams and gum- 
resins. Such are Orange, Lemon, Allspice, Cajuput, Caraway, and Peppermint. 
Their oils are antiseptic, locally anesthetic, stimulant and irritant, antispasmodic, 
stomachic and carminative. Internally they increase the circulation and tem- 
perature, promote digestion and nutrition (though in quantity they may cause 



CASCA BARK — CATECHU. 200 

inflammation), relieve pain and spasm, and are excreted by the kidneys, skin, 
liver and the bronchial mucous membrane, stimulating and disinfecting their 
routes throughout the organism. 

These agents are used to flavor pharmaceutical preparations, to corre< I 
the griping tendency of many purgatives, to correct flatulence, to relieve pain 
in the stomach and bowels, and to promote the flow of saliva and gastric juice. 
As external applications they are efficiently employed for anesthetic and counter 
irritant purposes, to relieve pain in chronic rheumatism, myalgia, lumbago, 
superficial neuralgia, and toothache. The Oil of Cloves is an effective deo- 
dorizer for sponge-tents, a good application to a painful tooth, and is occasion- 
ally applied over the course of an aching nerve with relief to the pain. 

CASCA BARK, Sassy Bark, Ordeal Bark (Unofficial),— is the bark of Erythro- 
phlaum Guinense, an African tree, used by the negroes as an ordeal in trials for witchcraft. 
It contains a poisonous glucoside, Erythrophlein, and when used in quantity produces nausea 
and vomiting, stricture across the brow, severe cephalalgia, narcosis and death. It is used 
as a remedy for intermittent fever, dysentery, diarrhea and colic, and is considered to resemble 
Digitalis in action and uses. A tincture is made ( oij ad Oj) of which the dose is ttjjx; or 
.1 water)' extract may be used in doses of gr. j. 

Erythrophlcein, the active principle, is a glucoside, and is said to be a local anesthetic 
of extraordinary power, even surpassing Cocaine. It is found in Africa in a red mass, called 
"Hayah." which is proven to be identical with an extract of the original plant described by 
Oertel early in the last century, and deposited by him in the Berlin Museum. It closely 
resembles Digitalis in action, being a cardiac tonic and a hydragogue diuretic. 

CASCARA AMARGA, Honduras Bark (Unofficial),— is the bark of a Mexican tree 
of the nat. ord. Simarubaceas, which has been used with apparent success as an alterative 
tonic and diuretic in syphilis and various chronic skin affections. The use of tobacco and 
alcohol seems to counteract its usefulness. It is certainly a very powerful tonic and has 
been employed by competent observers with uniformly good results in syphilis and syphilo- 
dermata, chronic liver complaints, chronic eczema, chronic nasal catarrh and psoriasis. A 
Fluidextract is on the market, of which the dose is 5ss-j thrice daily. 

CASCARILLA, (Unofficial), — is the bark of Croton Eluleria, a shrub or small tree of 
the nat. ord. Euphorbiaceas, growing in the Bahamas. It contains Cascarillin, a crystalline 
principle, two resinoid extracts, aromatic volatile oils, with tannic acid, etc. An Infusion 
(1 to 10) or a Tincture (1 to 10) may be prepared and given in doses of 5j- oj- 

Cascarilla is an aromatic bitter. It increases appetite and digestion, the mucous secre- 
tion, the flow of saliva and gastric juice, stimulates the intestinal secretions, and acts as a 
mild astringent by the influence of its tannin. Large doses produce nausea, vomiting and 
diarrhea, and in medicinal doses continued it will set up gastric catarrh and consequently 
indigestion. It has slight antiperiodic power. 

It has been used with success in epidemic dysentery, flatulent dyspepsia, debility, chronic- 
bronchitis, intermittents, and low nervous fevers. It is difficult to dispense, as the infusion 
decomposes quickly, and acids precipitate the resin from the tincture. 

CASSIA FISTULA, Purging Cassia, — is the dried fruit of Cassia Fistula, a tree of 
the nat. ord. Leguminosae, growing in tropical regions of Asia, Africa and America. No 
active principle has been isolated as yet. The pulp is the only valuable part of the drug. 
There are no official preparations, but it is one of the ingredients of Confectio Senna:. 

Cassia-pulp is laxative in doses of 5j-ij, and purgative in larger quantities, producing 
nausea, flatulence and griping. It is rarely prescribed alone, owing to its tendency to cause 
colic and flatulence. Dose, §ss-ij [av. 5j-] 

CATECHU (Unofficial), — is an extract prepared from the wood of Acacia 
Catechu, a tree of the nat. ord. Leguminosa?, native of the East Indies. It 



2IO CAULOPHYI.UM — CERA. 

occurs in irregular masses, bark brown and brittle, nearly inodorous, but of 
astringent and sweetish taste, soluble in alcohol, and partly so in water. It 
contains Calechutannic Acid 50 per cent.; also Catechuic Acid, which is con- 
verted into the former by heat. Dose, gr. j-^ss. Formerly official, it is now 
replaced in the U. S. Pharmacopoeia by — 

Gambir, Gambir {Pale Catechu), — an extract prepared from the leaves and 
twigs of Ourouparia Gambir, nat. ord. Rubiaceae. It occurs in irregular, red- 
dish-brown masses, of which not less than 70 per cent, should be soluble in 
alcohol. Dose, gr. x-xx [av. gr. xv.] 

Preparations. 
Tinctura Gambir Composita, Compound Tincture of Gambir, — has of Gambir 5, 
Cinnamon 2A, in Diluted Alcohol to 100. Dose, 3ss-jss [av. 5j-] 

Trochisci Gambir, Troches of Gambir, — each troche contains nearly gr. j of Gambir. 

Incompatibles 
Incompatible with Catechu and Gambir are: Acids (mineral), Albumin, Alkalies, Cal- 
cium salts, Cinchona infusion, Ferric and Ferrous salts, Gelatin, Lime-water, Mercuric 
Chloride, Zinc Sulphate. 

By virtue of their tannic acid Catechu and Gambir are powerfully astrin- 
gent, and their therapeutic employment depends entirely on this quality. In 
the diarrhea of children the tincture with chalk-mixture is very serviceable, 
and with opium it is efficient in dysentery. It is used as a gargle and mouth- 
wash in relaxed conditions of the pharyngeal mucous membrane, as an injec- 
tion in leucorrhea, and to control passive hemorrhages, and to harden spongy 
gums. 

CATJLOPHYLLUM, Blue Cohosh (Unofficial),— is the rhizome and rootlets of Caulo- 
phyllum thalictroides, a plant of the nat. ord. Berberidaceas, growing in Canada and the 
northern United States, and contains Saponin, a glucoside, and two resins. Dose, gr. v-x.x. 
There are no official preparations. The eclectic preparation Caulophyllin is a resinous 
precipitate obtained by pouring an alcoholic extract into water. 

Caulophyllum has not yet been made the subject of experimental work by reliable ob- 
servers. It was much used by the aborigines of this country in all affections to which their 
women were peculiarly subject, and was known among them by the name "squaw-root." 
It is said to produce intermittent contractions of the gravid uterus, to have diuretic, emmena- 
gogue, and antispasmodic powers; and is used as a remedy for deficient labor-pains, spas- 
modic after-pains, spasmodic pains in the uterus at any time, spasmodic dysmenorrhea, 
and pains in other organs seemingly in sympathy with uterine affections. It has somewhat 
of a reputation in acute rheumatism of the hands and fingers, and as a preparative medicine 
for labor. 

CERA, Wax, — a mixture of Myricin, Cerotic Acid and Cerolein, is formed 
by the honey-bee, and exists in the pollen and leaves of many plants, particularly 
in Myrica cerijera, the wax myrtle. That produced by the bee is alone official, 
in two forms, viz. — 

Cera Alba, White Wax, — is yellow wax bleached. 

Cera Flava, Yellow Wax, — is a solid substance prepared from the honey-comb of the 
bee, Apis mellijera. It is a yellowish solid, of agreeable odor and faint balsamic taste, in- 
soluble in water or cold alcohol, but soluble in ether, chloroform, fixed and volatile oils. 

Ceratum, Cerate, — consists of White Wax 30, White Petrolatum 20, Benzoinated Lard 50. 



ci Kii OX \i iS CHENOPODIUM. 21 I 

Unguentum, Ointment, -consists of Yellow Wax ao, Benzoinated Lard 80. 
Was is also .1 constituent of i of the 5 compound Cerates and \ of the 23 compound 
Ointments. 

Wax owes its value to its power of resisting decomposition and many chem- 
ical agents. Its fusibility at a modi-rate degree of heat and its solidity at the 
temperature of the body, together with its unirritating quality, make it a val- 
uable ingredient of the cerates and ointments to give them consistence. Ceratttm 
and Unguentum may be used as simple protective applications. 

CERII OXALAS, Cerium Oxalate, — consists chiefly of a mixture of the oxalates of 
cerium, didymium and lanthanum, and other rare earths of this group. It occurs as a fine, 
white powder, odorless and tasteless, permanent in the air, insoluble in water, alcohol or 
ether. Dose, gr. ss-v, [av. gr. j], in pill or powder. 

Cerium Oxalate is a gastric sedative, and is thought to possess selective action as such 
on the motor distribution of the pneumogastric nerve. It is considered to be particularly 
useful in vomiting of reflex origin, especially in the vomiting of pregnancy, but it often fails, 
probably because not given in sufficient doses. To be effective, at least 4 or 5 grains should 
be given 3 times a day to adults, and no results promised until after it has been used several 
days. It is also recommended in the vomiting of phthisis and bronchitis, cough with vomit- 
ing, chorea, and diarrhea. 

CHAULMOOGRA OIL (Unofficial), — is a fixed oil expressed from the seeds of Gyno- 
ciirdia odorata, an East Indian tree of the nat. ord. Bixaceae. It is nauseous and bulky, 
and soluble in alcohol, ether, chloroform, etc. Its active principle, Gynocardic Acid, is the 
best preparation for use, and may be given internally in doses of gr. ss-iij, or applied as an 
ointment, gr. xx ad o) of Petrolatum. Dose of the oil, gtt. v-x, in capsules. 

Chaulmoogra Oil is credited with a few cures of leprosy, and several cases improved by 
its use both internally and externally. It is recommended as an external application in scaly 
eczema, psoriasis, syphilitic skin-diseases, chronic rheumatism, rheumatic arthritis and tabes 
mesenterica. 



CHELIDONIUM, Celandine (Unofficial) — is the plant Chelidonium majtis, nat. ord. 
Papaveraceae, which grows in Europe and N. America, about rocky places. It contains the 
alkaloids Chelidonine, C^H^NO,, Sanguinarine and Chelerythrine, which occur also in 
Sanguinaria, and Protopine, which is present also in Sanguinaria and in Opium; also Cheli- 
doxanthin, a yellow, crystalline substance, and Chelidonic Acid, supposed to be identical 
with succinic acid. Dose of the plant, gr. v-xxx; of the fresh juice ttjjv-xx. 

Chelidonium used externally is irritant, internally it is a drastic purgative but an unre- 
liable one. It is also perhaps diuretic, diaphoretic and expectorant. In overdoses it is 
considered poisonous. It is an old remedy for jaundice and liver affections, but has been 
obsolete for some time. The fresh juice is a popular application for warts and corns, and 
a tincture in whiskey is used in Indiana as a remedy for phthisis, the menstruum being prob- 
ably the most useful agent. It seems to be of real service in simple jaundice, whooping- 
cough, right-sided pneumonia with hepatic involvement, and the catarrhal pneumonia of 
children. 

The actions of the alkaloids are described under Sanguinaria. 

CHENOPODIUM, American Wormseed, (Unofficial), — is the fruit of Chenopodium 
ambrosioides, var. antJielminticum, a plant of the nat. ord. Chenopodiaceae, indigenous to 
the United States. Its active principle is a Volatile Oil. 

Oleum Chenopodii, Oil of Chenopodium, — a thin, colorless or yellowish liquid, of 
aromatic odor and pungent, bitter taste. Dose, njv-x. 

The Oil is the only preparation used and that rarely, its odor and taste being very dis- 
agreeable. It increases the cardiac rate, and promotes the secretions of the skin, bronchi 
and kidneys. It is an efficient anthelmintic against the round worm in doses of gtt. x three 
times a day for two days, followed by a cathartic. It seems to possess some tonic properties, 



212 CHIMAPHILA — CHINOLINUM. 

and certainly is a diffusible stimulant. As such it has been used with benefit in chorea, 
hysteria, flatulent dyspepsia, and chronic malaria. 

CHIMAPHILA, Chimaphila, (Pipsissewa), — the leaves of Chimaphila umbelkUa, or 
Prince's Pine, an evergreen plant of the nat. ord. Ericaceae, indigenous to all parts of the 
United States. It contains Chimaphilin, a yellowish crystalline principle, Arbutin, also 
crystalline but colorless, with tannic acid, etc. 

Fluidextractum Chimaphila?, Fluidextract oj Chimaphila, — Dose, njjx- 3j [av. njjxxx.] 
Chimaphila is a tonic, astringent diuretic, belonging to the same class as Buchu, Uva 
Ursi, Pareira and Scoparius. It is probably the most active diuretic in this group, stimulating 
all the excretory organs, especially the kidneys. It is an agreeable tonic, excites the appetite 
and promotes digestion. The fresh leaves, bruised and applied to the skin, are rubefacient 
and vesicant, showing the presence of some irritant principle. It is a good diuretic in dropsy, 
and is efficient in several forms of chronic kidney disease with albuminuria, and in chronic 
catarrhal affections of the urinary passages, as hematuria, ischuria, dysuria and gonorrhea. 
It is believed to check the secretion of uric acid, and should prove useful in gout and rheu- 
matism. Externally, it has been applied to ulcers and tumors with benefit. 

CHINOLINUM, Chinolin, Leitcolin, Quinolin, C 9 H 7 N (Unofficial), — is an 
organic principle and a constituent of coal-tar oil, but may be obtained from 
quinine or cinchonine by their destructive distillation with potassium hydrate, 
and is artificially prepared by heating anilin or nitro-benzol with glycerin in 
the presence of a dehydrating agent. Chemically, it is considered to be formed 
by a union of benzene and pyridine. (Compare the article Cinchona.) It 
is a colorless, oily, strongly refractive liquid, soluble in alcohol, ether and carbon 
disulphide, sparingly soluble in water. It combines with acids to form crystalline 
salts; which, except the tartrate, are very deliquescent. The Cinchona alka- 
loids are derivatives of Chinolin. 

Chinolini Tartras, Chinolin Tartrate (Unofficial), — a white crystalline powder, of 
pungent odor, sharp taste, stable in the air and soluble in water. Dose, gr. v-xx. 

Derivatives. 

Quinalgen (Unofficial), — is the trade name of a complex synthetic derivative of chinolin, 
and is a re-formed and renamed Analgen (see page 60), differing therefrom by having the 
benzoyl radicle instead of the acetyl one. Dose, gr. vij-xv, not to exceed gr. xlv daily. It 
acts similarly to Antipyrine, and is said to be devoid of unpleasant symptoms. It has been 
used with asserted benefit in gout, influenza, migraine, sciatica, neuralgia, hay fever and 
rheumatic pains. 

Thallin, Telra-hydro-parachinanisol, — is a synthetically prepared substance, having 
also another chemical name, Telra-hydro-paramethyl-oxy-chinolin. It occurs as a colorless 
powder which is soluble in water, and enters into combination with acids, forming salts, of 
which the tartrate and sulphate are the most eligible, especially the latter. The dose of 
Thallin or its Sulphate ranges from gr. ij to gr. xv, a mean average dose being about 5 grains, 
given in the form of compressed tablets. Thallin is an antipyretic of very great power, 
doses of 5 to 12 grains lowering the temperature in typhoid fever 4 to 5 in 2 hours' time, 
the effect lasting nearly 3 hours. In tuberculosis similar results were obtained. Large doses, 
however, produce very profuse sweating and a dangerous degree of depression; so that this 
agent is not a favorite remedy for hyperpyrexia. 

Kairinum, Kairin, Hydrochlorate oj Oxy-ethyl-chhwlin-hydride, C, H 13 NO.HCl.H 2 O, 
— is prepared from Chinolin, belongs to the phenol group of carbon compounds, and is a 
powerful antipyretic in 8-grain doses hourly. It stains the urine a deep green, and has not 
proven fatal though 220 doses have been administered in one case. In some cases of typhus 
it has caused cyanosis and collapse. It produces profuse sweating and vomiting, and the 
subsequent rise of temperature after its antipyretic influence has worn off is generally ushered 
in by a severe rigor. It occurs in white crystals, which are freely soluble in water, but is 
best given in wafer paper, or capsules. Dose, gr. iij-xx. 



CHIKATA— CHLORAI I \l 1 1 V DK ATl'M. 213 

Chinosol, Quinosol (Unofficial), is the oxy-chinolin sulphonate of potassium, and 
occurs as a yellow powder which is soluble in water, insoluble in alcohol and in ether. Solu- 
tions of I in 1000 arc used as antiseptic applications in gynecological and obstetrical practice. 

Orexin, Phenyl-dihydro-chinazolin (Unofficial), — is a complex chinolin derivative, and 
occurs as a yellowish powder, insoluble in water, but soluble in dilute hydrochloric acid and 
in the gastric juice. It is incompatible with preparations of Iron. The Hydrochloride and 
the Tannate arc used, the latter being the favorite preparation. Dose, gr. ij-viij, twice daily, 
before meals, followed by a draught of warm water or beef-tea. 

Chinolin is antiseptic and powerfully antipyretic, and closely resembles 
quinine in its chemical construction and its physiological action. It has been 
extensively used as an antipyretic in pneumonia and other febrile disorders, 
but proving dangerous from its liability to cause collapse, it and its deriva- 
tives (kairin, thallin, etc.) have been superseded by antipyrine, phenacetin 
and acetanilide. The Tartrate has been employed with benefit in neuralgia 
and whooping-cough, also as an antiperiodic in intermittents. 

Chinosol is claimed to have antiseptic power nearly equal to that of mer- 
curic chloride, a solution of i in 40,000 preventing bacterial development. It 

- not coagulate albumin and is said to be non-toxic. The powder is irritant 
to wounds when applied dry, but not when in solution. Some observers say 
that its germicidal power is feeble, and that it impairs the functional activity 
of the kidneys. It is somewhat astringent and styptic. 

Orexin is a remarkable stomachic tonic, a true physiological appetizer, 
and a promoter of digestion. The Hydrochloride causes some gastric distress, 
but the Tannate and the base itself are free from this objection. The Tannate 
has been extensively used in the anorexia of many affections, and has proved 
remarkably efficient in increasing the appetite and promoting constructive 
metamorphosis in convalescence from acute disease and in wasting disorders 
when the requisite amount of aliment is taken with difficulty. It has proved 
beneficial in sea-sickness, in the nausea and vomiting of anesthesia, the vomit- 
ing of pregnancy, chronic gastric catarrh, nervous dyspepsia, neurasthenia, 
and other affections in which anorexia is a prominent symptom. It is reported 
to be contraindicated in acute inflammation and ulceration of the stomach, 
also in hyperacidity, and excessive gastric secretion. 

CHIRATA, Chirata, (Chiretta), — is the Indian plant Swertia Chirayita, nat. order 
Gentianaceae, occurring in bundles, composed of all but the coarser woody stems. It is 
inodorous, but intensely bitter, and contains two amorphous bitter principles, named Chiratiu 
and Ophelic Acid, but no tannin. Dose of the powdered plant, gr. x-xx [av. gr. xv.] 

Fluidextractum Chiratae, Fluidextract oj Chirata, — made with diluted alcohol. Dose, 
njx-xx [av. Tn>.\\\] 

The action of this plant is that of a simple bitter, like its congener Gentian. It is an 
excellent tonic, in this respect rivalling Cinchona, and is used in India as a substitute for 
the latter. It is laxative and stomachic, diminishes flatulency and acidity, and is particularly 
serviceable in the dyspepsia of gouty subjects. As it contains no tannin, it may be adminis- 
tered with preparations of Iron. 

CHLORALUM HYDRATUM, Hydrated Chloral, {Chloral Hydrate) C 2 H- 
CI3O + H 2 0, — is a crystalline solid, composed of trichloraldehyde (chloral) with 



214 CHLORALUM HYDRATUM. 

one molecule of water. It occurs in colorless, transparent, rhomboidal crystals, 
slowly volatilizing when exposed to the air; of aromatic, penetrating and slightly 
acrid odor, bitterish, caustic taste, and neutral reaction. It is freely soluble 
in water, alcohol, ether, chloroform, oils, etc.; liquefies when triturated with 
about an equal quantity of camphor, menthol, thymol or phenol; and is decom- 
posed by alkalies into chloroform and a formate of the base. Its aqueous 
solution becomes acid, but the alcoholic solution remains neutral. Dose, gr. 
x-xxx [av. gr. xv.] 

Chloral itself, (Trichloraldehyde, C 2 HC1 3 0), is an unstable, oily, color- 
less fluid, formed by the action of chlorine upon alcohol, whence its name, 
Chlor-al. 

The Dose varies much with individual susceptibility and with the presence or absence 
of cardiac and pulmonary disease. Death has been caused in several instances by gr. xxx, 
in one case by gr. x, and in another gr. vijss produced alarming symptoms, all being in adults. 
On the other hand, recovery has occurred after the ingestion of an ounce, several hundred 
grains have been taken at a time in more than one instance without fatal results, and where 
tolerance has been established by habitual use 3ij- 3iij are frequently taken without poison- 
ous symptoms. An average dose for a healthy adult is gr. xx, for a child gr. j for each year 
of age up to gr. vj. It is best given in Syrup of Tolu, or in Peppermint water. 

Incompatibles. 

Incompatible with Hydrated Chloral are: Acetanilide, Alcohol, Alkalies, Ammonium 
salts, Benzamide, Borax, Borneol, Camphor, Camphora Monobromata, Diuretin, Euphorin, 
Exalgin, Glycerin (with heat), Lead Acetate, Menthol, Mercuric Nitrate, Mercuric Oxide, 
Methacetin, Phenacetin, Phenol, Piperazin, Potassium Cyanide, Potassium Permanganate. 
Potassium Iodide, Pyrocatechin, Quinine Sulphate, Saligenin, Salocoll, Salol, Sodium Phos- 
phate, Thymol, Urea, Urethane. Physiologically incompatible are: Ammonium Chloride, 
Atropine, Brucine, Caffeine, Cocaine, Codeine, Digitalis, Phenol, Physostigmine, Picrotoxin. 
Strychnine, Thebaine. 

Hydrated Chloral should not be prescribed with preparations containing alcohol, as the 
Chloral is liable to separate as an alcoholate, especially if the Bromide of Potassium or Sodium 
is used in the same mixture and if the solutions are at all concentrated. In this way great 
danger is incurred of giving a heavy overdose, as the alcoholate floats on the surface of the 
mixture, and the entire amount of Chloral contained therein may be taken at a single dose. 

Derivatives oj Chloral. 

Chloralformamidum, Chloralformamide (Chloralamide) C 3 H < C1 3 N0 2 — is a crystalline 
solid, made by the direct union of formamide with anhydrous chloral. It occurs in lustrous 
crystals, which are soluble in about 20 of water and in 1^ of alcohol, also in glycerin, ether, 
etc.; and is decomposed in warm or hot solutions, also by alkalies, alkaline carbonates and 
silver nitrate. Dose, gr. x-xxx [av. gr. xv.], in whisky, brandy, or other alcoholic preparation. 

Chloralose, Anhydro-Gluco-chloral, CgHnCljOj (Unofficial), — is formed by heating 
together anhydrous Chloral and Glucose. It occurs in small crystals, of bitter taste, freely 
soluble in hot water, slightly in cold water. Dose, gr. ij-v, in capsule. 

Hypnal (Unofficial), — is the trade name of a combination of Chloral and Antipyrine, 
occurring as tasteless and odorless rhombic crystals, soluble in 6 of water, and credited with 
simultaneous action as a hypnotic and an analgesic. Dose, gr. xv-xxx in aqueous mixture 
with some alcohol, flavored with syrup of orange. It is said to cause no gastric disturbance. 

Somnal (Unofficial), — is the suggestive name given to a liquid preparation formed by 
the union of Chloral, Alcohol and Urethane, described as Ethylirles Chloral-urethane, repre- 
sented by the formula C 7 H ]2 C1 3 03N, and claimed to be a complex body, not a simple mixture 
of its constituents. It occurs as a colorless liquid, resembling chloroform in its behavior 
with cold water, with which it forms globules and refuses to mix or dissolve. It is soluble 
in hot water, in alcoholic solutions, and in alcohol, 3 parts in 1. Dose, njfxx- 3j, in whisky 
or syrup of tolu. 



CHLORALUM HYDKSTi'M. 215 

Official Analogue. 
Paraldehydum, Paraldehyde, C 6 H l2 O s , — is a polymeric modification (polymer) oi 
ncetaldehyde. It occurs as a colorless liquid, of strong and characteristic odor, and a burning 
and cooling taste; soluble in 8$ of water, misciblc in all proportions with alcohol or e 1 1 1 < r, 
I Vise, m'xx-oij [av. 'HJxx.x] in simple elixir. The doses usually given are too small for 
efficiency, ,~i will usually be required, especially in cases of drug-habit. Incompatible* are 
Alkalies, Hydrocyanic Acid, Iodides, Oxidizers. 

Sulphonmethane (SulphonaJ), Sulphonethylmethane (Trional), Ethyl Carbamate 
(Urethane), also the unofficial substances Veronal and Tetronal, are described under the 

title SUI.PFIOMETHANUM. 

Unofficial Analogues. 
Butyl-chloral Hydras, Butyl chloral Hydrate, Croton-chloral Hydrate (B.P.), — is a 
crystalline hydrate obtained by the addition of water to the liquid Butyl-chloral produced 
by the action of Chlorine gas on Aldehyde. It occurs in white laminas, of pungent odor, 
and acrid, nauseous taste, soluble in 50 of water, and in its own weight of glycerin or of alco- 
hol. Dose, gr. v-xx, in syrup or pill; but the best method is to give 5 grains every half hour, 
until 20 grains have been taken or until relief is afforded. Incompatible* are Alkalies, Camphor, 
Ethyl Carbamate, Exalgin, Menthol, Phenol, Piperazin, Pyrocatechin, Thymol. 

Amylene Hydrate, Dimethyl-ethyl Carbinol, C 6 Hi 2 — is a tertiary amylic alcohol, 
produced by the action of Sulphuric Acid on Amylene. It occurs as a limpid, colorless, oily 
fluid, of peculiar odor, soluble in S of water, miscible in all proportions with alcohol. Dose, 
5ss-jss. 

Dormiol, Amylene-chloral, — is the trade name of a mixture of equal molecules of 
Chloral and Amylene Hydrate, forming a colorless, oily fluid. Dose, 5ss-j of the 10 per 
cent, aqueous solution, in which form it is marketed. It is claimed to be a prompt, reliable 
and safe hypnotic. 

Chloretone, Acetone Chloroform, — is a Trichlor-tertiarv Butyl-alcohol, obtained by the 
action of Caustic Potash on equal weights of Acetone and Chloroform. It occurs as a white, 
crystalline powder, of camphoraceous odor, sparingly soluble in water, very soluble in alcohol, 
in ether, and in chloroform. Dose, gr. v-xxx. 

Hedonal, — the esther of methyl-propyl-carbinol-carbamic acid, occurs as a white powder, 
soluble in alcohol and in ether, insoluble in water. Dose, gr. xv-xxx. 

Hypnone, Phenyl-methyl-ketone, — a colorless, mobile liquid, soluble in alcohol, insoluble 
in water. Dose, n£ij-v, in emulsion or capsule. 

Isopral, Trichloro-isopropyl-alcohol, — a crystalline powder, soluble in water or alcohol. 
Dose, gr. viij-xij. 

Methylal, Methylene-dimethyl-ether, — a product of the oxidation of methylic alcohol, is 
a volatile, mobile liquid, soluble in water or alcohol. Dose, ttjiij-v, repeated thrice at short 
intervals. 

Physiological Action. 

Hydrated Chloral is a powerful hypnotic, also an antispasmodic, an anti- 
septic, a preventive of the coagulation of fibrin, indirectly an anesthetic, and 
a direct depressant of the cerebral, medullary and spinal centres and of the 
cardiac muscle. It is more hypnotic than chloroform but less anesthetic. Ap- 
plied to the skin or mucous membranes a 1 per cent, solution (gr. v ad 3j) is 
antiseptic, but strong solutions are irritant and vesicant, may produce slough- 
ing ulcers, and if taken internally may excite gastritis with nausea and vomiting. 

After a brief period of stimulation a medicinal dose depresses the heart, 
dilates the peripheral vessels and lowers arterial tension, diminishes oxidation 
and decreases the body-temperature. On the brain cells it has a selective action, 
producing a deep sopor very like normal sleep, from which the patient may 
be awakened, but immediately falls asleep again, and which is not followed 
by headache or depression. This effect is considered by most authorities to 



216 CHXORALUM HYDRATUM. 

be the result of cerebral anemia produced by the drug. In some persons, in- 
stead of sleep it causes headache, insomnia and delirious excitement. It is 
not an anodvne, as it does not affect the conductivity of the sensory nerves, 
and does not interrupt the transmission of pain; but by overwhelming the cen- 
tres it drowns the consciousness of pain, and is therefore indirectly anesthetic. 
A toxic dose produces profound narcotism, abolishment of reflexes and sensibil- 
ity, complete muscular relaxation, and a great fall of body-temperature. Death 
may result in the chloral sleep from paralysis of the respiratory centre or the 
cardiac motor ganglia, or by sudden failure of the heart-muscle in cases of fatty 
degeneration or in old drunkards. 

On the blood its action is to increase the fluidity, to crenate the red cor- 
puscles, and to destroy the leucocytes if used in large quantity. It is rapidly 
diffused and is excreted by the kidneys partly unchanged, but chiefly as uro- 
chloralic acid, producing some diuresis; also by the skin, causing various erup- 
tions if used for any lengthened period. It has been held that the blood, being 
an alkaline fluid, decomposes it, setting free chloroform, but there are many 
facts against this theory. Von Mering states that it is decomposed in the blood 
into trichlor-ethyl alcohol, to which its hypnotic action is due. 

The Chloral habit produces a state of marked anemia and muscular weak- 
ness, especially of the legs; its subject presenting a weak, irritable, often irregular 
heart, deranged hepatic functions, jaundice, bileless stools, congestion of the 
face and the bronchial mucous membrane, perhaps purpura and sloughing 
of a finger from decreased blood-supply. Its votaries are on the border of 
insanity, excitable, uncontrollable in speech and action, talking in a silly man- 
ner and very volubly, and showing a marked loss of power of the limbs, so 
much so as to simulate paralysis thereof. Many cases of insanity have their 
origin in chloralism. In some persons a very few doses of chloral will produce 
bile-less stools. 

Chloral and Atropine, though antagonistic in their action on the spinal 
cord, both produce motor paralysis, the former by paralyzing the cord, the 
latter by direct paralysis of the motor nerves. 

Therapeutics. 
Hydrated Chloral is of great value as a hypnotic and antispasmodic, but 
must be cautiously used if at all in persons with weak or fatty heart, atherom- 
atous vessels or advanced pulmonary disease. In combination with Potas- 
sium Bromide it is much used in asylum and general practice, and equally 
abused, both drugs being active cardiac poisons. It is by far the best hypnotic 
in acute mania and in delirium tremens, but has been too incautiously em- 
ployed therein. The condition of acute alcoholic intoxication seems, however, 
to antagonize its depressant action on the heart to a great extent, even in old 
topers, for 30-grain doses, repeated twice within 7 or 8 hours, are commonly 
used in inebriate asylums and by police surgeons, for the purpose of straight- 



CHI OK \i I v n\ DF \i i M. 217 

ening up a case of acute alcoholism, with no fatal effects resulting from its 
direct action. Chloral possesses marked power to relax spasmodically con- 
tracted unstriated muscle and to dilate the peripheral vessels, properties which 
govern its employment in many morbid conditions. Associated with Potas- 
sium Iodide it is of service in bronchial asthma, and has been used in the form 
of an enema for checking hemoptysis by the revulsion which it produces in 
dilating the cutaneous vessels. Chloral is exceedingly efficient as a gastric 
antiseptic and sedative in the so-called nervous dyspepsia of neurotic persons, 
characterized by severe pain in the cardiac region of the stomach. It is very 
serviceable in fevers, when high temperature exists with excitement, restlessness 
and a sthenic condition, as it lowers temperature and prevents the coagulation 
of fibrin. In typhoid fever, owing to the marked alkalinity of the tissues, small 
doses manifest the same effects as those produced only by large doses in other 
diseases; while in gout even large doses do not cause the desired results, as 
alkali is lacking in the blood for its decomposition (Liebrich). In the algid 
stage of cholera and in violent cases of cholera morbus it has been injected 
hypodermically in 15-grain doses with extraordinary efficacy. In sea-sickness, 
small doses (gr. v) two or three times a day are generally very efficient. In 
obstetrics it is used to relieve suffering, relax the os uteri, palliate convulsions 
and relieve afterpains. For nocturnal epilepsy a full dose at bedtime is a use- 
ful palliative. In neuralgia it may be triturated with Camphor and applied 
over the course of the affected nerve, and the same mixture is efficiently em- 
ployed as a local application for toothache and earache. 

Hydrated Chloral is well borne by children, and is an excellent remedy for 
infantile convulsions and colic, chorea, whooping-cough, laryngismus stridulus 
and the first stage of diphtheria, but it should not be used when the first sound 
of the heart becomes dull and weak. It is highly efficient for the purpose of 
calming children in scarlet fever. In these affections it may be given with 
paregoric, as its combination with opium enhances its value and guards the 
patient against its dangers. Its hypnotic power in adults is much increased 
by the conjoint administration of laudanum or morphine, and this combina- 
tion is an excellent remedy in colic, cholera and cholera morbus. Tetanus 
is well treated by this agent and Potassium Bromide given together in full doses. 
In strychnine-poisoning Hydrated Chloral is the antagonist. It is generally 
given by the mouth in very dilute solution with some simple elixir, syrup of 
tolu, or cinnamon-water, but is well absorbed by the rectum. Its hypodermic 
administration is liable to result in great local irritation and even sloughing ulcers. 

Hydrated Chloral may be applied to the skin as an antipruritic in the erup- 
tive diseases, for which purpose it is well combined with Phenol, ten grains 
of each to an ounce or two of water or oil. It is said to be the best of all local 
applications for boils, 3jss in §iv each of glycerin and water, constantly applied 
to the boil by a tampon of cotton. For ulcers and cancers a 25 per cent, solu- 
tion is a good antiseptic and anodyne application. 



21 8 CHLORALUM HYDRATU1I. 

The chief contra-indication to the use of Chloral is the presence of a cardiac 
affection, although it may be prescribed with much benefit in neurotic pal- 
pitation of the heart and in pseudo angina pectoris. Other contra-indications 
are rosacea, or a tendency to it, and hysteria of grave character. It readily 
produces congestion of the face, and in hysterical subjects it may excite parox- 
ysms of delirium and hallucinations. 

Butyl-chloral Hydrate closely resembles Chloral in action, but is feebler 
as a hypnotic, less depressant to the heart, and generally less poisonous, but 
more disagreeable to the taste. It has a specific paralyzant power over the 
fifth nerve, and over its distribution causes an anesthetic condition long before 
it produces general anesthesia (Liebreich). It has been used with benefit in 
various neuralgias, especially tic-douloureux, also in sciatica and dysmenorrhea. 
All statements concerning the action and therapeutics of this drug are to be 
received with hesitation, as wide differences therein are reported by the best 
authorities. 

Paraldehyde is a reliable hypnotic, almost equal in this respect to Chloral, 
though its hypnotic action is not so persistent as that of the latter drug, and 
it requires more frequent repetition to produce sustained sleep. It is also 
antispasmodic and diuretic but not diaphoretic, and is unquestionably safer 
than chloral, strengthening and slowing the heart's action, instead of weak- 
ening it. Its administration is followed by a well-marked stage of excitement, 
after which it produces a sound sleep which is described as refreshing. It 
does not interfere with the appetite or digestion, but occasionally causes an 
erythematous eruption; and may give rise to salivation, cerebral congestion, 
and vaso-motor paralysis, if used for any long period of time. A toxic dose 
paralyzes the medulla and the respiratory centre therein. 

Paraldehyde is used as a hypnotic in fevers, rheumatism, acute mania, hys- 
teria and insomnia from various causes, also as an antispasmodic in asthma. 
Several cases of tetanus have been treated successfully with it, and it has been 
found useful as a diuretic and hypnotic in a case of senile arterial degeneration 
with double aortic and mitral regurgitant murmurs, mental depression and 
very marked insomnia and restlessness. 

Cases of Paraldehyde habit are occasionally seen, and exhibit a train of symptoms simi- 
lar to those observed in delirium tremens. There is great emaciation and anemia, weak 
and irregular action of the heart, a soft and intermittent pulse, general muscular weakness, 
tremulousness and restlessness, the gait feeble and unsteady, mental anxiety, agitation and 
confusion, temporary loss of memory and incoherent speech, also hallucinations of sight and 
hearing and delusions, all of an unpleasant kind. There is marked gastric derangement, 
but an abnormally large appetite, excessive flatulence and constipation. The treatment of 
such a case generally takes about three months, and should be conducted in an inebriate 
asylum. 

Chloralformamide (Chloralamide) is an excellent hypnotic in solution, given 
about an hour before its action is required, and is usually efficient in simple 
insomnia, not due to pain, excitement or hallucinations. It does not seem to 
have cumulative action on repetition, or any tendency to induce a habit. It 
lias given satisfaction as an analgesic in carcinoma of the stomach, dysmenor- 



CHLOROFORMUM. 219 

rhea, and other painful diseases; and is reported as having cured several cases 

of chorea. The effects of largo doses are vertigo, thirst, nausea, vomiting, 
dryness of the mouth, anorexia, restlessness, slight delirium, and a weak and 
rapid pulse. 

Amylene Hydrate stands between chloral and paraldehyde in hypnotic power, but is 

more agreeable to the taste and safer in action than these agents. In dose of oj it is usually 
efficient, has no perceptible influence on the heart or respiration, and leaves no unpleasant 
after-effects. The mixture of this agent and chloral, known as Dormiol (see page 215), is said 
to be an efficient and safe hypnotic, but should be used as carefully as hydrated chloral. 

Chloralose is a prompt hypnotic, producing sound sleep in which sensibility is not lost, 
and leaving no unpleasant after-effects. It depresses the cerebral functions, but excites the 
spinal cord, so that reflex activity is exalted by it. A dose of 10 grains has produced pro- 
found unconsciousness. The maximum dose is 5 grains, in capsule, and this may have to 
peated in not less than an hour. 

Chloretone is hypnotic, antispasmodic, anesthetic, and antiseptic, also narcotic in over- 
dose. It moderate doses it promptly relieves gastric irritability, and prevents the nausea 
and vomiting due to ether or chloroform inhalation. As a hypnotic it is valuable in insanity 
.ind in cases of insomnia unattended with pain, high fever, or much nervous excitement. In 
epilepsy it has been used with benefit, and it is frequently employed with Cocaine for the 
production of spinal anesthesia by sub-arachnoid injection, also in a 1 per cent, solution as a 
iocal anesthetic application in ulcers and wounds. While large doses, ( oj _ 3vj) have been 
taken without ill effects, it is considered by many authorities to be a dangerous narcotic in 
doses over 30 grains. 

Hedonal is a feeble hypnotic of disagreeable taste, but is considered safer than most other 
agents of the class. In dose of 15 to 30 grains it acts usually within an hour, and leaves no 
unpleasant after-effects; but is contraindicated for alcoholics and in diseases producing 
dyspnea. 

Hypnone is a hypnotic of moderate power, but is said to be efficient in the insomnia of 
alcoholism. It is not dangerous, and has no unpleasant sequelae except a disagreeable odor 
of the breath. In very large dose it has induced coma, with paralysis of the heart and res- 
piration. 

Isopral is a prompt and efficient hypnotic in doses of 10 grains. It is much less toxic 
than chloral, and in ordinary dosage is free from depressant action on the heart and respiration. 

Methylal is a local anesthetic and an efficient hypnotic, producing a deep sleep of brief 
duration, with some general anesthesia and lowered reflex excitability. Large doses are 
depressant to the heart, respiration, and body temperature. 

Somnal is an efficient hypnotic in a dose of 30 minims, inducing quiet sleep within half 
an hour. Doses of 45 and 60 minims have caused no depression of the circulation or respira- 
tion. As a sedative it has been used with benefit in asthma, whooping-cough, nervous cough, 
spasmodic laryngitis, and chorea. It has given satisfaction in melancholia, but is inefficient 
in mania, delirium tremens, or severe pain, is said to be injurious in general paralysis, and to 
be contraindicated in cases of impaired digestion. 

CHLOROFORMUM, Chloroform, Trichloro-methane, CHC1 3 . Absolute 
Chloroform is formed by the substitution of 3 atoms of chlorine for 3 of hydrogen 
in marsh-gas, methyl hydride, CH 4 , and is obtained by the action of chlorinated 
lime on ethylic or methylic alcohol, or by that of an alkaline hydrate on chloral. 
If prepared from methylic alcohol (wood-spirit) it is called Methylic Chloro- 
form, and is purified with great difficulty. The object of its purification is the 
removal of the chlorinated pyrogenous oil. The official form is — 

Chloroformum, Chloroform, — a liquid consisting of 99 to 99.4 per cent. 
by weight, of absolute Chloroform, and 0.6 to 1 per cent, of alcohol. A heavy 



220 CHLOROFORM I'M. 

clear, colorless, mobile and diffusible liquid, of characteristic, ethereal odor, a 
burning, sweet taste, neutral reaction; volatile, not inflammable; soluble in 
200 volumes of water, freely so in alcohol and in ether, also in oils, benzol and 
benzin. Sp. gr. not below 1.490 at 59 F., or 1.476 at 77 F. Dose, internally, 
ni,ij-x, [av. "Lv], for inhalation 3ss-j, repeated until the desired effect is pro- 
duced. 

Chloroformum Venale, Commercial Chloroform, (Unofficial), — is a liquid containing 
at least 98 per cent, of Chloroform, and having a sp. gr. not lower than 1.470. It contains 
sundry Hydrocarbons, free Chlorine, Aldehyde and Hydrochloric Acid, and is used only for 
external applications, or to make the purified article. 

Preparations. 
Aqua Chloroformi, Chloroform Water, — a saturated solution, prepared by agitating 
an excess of chloroform in distilled water and pouring off the needed quantity of the solu- 
tion. Dose, oj- oj [av. 5iv.] 

Emulsum Chloroformi, Emulsion of Chloroform, — has of Chloroform 4, Expressed 
Oil of Almond 6, Tragacanth 1, Water to 100. Dose, §j-iv [av. 5ij-] 

Spiritus Chloroformi, Spirit of Chloroform, — has of Chloroform 6, Alcohol 94. Dose, 
njx- oj, [av. trpxxx], well diluted. 

Linimentum Chloroformi, Chloroform Liniment, — has of Chloroform 30, Soap Lini- 
ment 70. 

Linimentum Chloroformi Compositum, Compound Chloroform Liniment, (Unoffi- 
cial), — has of Chloroform 3j, Oil of Turpentine oj. Tincture of Opium 5ss, Tincture of 
Aconite 5ij- 

Tinctura Chloroformi et Morphinse Composita, Compound Tincture of Chloroform 
and Morphine (B.P.), — contains in each 10-minim dose Chloroform ttj;J, Diluted Hydrocy- 
anic Acid, ttjJ, Morphine Hydrochloride, gr. T y. A substitute for Chlorodyne (see below). 
Dose, ttjjv-xv. 

Chlorodyne, (Unofficial), — is a celebrated secret mixture, put forth by Dr. J. Collis 
Browne, of London, and since imitated by many others. It contains Morphine, Chloroform, 
Ether, Cannabis Indica, Hydrocyanic Acid, Capsicum, etc., and is powerfully anodyne, anti- 
spasmodic and narcotic, and therefore highly dangerous in non-professional hands. Of 
the original preparation each 10-minim dose contains gr. J of Morphine Hydrochloride, and 
the quantity of that alkaloid or its salts in the various imitations varies from gr. T ^ 3 to gr . J in 
the same dose. In the Therapeutic Gazette for October, 1883, twenty-five different formula? 
for Chlorodyne were published. 

Anesthetic Mixtures containing Chloroform, — are described under the title jEther, on 
page 88. 

Incompatibles. 
Incompatible with Chloroform are: Caustic Alkalies, Aqueous fluids. Physiologically 
incompatible are: Amyl Nitrite, Atropine, Morphine, Oxygen, Strychnine. 

Official Chlorinated Compound. 
JEXhy\is Chloridum, Ethyl Chloride, Monochlor-ethane (Kelene), C 2 H 6 C1, — is a haloid 
derivative prepared by the action of hydrochloric acid gas upon absolute ethyl alcohol. It is 
a rapid, efficient and safe anesthetic for short operations, if used with exclusion of atmospheric 
air. 

Unofficial Chlorinated Compounds. 
Ethylene Bichloride, Dutch Liquid, Chloric Ether, C 2 H 4 C1 2 , — is a rapid and powerful 
anesthetic, probably safer than Chloroform and less so than Ether. It always paralyzes the 
respiratory centre before the heart, so that its effects may be easilv watched and controlled. 
This is the substance which Guthrie supposed he had obtained when he discovered Chloro- 
form. 

Ethylidene Chloride, Chlorinated Muriatic Ether, CH 3 ,CHC1,. — is a mixture of varying 
sp. gr., and is not inflammable. It closely resembles Chloroform both physically and physio- 



rin OROFORMl \i. 221 

logically, but is less depressant u> the heart, consequently safer, and recovery from its effects 
is very prompt. 

Methyl Chloride, CH S C1, — a colorless gas, slightly soluble in water, of sweetish odor and 
taste, inflammable, burning with a greenish (lame. Cold liquefies it, and the liquid boils at 
— J.6° F. It is used locally in neuralgia to produce intense cold, and with remarkable success. 

Methylene Bichloride, Dichloro-methane, CH 2 C1 2 , — is an effective anesthetic which 
it was supposed would displace Chloroform as being much safer. Dr. Richardson introdui ed 
it and Sir Spencer Wells advocated its use, bul though little used as compared with other an- 
esthetics several deaths have occurred from its employment. It kills by paralyzing the heart. 

Carbon Tetrachloride, CO,,, — is less irritant than Chloroform, but for more dangerous 
to the heart. 

Somnoform, — is the trade name of a mixture of Ethyl Chloride 60, Methyl Chloride 35, 
and Ethyl Bromide 5. It is said to be more rapid in action than ethyl chloride. 

Schleich's Narcotic Mixture, — contains Ethyl Chloride 2, Chloroform 3, and Ether 
u. Its inhalation is employed for the rapid relief of local pain, as in gastralgia, colic, and 
uterine spasm, without producing unconsciousness. 

Physiological Action. 

The action of Chloroform is similar to that of Ether (see page 88), with 
several important differences. It is more irritant to the mucous membranes, 
and if swallowed undiluted it produces violent gastro-enteritis, which becomes 
apparent after the subsidence of the profound narcotism which at first follows 
its ingestion in quantity. A dose of 3J internally may cause death, though 
recovery has taken place after the ingestion of one, two and even three ounces 
(Wood). It clots the blood outside the body, converting it into a mass resem- 
bling sealing-wax. 

The inhalation of Chloroform produces sensations which are rather agree- 
able than otherwise, and many persons acquire a liking for it. After a few 
whiffs the patient experiences noises in the ears and flashes of light before the 
eyes, also a feeling of weight upon the chest; the heart is felt to be beating 
wildly and a throbbing sensation is experienced in the carotid arteries. In this 
lirst stage hysterical symptoms may become manifest, the patient laughing, 
crying, screaming or swearing. The pulse is at first quite rapid from nervous- 
ness, but soon falls in frequency and gains in force. In a short time all sensa- 
tion of discomfort passes away, the patient becomes quiet, breathes easily, 
and is evidently comfortable. The consciousness is soon affected, questions 
being heard but not fully understood, and answered hesitatingly and slowly 
and in an irrelevant manner. After a brief period of repose there may be an- 
other spell of excitement, during which the patient may struggle and endeavor 
to get up; but this soon passes away, the muscles, which were contracted, be- 
come flaccid, and the patient gradually assumes a condition of complete insen- 
sibility. In this state all reflex action is abolished and pain is not experienced; 
the pupils are contracted, and the limbs, when raised and let go, fall heavily. 
Dangerous symptoms are: — respiration becoming stertorous or shallow, sudden 
dilatation of the pupils, signs of cardiac failure. 

As compared with Ether the inhalation of Chloroform is less stimulating, 
more irritant to the kidneys, more depressant to the vital functions, and much 



222 CHLOROFORMUM. 

more dangerous on account of its direct paralyzant action on the heart. Its 
vapor is less irritant to the air-passages, non-inflammable, more agreeable, 
more prompt in action, produces much less subsequent vomiting, a shorter 
stage of excitement and a more profound degree of narcosis; and should be 
diluted with o6£ per cent, of air to produce anesthesia with safety, according 
to the general teaching on this subject. Its mortality is much greater, being 
about i in 3,000, against one in 10,000 for Ether, and fatal cases continue to 
be reported, though none of these have occurred in obstetrical practice. 

The Hyderabad Chloroform Commission's investigations, conducted under the direc- 
tion of Dr. T. Lauder Brunton, led to the conclusion that Chloroform and Ether act in the 
same manner upon the heart and respiration, both paralyzing the respiratory centre before 
the heart, and Chloroform acting more quickly and powerfully than Ether in both directions. 
Prior to this investigation it was taught that death from Chloroform is almost always sudden 
and occurs by cardiac paralysis, while from Ether it is slow and usually by paralysis of respira- 
tion. The subsequent researches of Gaskell, McWilliam and others tend to sustain the 
latter view, and show that the verdict of the commission cannot be accepted as conclusive. 
There is very little doubt but that Chloroform may paralyze the heart without first affecting 
the respiration; and it is probable that the paralysis of the vaso-motor centre, and the conse- 
quent withdrawal of blood from the heart and brain to the dilated splanchnic area, may be an 
important factor of a fatal result. Another view is that the early action of the anesthetic is to 
stimulate the cardio-inhibitory centre, causing the sudden death which has frequently occurred 
in the early stage of Chloroform anesthesia. Chloroform undoubtedly exerts a powerfully 
depressant action on the heart. Injected into the jugular vein it instantly arrests the cardiac 
action and destroys its muscular irritability. Its vapor, applied to the exposed heart, para- 
lyzes it, and even when artificial respiration is maintained the effect is very apparent. There 
can be no doubt but that Chloroform destroys the contractile power of the cardiac muscle 
(Murrell). 

Modes of Dying in Anesthesia are detailed under /Ether, on page 89. 

Therapeutics. 
Besides its use as an anesthetic Chloroform has a large field of therapeutic 
action. It is frequently employed in liniments as a rubefacient and anodyne 
application, also to promote the passage of other agents through the epider- 
mis, and to relieve itching. The vapor may be directed onto the raw surface 
of an ulcer or a superficial burn in order to relieve pain; and that arising from 
a few drops placed in the hand and held close to the eye will relieve photophobia. 
Internally it is administered with great benefit in vomiting, colic, dysmenor- 
rhea, and cholera morbus; also in true cholera, in which disease it has prob- 
ably been more efficient than any other single remedy, and in gastric ulcer, 
gastralgia and other painful affections of spasmodic character. In three to 
ten drop doses well diluted it markedly improves all the functions of the stom- 
ach, and is a valuable remedy for many gastric disturbances, especially acute 
dyspepsia. In sciatica, tic-douloureux and other neuralgia? of important nerves 
the deep injection of n^x-xv of pure Chloroform in the vicinity of the nerve is 
highly recommended, though it may cause dangerous local disturbance. In 
several cases of severe supra-orbital neuralgia, the writer has injected two or 
three minims of Chloroform into the vicinity of the supra-orbital nerve just 
above its foramen of exit, with the most gratifying permanent results, though 
severe local pain and considerable swelling were experienced for several days. 



CHLOROFORMUM. 223 

The vapor of Chloroform inhaled in small quantities from warm water or 
from a handkerchief is a very useful remedy in many neuroses, as hay fever, 
spasmodic asthma and reflex cough. It is one of the best palliatives in the 
cough of phthisis, as was long ago pointed out by Spencer Wells. It may be 
used with much benefit as a pulmonary antiseptic in many affections of the 
air-passages, as acute nasal catarrh, influenza and bronchitis; and has promptly 
checked a severe case of catarrh extending into the antrum and causing great 
pain. Carried to the production of muscular relaxation it is often used as an 
aid to diagnosis, especially in cases of malingering, in suspected disease of the 
abdominal viscera, and to aid in reducing dislocations and hernia;. It is used 
with great benefit in parturition, decreasing the sensibility to pain, relaxing 
the passages, and easing the labor, while it does not interfere with the uterine 
contractions, nor predispose to inflammation, hemorrhage or convulsions. In 
such cases the quantity needed is very small, a few whiffs from time to time 
being quite sufficient. In some cases, as in acute mania, a patient may require 
to be kept under the influence of chloroform for a long time, for hours, days, 
or even weeks; and this has been done in the digital treatment of subclavian 
and other aneurisms. The writer, on one occasion, kept an insane woman 
continuously under its influence for a period of three weeks, except during 
the time necessary for taking food. 

For the production of complete anesthesia the use of Chloroform is steadily 
decreasing in favor of Ether, except for young children and in obstetrical prac- 
tice. Its vapor being four times denser than air, and the rule for its effective 
use requiring fully 96^ per cent, of air with it, its administration according 
to the orthodox fashion requires most careful management, and should never 
be attempted in any but the recumbent posture. An ounce of brandy and a 
hypodermic injection of morphine, gr. J, with atropine, gr. -3-^, given 20 minutes 
before commencing the inhalation, are means of great utility in sustaining the 
heart and respiration and in rendering the anesthesia more profound; but this 
hypodermic injection should not be employed as a routine practice for all cases. 
It is contraindicated in weak subjects, in those who are particularly susceptible 
to the action of morphine, for operations likely to be attended with excessive 
hemorrhage, and in cases presenting any degree of respiratory insufficiency. 

The mortality under chloroform anesthesia, formerly stated at 1 in 5,000, 
is now placed at about 1 in 3,000; yet Luckett in ten years administered it in 
4,263 cases with only one death, and Syme used it in 5,000 cases without a single 
death. The latter ascribed his excellent record to his adherence to the follow- 
ing rule: "Never mind the pulse, never mind the heart, leave the pupil to it- 
self, but keep your eyes on the breathing, and if it becomes embarrassed to a 
grave extent, pull the tongue well out with an artery forceps." The Edinburgh 
rule is practically this: "Watch the respiration, the heart will take care of it- 
self"; but Professor Stewart suggests that a second one should be inculcated, 
namely — "Watch both the breathing and the pulse; and if the heart threatens 



2 24 CHLORUM. 

to fail for want of blood, fill it by raising the legs and compressing the abdo- 
men." No operation, especially on parts supplied by the fifth nerve, should 
be undertaken during partial chloroform anesthesia, for the reasons given on 
page 89. For the Schleich method with a mixed anesthetic see under /Ether, 
page 91. 

The purest Chloroform in prolonged contact with damp air has a tendency 
to decompose, forming the dangerous gas Phosgene, COCl 2 ; hence chloroform 
in partially filled bottles, or in bottles filled in the drug-store by drawing from 
larger vessels, should not be used for anesthesia. Temoin states that chloroform 
may be preserved indefinitely without decomposition by the addition to it of 
Sulphur in the proportion of about 4 grammes (3J) to each kilogramme (ftij). 

At a certain stage of chloroform anesthesia women often exhibit marked 
signs of sexual excitement, and on recovery it is not uncommon for them to 
bring charges of improper conduct against some one present, with no false 
intention but in the belief that impropriety actually occurred. It is never safe 
to administer an anesthetic to a woman without the presence of a third partv 
(Murrell). 

Dr. Sayre, the celebrated New York surgeon, used only ten or twenty drops of chloroform 
at a time, but he excluded all air not impregnated with the anesthetic on the principle that 
oxygen is the antidote to its action. He stated that with this small quantity he produced 
immediate and profound anesthesia in several thousand cases, without the least sign of dan- 
ger, and without the struggling usually seen when the anesthetic is given in the ordinary man- 
ner. 

Ethyl Chloride is increasing in popularity as a general anesthetic for minor 
operations, dental surgery, reduction of fractures and luxations, curettement, 
parturition, and examinations of sensitive subjects, especially children; also 
as a preliminary inhalation to prevent the early excitant effects of ether or chloro- 
form. It acts rapidly, anesthesia being usually complete within a minute or 
two, and its risks are considered slight, even in patients with unsound heart 
or lungs. It does not relax the muscles, and in operations requiring complete 
relaxation its use should be followed by that of ether or chloroform. Its mor- 
tality is stated at 1 in 15,000 cases. It may give rise to erotic sensations re- 
sulting in false accusations, and should not be used for women except in the 
presence of a witness. 

CHLORUM, Chlorine, CI, — is a greenish-yellow gas having a suffocat- 
ing odor, belonging to the Halogen group of elements; and though not official 
itself is represented in medicine by several of its compounds, also by several 
preparations which furnish it. 

Chlorine Compounds, described under the titles of their respective metal- 
lic bases, are: the Chlorates of Potassium and Sodium; the Chlorides of Am- 
monium, Calcium, Potassium, Sodium, Mercury, Gold, Iron, Zinc, etc.; also 
Hydrochloric Acid, classed with the mineral acids, and Chloroform, Ethyl Chlo- 
ride, Chloral and Butyl-chloral. 



CHLORUM. 225 

Preparations. 

Liquor Chlori Compositus, Compound Solution oj Chlorine, Chlorine Water, is an 
aqueous solution containing about 0.4 per cent, of Chlorine, with some oxides of chlorine 
and potassium chloride. It is prepared by adding Potassium Chlorate 5, Hydrochloric Acid 
iS. and Distilled Water 20, heating the mixture on a water-bath For two or three minutes, 
adding Distilled Water to 1000 and agitating. It should be freshly made when wanted. Dose 
tii'w 5ij [av. 5j ] in water; as a lotion or spray 5 j- 5 iv, well diluted. 

Chlorine Water may be extemporaneously prepared by mixing in a mortar Chlorate of 
Potassium 40 grains and Hydrochloric Acid oijss, adding a pint of distilled water by agita- 
tion during the evolution of the vapors. If done in a closed vessel danger may arise from 
the explosive gas, C'ljC),, which is liberated at the same time. It should be quickly bottled. 

Calx Chlorinata, Chlorinated Lime, Chlorinated Calcium Oxide, (often improperly called 
Chloride of Lime), — is a compound resulting from the action of chlorine upon calcium hydrox- 
ide, containing not less than 30 per cent, of available Chlorine. It occurs as a white or grayish- 
white, granular powder, of repulsive taste, partially soluble in water or alcohol, but when dis- 
solved in diluted Acetic Acid gives off an abundance of chlorine gas. Dose, gr. iij-vj [av. 
gr. iv] in water; for external use a 1 to 3 per cent, solution. The Liquor Calcis Chlorinata 
of the B. P. is a solution of 1 pound in 1 gallon of water. 

Liquor Sodae Chlorinatae, Solution oj Chlorinated Soda (Labarraque's Solution), — is an 
aqueous solution of several chlorine compounds of sodium, containing at least 2.4 per cent, 
by weight, of available Chlorine; prepared by adding together aqueous solutions of Mono- 
hydrated Sodium Carbonate 65, and Chlorinated Lime 90, then adding water to 1000. Dose, 
ttjx-xxx [av. njxv] in 20 parts of water. 

Incompatibles. 

Incompatible with Chlorine-water are: Alkalies, Ammonium salts, Arsenous salts, Bro- 
mides, Ferrous salts, Hypophosphites, Iodides, Lead salts, Lime-water, Mercurous salts, 
Oxalic Acid, Silver salts; with Chlorinated Lime are Fats, Glycerin, Iodides, Oils; with 
Chlorides are Hydrogen Peroxide, Lead, Mercurous, and Silver salts, Nitric Acid, Sulphuric 
Acid. 

Incompatible with Chlorates are Ammonium Picrate, Arsenites or Bromides in acid solu- 
tion, Charcoal, Cyanides, Ferrous salts in acid solution, Gallic Acid, Glycerin, Honey, Hydro- 
chloric Acid, Hypophosphites, Hyposulphites, Iodides in acid solution, Iodine, Iron (reduced), 
Lycopodium, Mercurous salts in acid solution, Oxalic Acid, Phenol, Phosphorous (amorphous) 
Salicylic Acid, Shellac, Starch, Sugar, Sulphides, Sulphites, Sulphuric Acid. 

Physiological Action. 
In the presence of moisture Chlorine is one of the most powerful of dis- 
infectants and deodorants, also an antiseptic and antifermentive agent of the 
highest activity; its power in these respects being due to its affinity for hydro- 
gen, decomposing all bodies which contain hydrogen as a molecular constituent, 
forming hydrochloric acid and setting oxygen free in its nascent form (ozone). 
Administered internally, it is converted, on reaching the stomach, into hydro- 
chloric acid and chlorides, losing all action on the organism in its own char- 
acter. Locally applied, it is irritant to the skin and mucous membranes, pro- 
ducing a sense of heat, with a burning sensation and even vesication. Inhaled 
in any quantity, it causes cough, sneezing and spasm of the glottis, also inflam- 
mation of the mucous lining of the air-passages and of the lungs. 

Therapeutics. 

The Chlorinated preparations are used as disinfectants and deodorizers of 

rooms, drains, and discharges from the body. They are rarely used about 

the person or clothing of patients by reason of the irritation produced by them 

when inhaled, and their power to destroy the color of fabrics. In dilute solu- 

16 



226 CHROMII TRIOXIDUM. 

tion they are well employed as local applications in aphthae, gangrene, scarlet 
fever and diphtheria, in which their principal action is to destroy fetor. The 
same may be said of their use in sloughing ulcers, gangrenous wounds and foul 
discharges, as they are rarely employed about the person in sufficient strength 
to have any destructive effect on disease germs. A strong solution of Chlori- 
nated Soda is a good application to bites of serpents and insects, to wash the 
hands after contact with infectious material, and to prevent infection by the 
syphilitic poison. 

The well-known solution of Potassium Chlorate and tincture of Ferric 
Chloride in glycerin and water'(see formula under the title Diphtheria in Part 
III), which was devised by Dr. Jacobi many years ago, has in diphtheria a high 
reputation which rests on a sound scientific basis. If properly prepared, by 
dissolving the potassium chlorate in water before adding the other ingredients, 
it contains some undecomposed Chloric Acid, HC10 3 . This at a higher tem- 
perature and in contact with organic matter is split up into perchloric acid and 
chlorine peroxide, which are fatal to bacteria, and especially to the bacillus 
diphtheriae. It is said that the glycerin in this mixture has occasionally caused 
a violent explosion, but the preparation has been used for many years with great 
satisfaction. 

Chlorine gas is a powerful local stimulant, and has been used with great 
benefit to promote healing in old ulcers. Absorbent cotton may be exposed 
to the gas extemporaneously prepared as directed on page 225, and bandaged 
on the surface of the ulcer. Chlorine inhalations were used forty years ago, 
by Sir James Simpson and others, in phthisis pulmonalis, with apparent benefit. 

Chlorinated Lime, freshly prepared, in solutions of varying strength, from 
1 in 60 to 1 in 12, is used by hypodermic injection in Australia as an antidote 
to serpent venom. The solution is injected into several points above the wound, 
20 to 100 minims being inserted at each place. In some cases this procedure 
causes great pain, but it does not seem to induce any local inflammation, and 
it is highly efficient for the purpose for which it is used. A common method 
of disinfecting a sick-room is to place a pound of Chlorinated Lime into a can- 
vas bag and immerse it in a mixture of common hydrochloric acid, 1^ pint, and 
water 4% pints, allowing it to remain for 24 hours. A still better method is to 
mix common salt, manganese dioxide and sulphuric acid in a saucer. The 
chlorine generated is heavier than atmospheric air, so that the vessel should 
be placed on a high shelf and not on the floor, in order that it may be diffused 
throughout the room. 



CHROMII TRIOXIDUM, Chromic Trioxide, {Chromic Acid) Cr0 3> — is 
obtained by the action of sulphuric acid on potassium dichromate. It occurs 
in small, crimson, needle-shaped crystals, deliquescent in moist air, very solu- 
ble in water. True Chromic Acid, H 2 Cr0 4 , does not occur in the free state. 
Chromic Trioxide should be kept in glass-stoppered bottles, and great caution 



CHROMII TRIOXI1H M. 227 

should be observed to avoid bringing it in contact with organic substances, 

such as cork, tannic acid, sugar, alcohol, glycerin, etc., as dangerous accidents 
arc liable to result . It is not used internally. 

Potassii Dichromas, Potassium Dichromate, K 2 Crj0 7 , — large, orange-red prisms of 
disagreeable, metallic taste and arid reaction, soluble in 10 of water at 59 F., and in iA of 
Uiiling water, insoluble in alcohol. It is used locally in aqueous solution (gr. v- 5j to the 5), 
and internally in doses of gr. fc- gr. ss [av. gr. J] in trituration. 

Incompatible with Chromic Trioxide are: Alcohol, Bromides, Chlorides, Ether, Glycerin, 
Hypophosphites, Iodides, Oxalates, Sulphides, Tartrates; with Chromales are the salts of 
Barium, bismuth, Lead, Manganese, Mercury, Silver, and Strontium; with Dichromates 
are many alkaloids, also Tannic Acid, Sugar, and other oxidizable substances. 

Physiological Action and Therapeutics. 

Chromic Trioxide is a powerful escharotic and penetrates deeply, but it 
is slow of action and is not very painful. It coagulates albumin and parts read- 
ily with its oxygen, oxidizing organic matter and decomposing ammonia and 
sulphuretted hydrogen; and is therefore an energetic disinfectant and deo- 
dorizer. When used as a caustic it is mixed with sufficient water to make a 
paste, which may be employed for the destruction of warts, hemorrhoids and 
other superficial growths; the neighboring parts being protected by cotton 
soaked in a strong alkaline solution. For syphilitic warts and condylomata, 
lupus, tinea tonsurans, etc., a solution of 100 grains to the 3 of distilled water 
is generally used. A solution of 1 in 40 is an excellent and inexpensive anti- 
septic lotion for putrid sores and wounds, syphilitic affections of the tongue, 
mouth and throat, ozena, leucorrhea and gonorrhea. In uterine catarrh and 
hemorrhages a solution of 120. grains to the 5 has been injected into the uterine 
cavity with good results. 

Potassium Dichromate is a good antiseptic and escharotic of milder action 
than the trioxide. In doses of 3ij-iv it has proved fatal to life in adults, with 
symptoms of gastro-enteritis, suppression of urine, and cardiac paralysis. It 
is chiefly employed as a local application in saturated solution to warts and 
venereal condylomata; and in dilute solution (gr. j-x to the 3) for catarrhal 
conditions of the nasal, buccal or vaginal mucous membrane. Internally it 
has been employed with benefit in locomotor ataxia and in dyspepsia simulat- 
ing gastric cancer; also in chronic gastric catarrh, the tongue having a thick 
yellow coat, in chronic diarrhea from intestinal ulceration, and in chronic ulcers 
of the pharynx and mouth. It is a good remedy in syphilitic sore throat, local 
rheumatism of the fibrous tissues, periosteal and syphilitic rheumatism, and 
acute catarrh and influenza, chronic nasal catarrh, chronic laryngitis, and 
chronic catarrhal affections of the bronchial mucous membrane, especially 
when the expectoration is tough and stringy. It has also been used with some 
success in diphtheria. In pharmacy it is employed in preparing chromic tri- 
oxide and valerianic acid, and as a test solution. Most of the medical gal- 
vanic and faradic batteries are run by a mixture of this salt with sulphuric acid. 
Poisoning by it should be treated as directed for mineral acids in Part III. 



228 CHRYSAROBINUM — CIMICIFUGA. 

CHRYSAROBINUM, Chrysarobin, C^H^O,,— is a neutral principle extracted from 
Goa Powder, a substance found deposited in the wood of Vouacapoiia Araroba, a Brazilian 
tree of the nat. ord. Leguminosac. It is commonly misnamed Chrysophanic Acid (one of the 
constituents of Rheum) — though easily converted into that substance. Occurs as an orange- 
yellow powder, odorless and tasteless, nearly insoluble in water and in alcohol, but readily 
soluble in ether, solutions of alkalies, and sulphuric acid. Dose, gr. J-j [av. gr. ss]. 

Unguentum Chrysarobini, Chrysarobin Ointment, — Chrysarobin 5, Benzoinated Lard 
95 parts. Should be diluted for average use from 1 to 3 times. 

In 20-grain doses Chrysarobin is a gastro-intestinal irritant, producing large, watery, 
bilious stools, with repeated vomiting, but not much nausea. Locally it produces diffuse 
dermatitis, often followed by follicular and furuncular inflammation. It stains the skin a 
dark yellowish-brown color, which may be removed by a weak solution of chlorinated lime. 
The use of this remedy is confined to superficial parasitic skin diseases of vegetable origin, 
and for psoriasis, in the latter affection being the best remedy known. 

CIMICIFUGA, Cimicifuga, (Black Cohosh) — is the dried rhizome and 
roots of Cimicifuga racemosa, a plant of the nat. ord. Ranunculaceae, native in 
the United States. It contains a Volatile Oil when fresh, resin, tannic and 
gallic acids, also an acrid, crystallizable, neutral principle. Cimicifugin or 
Macrotin is an impure resin obtained by precipitation from a concentrated 
tincture by the addition of water. The active principle has not been isolated. 
Dose, gr. x-xx [av. gr. xv.] 

Preparations. 
Extractum Cimicifugae, Extract 0} Cimicifuga. — Dose, gr. j-vj [av. gr. iv] 
Fluidextractum Cimicifugae, Fluidextract oj Cimicifuga. — Dose, ttjv-xx [av. Ttjfxv.] 
Tinctura Cimicifugae, Tincture oj Cimicifuga, — 20 per cent. — Dose, ngx- 5ij [av. 3j-] 
Macrotinum, Macrotin, (Unofficial). — Dose, gr. ss— ij. 

Physiological Action and Therapeutics. 

Cimicifuga is stomachic, antispasmodic, aphrodisiac, diaphoretic, diuretic 
and expectorant. Its taste is bitter and nauseous, resembling that of Opium. 
It acts on the heart and circulation similarly to Digitalis, and on unstriped mus- 
cular fibre like Ergot, but is much feebler in activity than either of these agents. 
Small doses stimulate digestion and secretion, the generative function and the 
menstrual flow, and especially the secretions of the bronchial mucous mem- 
brane and the kidneys. Full doses slow the heart while increasing its force, 
raise arterial tension and stimulate uterine contraction. Large doses dilate 
the pupils and produce dimness of vision, vertigo, intense headache, nausea, 
vomiting, and in some persons soporific and anodyne effects. 

Cimicifuga closely resembles Digitalis in action, but is safer, and should 
be more frequently used when the latter drug is indicated. In cardiac diseases 
it is very efficient, especially in weak or fatty heart where Digitalis would be 
dangerous. It is a good stomachic tonic, particularly in the irritable dyspepsia 
of alcoholism. As an expectorant it is used in acute and chronic bronchitis. 
It is a good nerve tonic in delirium tremens, and in functional impotence it 
is often efficient. In rheumatoid arthritis and rheumatism of the localized 
muscular variety, as lumbago, torticollis, and intercostal rheumatism, it is one 
of the most efficacious remedies, having a strong affinity for the muscular sys- 



CINCHONA. 22Q 

tern. Neuralgias of various kinds arc benefited by it, particularly ovarian 
neuralgia. Chorea about the age of puberty is one of the affections in which 

it is most useful, and the same may be said of the hysterical form of this 
disease. 

Many uterine disorders are benefited by Cimicifuga, such as amenorrhea, 
neuralgic and congestive dysmenorrhea, passive monorrhagia, subinvolution, 
spinal irritation due to some obscure sympathetic or neuralgic affection of the 
womb, sympathetic pains and neuralgia arising from the so-called irritable 
womb. In obstetrics it gives excellent results when used to initiate uterine 
contractions, to check hemorrhage, and to allay afterpains and nervousness 
after delivery. In puerperal mania and peritonitis its good effects are frequently 
remarkable, and in puerperal hypochondriasis it is strongly recommended by 
high authority. 

CINCHONA, Peruvian Bark. — The Cinchona tree belongs to the nat. 
ord. Rubiaceae and is a native of the eastern slope of the Andes, but has been 
largely planted in India, Ceylon, Java and Burmah, with the result of improv- 
ing the quinine-yielding value of many species by cultivation. In late years 
the test of appearance has given way to that of assay in judging of the various 
barks of commerce, and only those are official which yield 5 per cent, of total 
alkaloids. The official species are: — 

Cinchona, Cinchona, — the dried bark of Cinchona Ledgeriana, Cinchona 
Calisaya, Cinchona officinalis, and of hybrids of these and of other species of 
Cinchona, yielding, when assayed by a prescribed process, not less than 5 per 
cent, of total alkaloids. 

Cinchona Rubra, Red Cinchona, — is the bark of Cinchona Succirubr a or 
of its hybrids, containing not less than 5 per cent, of cinchona alkaloids. From 
it is prepared the Compound Tincture of Cinchona. 

Bark may be administered in doses of gr. x-xxx [av. gr. xv.], but it is never 
used now in substance, being bulky and very disagreeable to the taste. 

The principal varieties of the sub-order Cinchoneas, the barks of which are found in 
commerce and are used by manufacturers of the alkaloids, axe— Cinchona Calisaya, Cin- 
chona Flava, Yellow Bark, from Peru, Bolivia and India; C. Succirubra, Red Bark, from 
Ecuador, Java and Ceylon; C. Condaminea, Pale Bark, from Ecuador and Peru; C. Pita- 
yensis, Pitaya Bark, from New Granada; C. Micrantha, Gray Bark, from Peru and Bolivia. 
Altogether there are some 31 species acknowledged by botanists, and the list is constantly 
increasing, from the tendency of the different trees to hybridize. Several trees formerly 
acknowledged as Cinchonas are now placed in the genus Cascarilla, but their barks are to be 
found on the market. Cuprea bark is from trees of the genus Remijia, growing in Columbia; 
it contains Quinine and a peculiar alkaloid, Cinchonamine, but no Cinchonidine. 

Composition of Cinchona. 
Cinchona bark contains 21 natural alkaloids, 3 of which are official, 8 arti- 
ficial alkaloids, 2 simple acids, 2 tannic acids, a resinoid and a coloring matter, 
as follows: — 



230 CINCHONA. 

Quinine, C 20 H j4 N 2 O 2 , — a strong base, fluorescent, the most valuable of all the alka- 
loids; heated with glycerin to 374 F., it is converted into the isomeric base, Quinicine. 

Quinidine, CjoH^NjOj, — isomeric with Quinine, fluorescent, probably the most power- 
ful as an antiperiodic, but existing in very small quantity. 

Cinchonine, C^H^NjO,— the least active of the official three, having about half the 
therapeutic power of quinine. Not fluorescent. 

Cinchonidine, C !0 H 22 N 2 O, — isomeric with Cinchonine, not fluorescent, one of the most 
powerful of the alkaloids. 

The other alkaloids are of no interest medicinally. 

Kinic and Kinovic Acids, — are combined in the bark with the alkaloids. The former 
is used to make a Kinate of Quinine, and the latter occurs in non-official pharmacy as Kino- 
vate of Lime, an ingredient in Deloudre's Extract, which is used in Europe and India for 
dysentery. 

Kino-tannic and Kinovo- tannic Acids, — give to bark its peculiar and powerful astrin- 
gent qualities. They have not been fully studied. 

Kinovin, — is a bitter, amorphous resinoid, which is resolvable into Kinovic Acid and 
sugar. It is soluble in alcohol, but not in water. 

Cinchona Red, — a reddish-brown, insipid, inodorous substance. 

Preparations 0} the Bark. 

Fluidextractum Cinchonas, Fluidexlract of Cinchona. — Dose, ttjx-xxx [av. tijxv.] 

Tinctura Cinchonas, Tincture oj Cinchona, — has of Cinchona 20, in Alcohol 67J, Water 
25 and Glycerin *]\. Dose, 5ss-ij, [av. 5j.] 

Tinctura Cinchonas Composita, Compound Tincture 0} Cinchona, — has of Red Cin- 
chona 10, Bitter Orange Peel 8, Serpentaria 2, in Alcohol 85, Water y\ and Glycerin 7^; and 
is intended to replace Huxham's Tincture of Bark (see below). Dose, 3 ss— i j [av. 3j-] 

Huxham's Tincture of Bark, 1788 (Unofficial), is still used. Red Cinchona giv, 
Orange-peel oiij, Serpentaria gr. lxxx, Spanish Saffron gr. clx, Cochineal gr. lxxx, Brandy 
oxl, digested for 4 days, expressed and filtered. Dose, 5 ss— ij . 

Quinine and its Salts. 

Quinina, Quinine, C 20 H 24 N 2 O 2 +3H 2 O, — a white, amorphous or minutely crystalline 
powder, of alkaline reaction and very bitter taste, soluble in 1670 of water and in 0.6 of 
alcohol at 59 F. and readily in dilute acids. Dose, gr. j-xx [av. gr. iv], or gr. xl in special 
cases. Is insoluble in saliva. 

Quininae Sulphas, Quinine Sulphate, (C 20 H 24 N 2 O 2 ) 2 .H,SO 4 +7H 2 O, — very light, snow- 
white, fragile crystals, of bitter, persistent taste, soluble in 740 of water and in 65 of alcohol 
at 59° F., more soluble in acidulated water. Dose, gr. j-xx, or even gr. xl in special cases, 
[av. gr. iv.] 

Quininas Bisulphas, Quinine Bisulphate, C 20 H 24 N 2 O 2 .H 2 SO 4 + 7H 2 0, — clear, colorless 
efflorescent crystals or small needles, of very bitter taste and strongly acid reaction, soluble 
in 10 of water with blue efflorescence, and in 32 of alcohol, at 59 F. Dose, gr. j-xx, or even 
gr. lx in special cases, [av. gr. iv.] 

Quininas Hydrobromidum, Quinine Hydrobromide, CjoH^NjOjHBr+HjO, — color- 
less needles, of very bitter taste, soluble in 54 of w-ater and in 0.6 of alcohol at 59° F., very 
soluble in boiling water and in boiling alcohol. Dose, gr. j-xx, [av. gr. iv.] 

Quininas Hydrochloridum, Quinine Hydrochloride, C 20 H 24 N 2 O 2 HCl + 2H 2 0, — white 
needles in tufts, of very bitter taste, soluble in 34 of water and in 3 of alcohol at 59 F., in 1 of 
boiling water or alcohol. Dose, gr. j-xx [av. gr. iv.] An excellent salt which should be more 
generally used; 5 to 10 grain doses are antipyretic. 

Quininas Hydrochloridum Acidum, Acid Quinine Hydrochloride, C 20 H 24 N 2 O 2 (HCl) 2 + 
3H 2 (B.P.), — is soluble in less than its own weight of water, and may be used hypodermi- 
cally. Dose, gr. j-x. 

Quininas Hydrochloridum Carbamidatum, Quinine Carbamide Hydrochloride, (Un- 
official), — is a compound salt of Quinine and Urea, soluble in equal parts of water and there- 



CINC'llii\ \. 231 

fore admirably adapted for hypodermic administration in a 50 per cent, solution, It is almost 

unirritating to the tissues, and is given subcutaneously in doses of gr. j-iij. 

Quinines Salicylas, Quinine Salicylate, — is soluble in 77 of water, in n of alcohol, in 
.57 of chloroform, and in no of ether, at 77° F. It contains 70 per cent, of quinine. Dose, 
gr.j-xx [av. gr. iv.], in pill or capsule. 

Tinctura Pyrexialis, Tinctura Anti periodica, Warburg's Tincture (Unofficial), — is a 
celebrated and formerly secret preparation. The formula, published in 1875 by the originator, 
includes 16 ingredients, one of which (Confectio Damocratis) contained many drugs which 
are not now obtainable. The tincture contained Quinine Bisulphate, 2 per cent., with Aloes, 
Rhubarb, Camphor and several aromatic herbs. Dose, o) (about o$ grains of Quinine Bi- 
siilphate) in 2 doses given 3 hours apart. Hagcr's modification of the original formula is — 
Quinine Sulphate 1, Spt. Camphorac 2, Tinct. Aloes ct Myrrhae 22, Alcohol 16. Dose, as above. 
Some of the preparations now sold under this name contain few, if any, of the original ingre- 
dients. The so-called Warburg's Pill is a most irrational form in which to administer this 
complex medicine, even if it contains the proper constituents. 

Quinine is a constituent of the Glycerite and the Syrup of the Phosphates of Iron, Quinine 
and Strychnine (see under Ferrum). 

Unofficial Derivatives oj Quinine. 

Aristochin, Diquinine Carbonic Acid Ester, — occurs as a white, tasteless powder, insol- 
uble in water, soluble in alcohol and in chloroform, and contains 96 per cent, of quinine. It 
is said to be free from the unpleasant effects of quinine, though twice as powerful against pro- 
tozoa and twice as efficient in malarial fever. Dose, gr. viij-xv, thrice daily; gr. j-v for 
children, according to age. 

Euchinin, Euquinine, Quinine Carbonic Ether, — occurs in light, fleecy, white needles, 
soluble in alcohol, ether, and chloroform, very slightly soluble in water. Is tasteless in sub- 
stance, though decidedly bitter in solution; and is claimed to have no unpleasant gastric 
effects, to cause cinchonism less frequently and less intensely than quinine sulphate, though 
equally efficient as an antimalarial, antispasmodic and antineuralgic. Dose, gr. v-xx. 

Saloquinin, — is a salicylic acid ester of quinine, and occurs as a tasteless, crystalline 
powder, insoluble in water. It is said to be free from the cerebral effects of ordinary quinine 
salts, and to have been used with satisfaction in malarial fevers, sciatica, rheumatism, dys- 
menorrhea, and nervous headaches. Dose, gr. v-xx or more. 

Salts 0} Other Cinchona Alkaloids. 

Cinchoninae Sulphas, Cinchonine Sulphate (Ci 9 H 22 N 2 0) 2 H 2 S0 4 4-2H 2 0, — white, shin- 
ing prisms, of very bitter taste, soluble in 66 of water and in 10 of alcohol at 59 F., and readily 
soluble in dilute acids. Dose, gr. v-xx or more [av. gr. iv.] 

Cinchonidinae Sulphas, Cinchonidine Sulphate (C, H /2 N 2 O) 2 H 2 SO < -r3H 2 O, — white, 
silky crystals, of bitter taste, soluble in 70 of water and in 66 of alcohol at 59 F., freely sol- 
uble in acidulated water. Dose, gr. j-xx or more [av. gr. iv.] 

Cinchonidinae Salicylas, Cinchonidine Salicylate (Unofficial), — has antimalarial prop- 
erties which are but slightly inferior to those of the quinine salts. Dose, gr. v-xx or more. 

Unofficial Preparations. 

Chinoidinum, Chinoidin, Quinoidin, — a mixture of alkaloids, mostly amorphous, ob- 
tained as a by-product in the manufacture of the crystallizable alkaloids from Cinchona. A 
black solid when cold, plastic when warmed, of bitter taste, almost insoluble in water, freely 
soluble in alcohol and in dilute acids. It contains the 4 alkaloids in amorphous condition, 
and has about i the therapeutic power of Quinine. Dose, gr. v-xxx or more. 

Quinquinina, Quinetum, — is an Indian preparation containing the total alkaloids ex- 
tracted from bark by acidulated w-ater, then precipitated by soda and dried. In India it is called 
"febrifuge." 

Incompatibles. 

Incompatible with Cinclwna are Acids (mineral), Alkalies, Carbonates, Alkaloidal pre- 
cipitants (see page 5), Ferric and Ferrous salts, Lead Acetate, Lime-water, Magnesia, 
Mercuric Chloride, Rhubarb infusion, Silver Nitrite, Tartar Emetic, Zinc Sulphate; with 
Quinine as for other alkaloids (see page 6). 



232 cinchona. 

Substitutes for Quinine. 
The synthetical production of Quinine has been the philosopher's stone 
of the modern chemists, who have prosecuted with untiring energy the search 
for an artificial product possessing all its properties. Though in this they 
have as yet been unsuccessful, they have discovered several organic bodies, 
which closely resemble each other and also quinine, both in chemical consti- 
tution and physiological action. These substances belong to the aromatic 
series of carbon compounds, all of which are derivates of Benzene, C 6 H 8 , the 
hydride of the organic radicle Phenyl, C fi H 5 . The distinctive action of the 
lower members of this series is their antiseptic and antipyretic powers, — as 
that of the fatty series of carbon compounds is stimulant and anesthetic (Brun- 
ton). Many of these agents are obtained from coal-tar oil (petroleum) by 
fractional distillation, and they are all derivatives of benzene, either directly 
or from some one of the products formed therefrom by substitution, various 
radicles replacing the different constituent atoms of H and C. 

Thus by the atomic ring-arrangements peculiar to this series, there are formed from Ben- 
zene, C 6 H 6 , the following substances, viz. : — 

Phenol, {Carbolic Acid), C B H 5 OH— by replacing H by OH (hydroxyl). 

Pyrocatechin,. or Ortho- | C 6 H 4 (OH) 2 . 

Resorcinol, . . . or M eta- > dioxybenzene, — by replacing 2H by 2OH. 

Hydroquiiwne, or Para- J C 6 H 4 (OH) 2 . 

Pyrogallol, Pyrogallic Acid, Tri-hydroxybenzene, C 6 H 3 (OH) 3 , — 3H by 3OH. 

Amido-benzene, or Anilin, C e H 5 .NH 2 — by replacing H by NH 2 (amidogen). 

Nitro-benzetie, C 6 H 5 .N0 2 — bv replacing H bv N0 2 (nitroxvl). 

Benzoic Acid, C„H 5 CO.OH— bv replacing H bv CO. OH (carboxvl). 

Salicylic Acid, HC-H 5 3 — by replacing 2H by OH and CO. OH. 

Naphthalene, C 10 H S — by uniting two Benzenes in an over-lapping ring. 

Pyridine, C 5 H,N — by replacing tetrad C by triad N. 

Chinolin, C 9 H 7 N — by uniting Benzene, C 6 H 6 , and Pyridine, C 5 H 5 N. 

Derived from Chinolin is the hypothetical base — 

Chin-kin or Quinicin, C 9 H 9 N 2 , — represented in Antipyrine. 

Kairin, Thallin, and other compounds; also probably the Cinchona alkaloids. 

The most important of these are Antipyrine, Acetanilide, Resorcinol, Chinolin and 
Naphthalene, which are respectively described in separate articles. 

Physiological Action. 
Cinchona is an astringent bitter and a stomachic tonic. At first it pro- 
motes appetite, digestion, the flow of saliva and of gastric juice; long continued 
it sets up a gastric catarrh, impeding digestion and causing constipation. The 
action of Cinchona in sufficient dose is generally that of its alkaloid Quinine, 
except that the bark is decidedly astringent, more of a gastric irritant, and its 
active principles are more slowly absorbed by reason of its bulk. In large 
doses (gij) the powdered bark has produced flatulence and eructation, and in 
many well-authenticated instances has apparently caused a well-marked febrile 
paroxysm, beginning with chill, then fever and headache, which gradually sub- 
sided with slight perspiration. So also, Quinine, while incapable of produc- 
ing intermittent fever in a healthy person, if taken in large doses unneces- 



CINCHONA. 233 

sarily, may throw the nervous system into high commotion, and if untimely used by 
8 malarial subject may reproduce the paroxysm with greater or less severity. 

Quinine is a hitter tonic, an antiseptic, antiperiodic and antipyretic, a di- 
minisher of reflex action, a protoplasmic poison and a cardiac depressant. H 
is rapidly diffused and slowly excreted, being found in the urine in 15 minutes 
after its administration and for two or three days afterwards. Its action on the 
Stomach is similar to that of cinchona, small doses having tonic effects, while 
large doses are irritant. The heart and arterial tension are somewhat stimu- 
lated by small doses, but depressed by large ones (gr. xl-lxxx), which slow 
and enfeeble the pulse by direct action on the cardiac ganglia. The brain is 
rendered hyperemic and exhilaration is caused by small or moderate doses, 
but large ones produce a train of congestive cerebral symptoms, collectively 
termed cinchonism, and including a sense of fulness and constriction in the 
head, tinnitus aurium, vertigo, staggering gait, amblyopia and deafness, great 
headache, dilated pupils, delirium, coma, and in the lower animals convul- 
>ions. The eyes and ears, though suffering severely, are rarely injured perma- 
nently. In very large doses it abolishes the cerebral functions. 

Quinine reduces the size of the spleen when enlarged, and lowers the tem- 
perature of pyrexia by lessening oxidation, though it does not depress the body- 
temperature in health. Large doses lower the reflex function of the spinal 
cord. It depresses the retrograde metamorphosis of the tissues, and lessens 
the formation of the nitrogenous excretory products, the elimination of uric 
acid and urea being decidedly decreased during its administration. It arrests 
the movements of the white blood-corpuscles though increasing their number, 
and prevents acetification and decay of the blood outside of the body. It is 
actively destructive to lowly organized life, a solution of 1 in 800 killing the 
larger infusoria immediately, 1 in 1,000 after some minutes, and 1 in 20,000 
after some hours. Upon the higher infusoria and' mould penicillium much 
stronger solutions are required for its fatal action, while vibrios and bacteria 
resist solutions weaker than 1 in 100. The ameboid movements of human 
white blood cells are arrested by a solution of 1 in 4,000. 

Individual idiosyncrasies are frequently observed with regard to the action 
of Quinine. In some persons even small doses produce a severe erythema or 
urticaria, with subcutaneous edema, often followed by desquamation of the 
cuticle, and accompanied by pronounced disturbance of the nervous system 
and the circulation. In one case the symptoms simulated those of strychnine 
poisoning. Occasionally it produces renal and vesical irritation, and in some 
persons it causes sexual excitement. It acts as a uterine stimulant in labor, 
and is used as an oxytocic, but its power to initiate uterine contractions is strenu- 
ously denied by many investigators. 

The fatal dose of Quinine is undetermined. In one case five ounces taken 
in the course of ten days caused death; in another 7.7 grains (gramme 0.5) 
given hypodermically caused profound toxic symptoms which terminated in 



234 CINCHONA. 

death after seven days. On the other hand an ounce of the sulphate has been 
taken without causing more than a mild stupor, and in another case half an 
ounce produced neither vomiting nor other ill effects. Surgeon Roberts of the 
Indian army has recorded a case in which a woman aged 35 years took 6 drachms 
of the sulphate at one dose, and survived, after profound coma for several hours, 
also slow and shallow respiration, slow pulse, abolished reflexes, deafness and 
blindness. The hearing was restored within a week, but the blindness was 
absolute for two weeks, when light began to be distinguished. Objects were 
not perceived until after three or four weeks, and then indistinctly for several 
months, the vision remaining greatly impaired for a long time. 

Cinchonine and the other alkaloids closely resemble quinine in their physi- 
ological and therapeutical properties, in doses about one-third larger. In 
large doses Cinchonine has some and Cinchonidine has a very strong tendency 
to produce epileptiform convulsions, while small quantities of the latter given 
to epileptics will increase the number of their attacks. Cinchonine produces 
greater headache than qunine, also much precordial pain and muscular weak- 
ness, but is asserted to have little effect on the sight or hearing. By some au- 
thorities it is said to be the least active of the four alkaloids; by others Cin- 
chonidine is considered to be the most poisonous, Quinine coming next in rank, 
then Cinchonine, and lastly Quinidine. 

Therapeutics. 

Cinchona is used as a tonic, and has many applications. The infusion or 
compound tincture with a mineral acid is serviceable in atonic dyspepsia, gas- 
tric catarrh of alcoholics, adynamia, and convalescence; also in asthma, chronic 
bronchitis, and generally in weak subjects of flabby flesh and freely perspiring 
skin. Quinine in small doses is much employed as a tonic, usually in con- 
junction with iron. Its tonic power is believed by some to be due to its lessen- 
ing tissue-change, by others to its increasing the number of the red blood cor- 
puscles. 

Quinine finds its principal field of action in the malarial diseases, over which 
its influence is specific, by reason of its power to prevent the development of 
the plasmodium to which malaria is due. In intermittents, a ten-grain dose 
of the sulphate should be given in the sweating stage and again 5 hours before 
the expected time of the next paroxysm. In the intervals Arsenic is a better 
remedy, as quinine may cause a daily exacerbation of temperature if long con- 
tinued. In remittents from 20 to 30 grains are administered once or twice 
daily until the temperature becomes normal, and in pernicious remittents doses 
of 30 to 60 grains are necessary to the safety of the patient. In chronic ma- 
larial toxemia Chinoidin is considered more effective than quinine. As a proph- 
ylactic against malarial fevers the use of small doses of quinine, 3 to 5 grains 
daily, has been universally approved until recently, especially in tropical coun- 
tries. Professor Koch considers this to be dangerous practice and to be respon- 



CINCHONA, 235 

Bible for the increased death rate in certain parts of West Africa during late 
years. He holds that the indiscriminate use of quinine as a prophylactic in 

malarial countries is in many cases the indirect cause of the pernicious "black- 
water" fever, one of the most virulent forms of malarial disease; also that this 
drug seriously weakens the action of the heart when taken regularly in ej 
>i\e doses, and will so inure the system to its influence that it becomes useless 
as a remedy when required for this purpose. Warburg's Tincture obtained 
a very high reputation in the hands of Indian army-surgeons in the treatment 
of remittent and other malarial fevers of the most malignant types, in malarial 
neuralgia-, acute nervous exhaustion and sudden collapse without organic dis- 
ease. Dr. Maclean affirmed that the influence of this combination to arrest 
an exacerbation of remittent fever is far more powerful than that of quinine 
alone. The remedy has become much less of a favorite since its originator 
was induced to make public the secret of its composition. 

As a general antipyretic large doses of Quinine were in common use before 
the introduction of the modern synthetical antipyretics, to which it is inferior 
for this purpose. Its power of lowering temperature in non-malarious fevers 
is decided, and is especially manifested at the beginning of a natural remission 
of the fever. In the exanthemata and typhoid fever, after the use of the cold 
bath, a 20-grain dose of quinine will usually delay the return of high tempera- 
ture, but the large dose necessary causes much discomfort by its action on the 
brain and the hearing. Quinine has been employed as an antipyretic and anti- 
septic in typhus and typhoid fevers, variola, pneumonia, acute rheumatism, 
surgical fever, septicemia, pyemia, hectic fever, scarlet fever, measles and ery- 
sipelas, in many of which it has enthusiastic advocates, who recommend its 
administration throughout the course of the disease. In exhausting suppura- 
tions it is generally employed, and in some skin diseases, particularly erythema 
nodosum, it is said to be very efficient. It is used in conjunction with mor- 
phine, a full dose of each, at the commencement of acute inflammations, with 
the object of aborting them; also in acute tonsillitis and acute coryza for the 
same purpose. Quinine is a routine remedy with many persons to break up 
a cold, but there is no evidence, clinical or experimental, that it has any such 
power, and its only effect in these cases probably depends upon its anodyne 
and antipyretic action. Neuralgia of malarial origin, and that of the ophthal- 
mic division of the fifth nerve, are decidedly amenable to it. In whooping- 
cough the internal administration of Quinine, also its inhalation in the form 
of a sprayed solution, have been employed with asserted benefit. In hay-fever, 
the application of a weak tepid solution of the hydrochloride, gr. iij to the g, 
was recommended by Helmholtz, who was benefited thereby, but it has not 
proved generally efficacious in this affection. The Salicylate is an efficient 
antirheumatic and intestinal disinfectant, and has been used with benefit in 
acute and subacute rheumatism, influenza, pneumonia, diphtheria, typhoid 
fever, erysipelas and other exanthemata, also in chlorosis. The Sulphate, in 



236 CINCHONA. 

dose of gr. viij followed by gr. iv an hour later, is effective in uterine inertia, 
and is used by many practitioners in labor to increase the expulsive power of 
the uterus, and by promoting firm uterine contraction to lessen the tendency 
to hemorrhage. 

Quinine Sulphate was used in Asiatic cholera from 183 1 to 1873 w 'th much 
success, 3146 cases so treated showing a mortality of less than 24 per cent., 
including 30 cases with 2 deaths (Kosser), 220 cases with only 3 deaths (Schlo- 
tnann), and 350 cases with 15 deaths (Henry). Dr. Fullerton has called atten- 
tion to the value of Quinine as an inhibitory agent on the comma bacillus, and 
has shown that the instances of its unsuccessful use in cholera were chiefly 
those in which it was administered hypodermically or by intra-venous injection, 
and therefore did not reach the contents of the intestinal canal. He insists 
that it should be given only by the mouth or by enteroclysis; in the former 
case in 10-grain dose as powder or in acid solution, repeated every hour until 
40 grains have been taken, then less frequently. In amebic dysentery the use 
of high intestinal irrigation with a solution of the sulphate, 1 in 3000, has been 
highly successful in many cases, the drug having destructive action on the 
ameba coli. 

Quinine is contraindicated in patients who have any idiosyncrasy in regard 
to it, also in gastritis, cystitis, epilepsy, meningitis, cerebritis, and otitis media, 
on account of its congestive action upon the regions affected in these diseases. 

A dministration. 
It is said that Quinine is tasted by the posterior part of the tongue and not 
by its tip. Its persistently bitter taste is best obviated by administering it in 
capsules, or in pills made with glycerin as an excipient. If given as a powder 
or in solution Licorice or Chocolate may be used to cover the taste. An ex- 
cellent vehicle for quinine in solution is a combination of glycyrrhizin and the 
fluid extract of eriodictyon, named Velatine, but the quinine salt must be sus- 
pended in it by the aid of mucilage, for when dissolved by the aid of an acid 
its taste cannot be disguised. 

The Hypodermic Injection of Quinine is advocated by many authorities as more effectual 
in obstinate cases than any other method of administration. It becomes necessary in malarial 
fevers when vomiting is persistent and the rectum irritable, if the patient is insensible and 
cannot swallow, also when life is in imminent danger and the earliest possible action of the 
drug is important (Manson), The best salt for hypodermic use is the Acid Hydrochloride 
(see page 230), which is soluble in its own weight of water. The Sulphate may be used, its 
solution being effected by adding one-half its weight of tartaric acid. The Bisulphate is 
soluble in 10 of water, but even its solution should be slightly acidulated, in order to prevent 
precipitation of the quinine by the alkaline juices of the cellular tissue. The Carbamide 
Hydrochloride is soluble in its own weight of water, and is said to be devoid of irritant effects. 
The addition of Urethane or Antipyrine to solutions of the Hydrochloride, increases its solu- 
bility. Aujrecht's Formula is — Quinine Hydrochloride gr. vijss, Urethane, gr. iv, Distilled 
Water, njjlxxx. Laveran's Formula is — Quinine Hydrochloride 3, Antipyrine 2, Distilled 
Water 6 parts, giving a 50 per cent, solution, the injection of which is painless. This solution 
was used extensively during a severe epidemic of malaria in Algiers in 1894 and always proved 
satisfactory (Blum). In it is formed by chemical transformation a new salt, named Chino- 
pyrin, which is similar but not equivalent to the quinine salt (Santesson). 



CINNAM0M1 \i COC V. 837 

CINNAMOMUM, Cinnamon, is official under two titles, viz. Cin- 
mtnomum Saigonicum, Saigon Cinnamon, the bark of an undetermined spei 
of Cinnamomum, nat. ord. Lauracese; and Cinnamomutn Zeylanicum, Ceylon 
Cinnamon, the inner hark of the shoots of Cinnamomum zeylanicum. The 

official Oil is distilled from Cassia Cinnamon, an undetermined species. The 
tir>t named is a constituent of the compound tinctures of Cardamom, Gambir, 
and Lavender. Their taste is warm and aromatic, and their odor is very fra- 
grant. Their active principle is the Volatile Oil, which contains Cinnamic 
Aldehyde. Dose, gr. j-x [av. gr. iv.] 

Official Preparations. 

Oleum Cinnamomi, Oil oj Cinnamon, Oil oj Cassia, — a volatile oil distilled from Cassia 
Cinnamon. A yellowish liquid, soluble in 2 of 70 per cent, alcohol. Becomes darker and 
thicker by age and exposure to air. Dose, njjss— ij [av. njjj.] 

Aqua Cinnamomi, Cinnamon Water, — has of the Oil 2, triturated with Talc 15, and 
Distilled Water to 1000. Dose indefinite [av. 5iv.] 

Spiritus Cinnamomi, Spirit oj Cinnamon, — has 10 per cent, of the oil in Alcohol to 100. 
Dose, njv- 5j [av. njjxxx.] 

Tinctura Cinnamomi, Tincture of Cinnamon, — has of Cinnamon 20, Glycerin *j\, 
Alcohol and Water to 100. Dose, njxx- 5j [av. njxx.x.] 

Pulvis Aromaticus, Aromatic Powder, — has of Cinnamon 35, Ginger 35, Cardamon 15, 
Nutmeg 15, triturated together to a fine powder. Dose, gr. x-xxx [av. gr. xv.] 

Fluidextractum Aromaticum, Aromatic Fluidextract, — has of Aromatic Powder 100 
per cent, in Alcohol. Dose, njx-xxx [av. njjxv.] 

Cinnaldehydum, Cinnamic Aldehyde, C 9 H s O, — is an aldehyde obtained from Oil of 
Cinnamon or prepared synthetically; soluble in alcohol, ether, and fixed and volatile oils. 
Dose, iij;ss-ij [av. tijrj.] 

Cinnamon is an agreeable carminative, somewhat astringent and stimulant, 
also highly aromatic and antiseptic. The Oil is not astringent, but is a stimu- 
lant to the nervous and vascular systems, and seems to have the specific action 
of a uterine hemostatic. In overdose it acts as an irritant and narcotic poison. 
The various preparations are in general use as flavoring excipients, and the 
Water is a pleasant vehicle for extemporaneous mixtures. The Bark and its 
preparations, in combination with opium, chalk, or some vegetable astringent, 
are used to check diarrhea. 

Oil of Cinnamon is a good remedy for flatulence, cramp of the stomach, 
enteralgia, and paralysis of the tongue, and is sometimes used to check nausea 
and vomiting. It has an ancient reputation for healing and antiseptic proper- 
ties, especially on the mucous membranes, and has been employed as an injec- 
tion in gonorrhea. It has been used as an internal germicide, and has given 
good results in the treatment of typhoid fever, against the bacillus of which 
it is believed to have specifically destructive power. In influenza it has proved 
a valuable remedy, cases in which it was used early having returned to their 
avocations within three or four days. 

COCA, Coca, [Cued) — the dried leaves of Erythroxylon Coca, or of E. 
Truxillense, shrubs of the nat. ord. Erythroxylaceae, indigenous to the mountains 



238 COCA. 

of Peru and Bolivia, and cultivated in those and other S. American states, also 
in India and Java. Their odor is tea-like, taste slightly bitter and aromatic. 
They contain a crystalline alkaloid, Cocaine, C 17 H 21 N0 4 , which when heated 
with HC1 is split up into methvlic alcohol, benzoic acid and another alkaloid 
named Ecgonine, a pyridine derivative, resembling tropine very closely in com- 
position. The Java leaves furnish another alkaloid, Tropacocaine, which is 
also a compound of benzoic acid, with a base resembling the pseudotropine 
derived from hyoscine, but of somewhat different constitution. Other con- 
stituents are the alkaloids Cocamine, Isococamine, Homococamine, and Homo- 
isococamine, all of which contain the ecgonine molecule, also an aromatic oil 
and coca-tannic acid. The leaves should contain not less than 0.5 per cent, 
of the ether-soluble alkaloids. Coca should not be confounded with Cocoa, 
the seed of the chocolate-tree. Dose gr. x-gj [av. gr. xxx.] 

Preparations. 

Fluidextractum Cocae, Fluidextract of Coca, — made with diluted alcohol. Dose, 
njjx- 5j [av. TTJJXXX.] 

Vinum Cocae, Wine of Coca, — has of the Fluidextract b\, Alcohol 7J, Sugar 6£, Red 
Wine to 100. Dose, 5j- 3j [av. 5iv.] 

Glyceroles, Elixirs, Pastes, etc. (Unofficial), — are manufactured in great variety, usu- 
ally as proprietary preparations. 

Celerina, (Unofficial), — a proprietary preparation said to contain in each fluid-drachm 
gr. v each of Coca, Celery, Kola and Viburnum, with aromatics. Dose, 3 j — ij • 

Alkaloids and their Preparations. 

Cocaina, Cocaine, C 17 H 2 iN0 4 , — exists in the leaves in very small quantity, from 0.02 
to 0.04 per cent., is soluble in 600 of water, in 5 of alcohol, and in 3.8 of ether at 77 F., very 
soluble in chloroform, soluble in 12 of olive oil, in 4 of oleic acid, insoluble in glycerin. Dose, 
gr. J-j [av. gr. ss.] 

Cocaina? Hydrochloridum, Cocaine Hydrochloride, C 17 H 21 N0 4 .HC1, — occurs in color- 
less prisms or a white, crystalline powder, of slightly bitter taste, producing on the tongue a 
tingling sensation followed by numbness; soluble in 0.4 of water and in 2.6 of alcohol at 77 F. 
Dose, gr. $— j [a v. gr. ss]; by hypodermic injection gr. \-\. 

Oleatum Cocainae, Oleate of Cocaine, — has of Cocaine 5, Alcohol 5, Oleic Acid 50, 
Olive Oil to 100. 

Injectio Cocainae Hypodermica, Hypodermic Injection of Cocaine (B.P.), — is a 10 
per cent, solution, and has of Cocaine Hydrochloride gr. xxxiij, Salicylic Acid gr. ss, Distilled 
Water to 3yj. Dose, by subcutaneous injection, ngij— v. 

Schleich's Solutions for infiltration anesthesia. No. 1, Strong, has of Cocaine Hydro- 
chloride gr. iij, Morphine Hydrochloride gr. ss. Sodium Chloride gr. iij, Distilled Water, 
sterilized 3 iij 3 iij, of which 3yj may be used during one operation. No. 2, Normal, — 
Cocaine r Hydroch. gr. jss, Morph. Hydroch. gr. ss, Sod. Chlor. gr. iij, Distilled Water, ster- 
ilized, oiij 3iij, of which 3 hjss may be used at one operation. No. 3, Weak, — Cocaine Hy- 
droch. gr. $, Morph. Hydroch. gr. ss, Sod. Chlor. gr. iij, Distilled Water, sterilized, oiij 3"j, 
of which a pint may be used at one operation. 

Tropacocaine, Benzoyl Pseudotro peine (Unofficial), — is an alkaloid obtained from the 
Java coca leaves, now made synthetically. It is much less toxic than cocaine and is used as 
a succedaneum therefor, as it may replace the latter in every case as a mydriatic and an anes- 
thetic. The Hydrochloride is applied in 3 to 10 per cent, solution in 0.6 per cent, sodium 
chloride solution. Dose, gr. J-j; by spinal injection for general anesthesia, gr. \-f$- 

Incompatibles. 

Incompatible with Cocaine are: Acids (concentrated), Alkaloidal precipitants (see page 
5), Alkalies, Hot Water; with the Hydrochloride are: Calomel, Chloroform water, Mer- 



COCA. 

curie Oxide, Silver Nitrate. Physiologicall) incompatible are: Alcohol, Ann! Nitrite, I il 
(Vine, Chloral Hydrate, Digitalis, Morphine. 

Unofficial A nalogues. 

Anesthesia,- -is the ethyl-ester oj paramido-betuoic acid, and occurs as a white powder, 
soluble in ether, alcohol, fatty and ethereal oils, insoluble in water. It is used as an an 
thetic for minor injuries, painful skin affections and those of mucous membranes, carcinoma- 
tous uleers, etc., as a dusting powder, also in throat and nose practice. Its anesthesia lasts 
longer than that of Cocaine, and it is much less toxic. The Hydrochloride is used internally 
in gastric hyperesthesia and ulcer, in doses of gr. v-vij. Doses of 30 grains have not proved 
(OXH . 

Eucaine-A, C 18 H JT NO, — is an artificial alkaloid, which is much less toxic than Cocaine 
and almost as efficient as a local anesthetic, but causes irritation anil some pain. The Hydro- 
chloride is soluble in 10 of water and in 3 of alcohol. 

Eucaine-B, C 15 H 2 ,NO, — is preferred to Eucaine-A for ophthalmic work, being less 
irritant. Solutions of the Hydrochloride of 1 to 2 per cent, are used in the eye, of 2 to 5 per 
cent, for other mucous surfaces and for hypodermic injection. This salt is soluble in 20 of 
water and in 14 of alcohol, and its solutions may be sterilized by boiling without undergoing 
decomposition. Locally it causes hyperemia of the mucous membranes, which militates 
against its use in active inflammatory conditions thereof. Alone, or in combination with 
Cocaine, it is employed for producing general anesthesia, by injection into the spinal canal, 
with great satisfaction, and less toxic action than occurs from the injection of Cocaine. The 
Eucaine preparations are proprietary, being manufactured by patented processes. Dose, 
gr- H- 

Euphthalamin, — the hydrochloride of the mandelic acid derivative of Eucaine-B, is a 
brief and efficient mydriatic, but not an anesthetic. Two drops of a 5 per cent, solution 
cause maximal dilatation of the pupil in 35 minutes, without any raise of tension or appre- 
ciable effect on accommodation, the patient being able to read as usual. The effect passes 
off in 2 to 4 hours. It is the most satisfactory mydriatic for ophthalmoscopy, being safe in 
glaucomatous cases, and of rapid and short action. 

Holocaine, — is a patented synthetic product prepared by the interaction of Phenac- 
etin and Paraphenetidin. The Hydrochloride is soluble in 50 of water and in 6 of alcohol. 
It is highly toxic and cannot be used hypodermically, but is employed by ophthalmologists 
in a r per cent, solution. It produces complete and rapid anesthesia and neither dilates the 
pupil nor affects the blood-vessels. 

Nirvanin, — a patented coal-tar derivative of the orthoform type, is very soluble in water, 
can be sterilized, and is antiseptic as well as anesthetic, non-irritant and only one-tenth as 
toxic as cocaine. It is used for local anesthesia in 2 to 5 per cent, solutions. 

Orthoform, — a patented product, is the methylester oj amido-oxybenzoic acid, and has no 
chemical relation to cocaine, which it resembles only in its action on the sensory nerve ter- 
minations. It occurs as a white, crystalline, odorless and tasteless powder, almost insoluble 
in water. It is efficient as a local anesthetic only when it comes in contact with exposed 
sensory nerves, and has been used chiefly as a dusting powder or ointment for painful abra- 
sions, ulcers, or burns. Applied in powder to raw surfaces, as burns, and excoriated nipples, 
it has frequently produced local gangrene. Internally it has been given in doses of gr. viij-xv 
for the pain of gastric ulcer and cancer. It does not relieve the pain of simple gastralgia, and 
hence it has been employed as a test for gastric ulcer. A saturated solution in collodion 
may be used as a paint, and an emulsion in glycerin is employed during operations within 
the uterus. The Hydrochloride is more soluble in water and may be used for internal adminis- 
tration or urethral injection, but is too acid for hypodermic injection or eye application. Its 
Incompatibles are Antipyrine, Bismuth Subnitrate, Silver Nitrate. 

Stovaine, — is the trade name of a synthetic derivative of the amino-alcohols, chemically 
a Hydrochloride of Dimethylamine-^ benzoyl-pentanol. It is more stable than Cocaine, 
though decomposed by the least trace of an alkali, and its aqueous solutions are sterilizable 
by heat below 248 F. It is less than one-half as toxic as Cocaine, though equally powerful 
as an anesthetic, and has the great advantage of being a vaso-dilator, Cocaine being a vaso- 
constrictor. As a substitute for the latter it is used with great satisfaction for local and spinal 
anesthesia. For anesthesia of the skin it should be injected under the epidermis or into the 
derma, not subcutaneouslv, and when employed in the cephalo-rachidian fluid, (which is alka- 
line), sodium chloride should be added to it in the proportion of 5 per cent. Dose, gr. 3V-SS, 
in pill; for intramuscular or epidural injection njjxxx of a 1 per cent, solution; for spinal 
injection, gr. J— r * ff in the spinal fluid. 



240 COCA. 

Physiological Action. 

Coca is an aromatic bitter tonic, a diuretic and a cerebral and nervous stimu- 
lant. Small doses improve digestion, stimulate respiration, increase the heart's 
action after a brief depression, raise the arterial tension, and increase the ex- 
citability of the sensory nerves. It stimulates the brain by increasing its blood- 
supply, producing wakefulness, a sense of well-being, and a marked diminu- 
tion of the senses of fatigue, hunger and thirst. Under its daily use a considerable 
amount of labor and loss of sleep can be borne without suffering. Though 
diuretic, it lessens the quantity of urea eliminated by checking the processes 
of waste. Large doses produce impaired coordination, hallucinations and de- 
lirium. 

Cocaine acts upon the lower animals similarly to Caffeine. It tetanizes 
frogs, and in large doses paralyzes their sensory nerves and the posterior columns 
of the spinal cord. It kills rabbits and dogs by paralysis of the respiratory 
centre. In proper doses it raises arterial tension by stimulating the vaso-motor 
centres and the cardiac motor system. An affect of cocaine, observed in mice, 
is a wide-spread destruction of the hepatic cells, which become vacuolated and 
frequently necrosed, and the liver is much enlarged and pale from fatty infil- 
tration. 

On man, in small doses Cocaine is a cerebral, cardiac, respiratory and 
nervous stimulant, a -vaso-constrictor, and a prompt diuretic. It improves di- 
gestion, stimulates respiration, increases the heart's action, raises the arterial 
tension and exalts the irritability of the sensory nerves. It stimulates the brain 
by increasing its blood-supply, producing wakefulness and marked diminu- 
tion of the senses of fatigue and hunger. Though decidedly diuretic, it lessens 
the quantity of urea by checking the processes of waste, thus acting as an in- 
direct nutrient, and enabling the body to maintain its energy on a lessened 
supply of food. It first decreases and then increases the cutaneous circulation, 
flushing the surface, exciting perspiration and a sense of heat, and raises the 
body-temperature. It dilates the pupil, both when locally applied and when 
taken internally, and stimulates intestinal peristalsis as well as the evacuation 
of the bladder in a few minutes after its ingestion. 

An overdose produces symptoms of cardiac and respiratory embarrassment 
in a very short time. The pulse, at first quick and forcible, becomes small, 
rapid and intermitting, the heart apparently standing still in systole once in 
every 10 or 12 beats. Respiration is slow and shallow, and a sense of tightne.-- 
about the chest is often very marked ; the blood pressure falls, the skin becomes 
cold and clammy, and the subject is seized with a sense of impending dissolu- 
tion. Death occurs in animals by paralysis of the respiration, but in man a 
tetanoid spasm of the cardiac muscle seems to occur, which is equally danger- 
ous to life. Maurel has shown that, as the capillaries contract powerfully under 
the influence of cocaine, thromboses and embolisms, particularly pulmonary 
embolisms, capable of causing fatal accidents, may be produced thereby. It 



COCA. 241 

profoundly affects the leucocytes, which become spherical and rigid, increase 
in size, and no longer adhere to the walls of the vessels. Other symptoms 

are impairment of coordination, hallucinations and delirium. Lethal doses 
paralyze the intracardiac motor ganglia, the posterior columns of the cord, 
the sensory nerves, and the respiratory centre. 

In general action, Cocaine resembles Atropine very closely, especially in 
its influence upon the pulse and blood-pressure, the respiration, pupils, salivary 
glands, sweat-glands and intestinal peristalsis. In its symptoms, both from 
large and small doses it almost parallels Sparteine, another cardio-inhibitory 
depressant. It is the most complete antagonist to the effects of Morphine, 
stimulating the respiration, heart, vaso-motor system, general metabolism, the 
muscular system, and the psychic functions, increasing arterial pressure and the 
body temperature, all of which are profoundly depressed by morphine in the 
second and third stages of its toxic action. 

Several years ago, Satterwhite, as a result of the study of one hundred cases of poisoning 
by this alkaloid, called attention to the dangers attending the use of even very small doses, 
and at about the same time another author, after summarizing the records of fifty cases, made 
a similar announcement. A case is reported by Broughton in which unconsciousness, an 
irregular, slow respiration, and a slow pulse, followed the application of three minims of a 
twenty per cent, solution within the cavity of a tooth. Whistler, after the application of a 
four per cent, solution to the nasal cavity, noted vertigo and threatening syncope. In a case of 
glossitis, Ricket states that the patient became moribund after the use of a similar solution. 
Mvrtvle dropped three minims of a three per cent, solution into each eye, which immediately 
caused a sense of numbness in the back of the tongue and throat, palpitation, threatened syn- 
and nausea. Bettleheim records that in one case the hypodermic injection of one-sixth 
of a grain induced alarming symptoms; and in another, one-eighth of a grain similarly 
injected caused unconsciousness, congestion of the face, irregular breathing and trismus. 
Baker mentions a case in which one grain injected into the gums by a dentist produced death 
in a few minutes, and Hainel records the case of a man in whom the injection of 1$ grains was 
followed by a fatal result. 

As a Local Anesthetic the power of Cocaine is very great over a limited area. 
Applied to such structures as the Schneiderian membrane, and the mucous 
covering of the glans penis, or injected hypodermically in other locations, it 
blanches the structures and causes a profound but temporary anesthesia through- 
out a small space. Applied to the tongue it temporarily destroys both taste 
and tactile sensibility; to the ocular conjunctiva, it produces profound anes- 
thesia of that membrane, together with dilatation of the pupil, partial paralysis 
of accommodation, enlargement of the palpebral fissure, slight lachrymation, 
and sometimes temporary ptosis. This profound degree of anesthesia is thought 
by some to be caused by its paralyzing the terminal twigs of the sensory nerves, 
— by others to be due to vaso-motor stimulation rendering the nerves blood- 
less and therefore unable to transmit sensory impressions. It produces myd- 
riasis by stimulation of the ends of the sympathetic in the iris, but does not 
affect the third nerve or the sympathetic centre. 

As a General Anesthetic Cocaine is remarkably efficient when injected into 
the spinal canal. After the administration of gr. \ by this method complete 
anesthesia usually follows in the lower extremities within ten minutes, in the 
upper parts of the body within twenty or thirty minutes, and lasts from one to 



242 COCA. 

four hours, with no effect on consciousness. The after-effects in many cases 
include vertigo, headache, nausea and vomiting. This procedure is not free 
from danger, mental shock, circulatory disturbances, and profound collapse 
being frequently experienced, and death has occurred in several cases. Tropa- 
cocaine, in dose of about gr. f , is equally efficient and much less toxic, and is 
preferred for this purpose by many operators. 

The Cocaine-Habit. 

Cocainism, the Cocaine-habit is now presenting itself to observation, numerous instances 
of persons addicted to its excessive use being met with. Loss of digestive power, absolute 
insomnia, enfeeblement of the intellect, great emaciation, ascites, general marasmus, nausea, 
decay of the teeth, an excessively fetid breath, amblyopia, visual hallucinations and complete 
anorexia, form a consensus of symptoms which rival the worst effects of the opium habit. 
Peculiar hallucinations are characteristic of the action of cocaine. One patient was always 
scraping his tongue to extract from it little black worms; another made his skin raw in the 
endeavor to draw out cholera microbes; a third was constantly looking for crystals in his 
skin. Two of these subjects suffered from epileptic attacks and the third from cramps. 
(Magnan and Saury.) Some observers report the most extraordinary mental changes re- 
sulting from cocainism, exceeding those produced by any other drug. Intense selfishness, 
utter disregard of all social and domestic duties, the most debasing habits, complete destruc- 
tion of all noble qualities, and a general condition of depravity, are some of the results which 
are charged to this drug. The author's experience with a large number of such cases con- 
vinces him that a cocaine habitue who has used the drug daily for a month is practically an 
insane individual while under the influence of the drug; but that the mind soon resumes its 
normal condition after withdrawal thereof, which can be done, in nearly all cases, at once, 
without involving any great suffering. 

Many of the proprietary catarrh-snuffs contain cocaine, and their use may cause the 
cocaine-habit, which, however, is in most cases acquired by morphine habitues who go to 
cocaine in the expectation of finding help in their struggle against the tyranny of the former 
drug. In this hope, however, they are always disappointed when the drugs are in their 
own hands. The victim soon finds that one of these agents antagonizes the other to a great 
extent, while, at the same time, it sets up peculiar troubles of its own; and that there is a 
constant need of more morphine to counteract the cocaine-symptoms, and of more cocaine 
to antagonize the symptoms due to the increased amount of morphine. The result is that 
one who is using only a moderate daily amount of morphine, if cocaine be added will soon be 
using a very great amount of morphine, as well as of cocaine, and " the last state of that man is 
worse than the first." 

As the stimulant effect of a single hypodermic injection passes off very quickly, within 
about 15 or 20 minutes, the cocaine habitue is under the necessity of constantly injecting the 
drug, so that, as one expressed it, "I had no time to go home, — no time to do anything except 
to prepare and take one 'shot' after another." The effect of such repeated puncturing of the 
skin is very disastrous to that tissue, causing great induration and numerous sloughing sores. 

Therapeutics. 
Coca-leaves are chewed by the Peruvians for the purpose of sustaining 
them during arduous labors and long journeys, and are so highly esteemed as 
to be represented on their national coat-of-arms, the people using them much 
as we do tea, coffee or tobacco. This example was imitated by Weston, the 
pedestrian, who is said to have been detected chewing the coca-leaf during one 
of his protracted walks. Cocaine is a useful stimulant to the brain and the 
nervous system in many morbid conditions, particularly cerebral and spinal 
anemia, neurasthenia, melancholia, hysterical and hypochondriacal insanity, 
and in protracted mental depression with suicidal tendency. It may be em- 
ployed with benefit in wasting diseases to retard waste and to stimulate diges- 
tion, in convalescence from fevers and other acute maladies, and in migraine 



COCA. I ; 

and neuralgia due to depression of the nervous system. It is very beneficial 
in some eases of the vomiting of pregnancy, in stomatitis and gastralgia, and 
in functional impotence due to general atony of the system. 

A wine of the leaves is thought by singers and speakers to relieve hoarse 
ness, to make tense the vocal cords and to improve the timbre of the voice. 
Coca leaves may be smoked in cigars or cigarettes to obtain the exhilarating 
effects of the drug, and for the relief of asthma, hay-fever and many irritable 
throat affections. The Oleate of Cocaine is an efficient palliative application 
to painful hemorrhoids, fissures of the anus, burns, boils, and irritable ulcers; 
also in pruritus pudendi et ani and skin diseases attended with intolerable itch- 
ing. 

Cocaine Hydrochloride has achieved celebrity as a local anesthetic, and 
is of great value in many operations on the eye and ear, nasal passages, uterus 
and urethra. A 2 to 4 per cent, solution is brushed lightly over the mucous 
surface or injected into the urethral canal, the application being repeated within 
5 or 10 minutes if profound local anesthesia is required. After about fifteen 
minutes any superficial operation may be performed without giving the slight- 
est pain. It is used in the same manner with decided benefit in congestion 
of the nasal passages from acute catarrh and hay-fever; and is applied to the 
cervix uteri to relieve the first pains of labor, to the ear for tinnitus aurium, 
and by inhalation to strengthen the vocal cords, to relieve hoarseness and cough, 
and to improve the quality of the voice. It may be injected into the bladder 
before lithotrity, into the urethra before the passage of sounds or catheters 
or to relieve chordee, and it is an excellent application to the gums of teething 
infants. To be efficient it must reach the terminal filaments of the sensory 
nerves in sufficient concentration. Rhus poisoning, by either the oak or ivy, 
is promptly controlled by the application of a 5 per cent, solution or oleate, 
freely over the affected surface. It gives instant relief from the burning and 
itching, and speedily reduces the dermatitis. It is injected hypodermically 
around the prepuce to prevent pain during circumcision, into the vicinity of 
the supra-orbital and infraorbital foramina to cut short neuralgia of those nerves, 
into hemorrhoids previous to their ligation, and into the skin and the subcuta- 
neous tissues to produce local anesthesia in many minor operations. The 
conjoined use of Adrenalin with cocaine ("liij of the ordinary solution of ad- 
renalin chloride with r^xvij of a 1 per cent, solution of cocaine hydrochloride), 
diminishes the toxicity of the latter and increases its anesthetic power in dura- 
tion, intensity and area. 

The Infiltration Method of Schleich is the injection in quantity (up to 100 Cc.) of very 
dilute solutions (1 in 10,000, 1 in 1,000 and 1 in 500), at first superficially into the epidermis 
and then deeper, by long, fine needles, so as to produce a local edema over the field of opera- 
tions (see page 238 for the solutions used). The Intraneural Method is the injection of a 2 per 
cent, solution into the nerve-trunk supplying the region to be anesthetized, but this has pro- 
duced neuritis. The Paraneural Method is the injection of the same solution in the immediate 
vicinity of the nerve-trunk. 

The rapid accumulation of cases in which alarming symptoms followed the local applica- 
tion of small quantities of cocaine, together with the fact that these untoward effects are due 



244 



COCA. 



to individual idiosyncrasy and do not invariably occur immediately, is a positive warning to 
the profession that this powerful substance should not be used in any case for the first time 
without the proper antidotes at hand and the patient being kept under surveillance for 
at least a half hour. There seems to be no doubt that cocaine is absorbed with extraordinary 
rapidity and that the stronger the solution which is locally applied, the greater the danger of 
toxic symptoms, but whether the latter are to be attributed merely to the larger dose or to some 
obscure action, is not apparent. Falk has found that the rapidity of absorption varies in the 
different tissues — absorption taking place most rapidly through the conjunctiva, then in the 
following order: nose, larynx, mouth, and ear. 

For the purpose of general anesthesia without loss of consciousness the 
injection of Cocaine into the spinal canal was introduced by Corning in 1884, 
but received little attention at that time. It was revived fifteen years later 
by Bier, and has been employed by many surgeons in major operations on all 
parts of the body, also by physicians in cases of labor, for the cure of sciatica, 
and the relief of eclampsia. Unpleasant and even dangerous symptoms are 
occasionally experienced, but as a rule this method of producing anesthesia 
has given satisfaction to those who have used it. Ten or fifteen minims of a 
freshly made and sterilized solution (gr. \ to \) of Cocaine Hydrochloride, (or 
gr. |to T \of Tropacocaine Hydrochloride), are injected through a long needle 
inserted between the 2nd and 3rd or the 3rd and 4th lumbar vertebrae into 
the spinal subarachnoid space. A more recent method of preparing the injec- 
tion is to dissolve the proper quantity of the drug in the cerebro-spinal fluid 
which escapes from the needle. The maximum quantity of Cocaine is stated 
by Bier at gr. \, that of Tropacocaine gr. 4 (Schwarz), gr. y 9 -^ (Neugebauer) . 
Eucaine-B has been used alone, as well as in combination with cocaine, and 
is considered to be as efficient as the latter, and less toxic. Stovaine is equally 
efficient, much less toxic, and has the advantage over cocaine in being a vaso- 
dilator (see page 239). Complete anesthesia occurs in the lower extremities 
usually within ten minutes, in the upper parts of the body within twenty or 
thirty minutes, and lasts from one to four hours. During its continuance any 
surgical operation may be performed, with no sensation of pain being experienced 
by the patient, who is entirely conscious of his surroundings. 

Tuffier has reported 1,300 cases with only one death, Hahn 1,700 with 8 deaths, and 
Morton states that he has used this method in over 1,000 cases, 80 of which were for opera- 
tions above the diaphragm, including excision of the tongue and the maxillary bones. Murphy 
reports 631 cases, in 21 of which the injection failed of effect. Tropacocaine was used by 
Schwarz in 100 cases, by Kopfstein in 40, by Neugebauer in 60 cases, and is preferred to 
cocaine or eucaine by Morton, Kozlowski, and Schwarz. 

As a mydriatic for ophthalmological use, Cocaine has peculiar qualities 
which make it one of the most serviceable agents of the class. The dilatation 
produced by it is great, is quickly attained, lasts only 12 to 20 hours, is promptly 
overcome by physostigmine, and is not accompanied by much photophobia, 
due to the fact that the cocainized pupil is not rigidly dilated (as with atropine), 
but reacts to light. The accommodation, moreover, is greatly reduced, but 
not entirely paralyzed, and is quickly regained. 

As an antagonist Cocaine is of especial value in narcotic poisoning by chloral 
or opiates, where depression of the cardiac and respiratory centres exists. It 



COCCI S CO! CHIC1 M. 245 

is the most complete antagonist to morphine (see page 241)1 bul has no value 
in the treatment of morphine addiction except to antagonize certain heart symp- 
toms, for which purpose it should be administered only by the physician in 
charge of the case; but never as a regular remedy, at regular intervals of time, 
even by him. It is indicated in chronic depressant poisoning from the bro 
mides, and in spinal paralyses, in which it has all the advantages of strychnine 
without its poisonous character. 

COCCUS, Cochineal, — is the dried female insect, Pseudococcus cacti, nal. ord. Hemiptera, 
which feeds on the cactus plants of Mexico and Central America. It is of ovate, plano- 
convex form, of a purple-gray or purple-black color, yielding when crushed a dark-red powder, 
which contains Carminic Acid, or Carmine, the red coloring-matter, which is soluble in water 
and in alcohol, but not in oils. Cochineal is an ingredient of Tinctura Cardamomi Composita, 
and is used in pharmacy solely as a coloring material. 

The only therapeutic use of Cochineal is in whooping-cough and neuralgia, in which 
affections it is supposed to have considerable influence, especially in the former. Its dose for 
an infant is about gr. j\ thrice daily. 

COLCHICUM, Meadow Saffron, — is the corm and seed of the Cohhicum 
autumnale, a European plant of the nat. ord. Liliacea;. It contains an intensely 
bitter, poisonous alkaloid, Colchicine, C 22 H 25 N0 6 , which by the action of acetic 
and mineral acids is converted into Colchiceine and a resin; also tannic and 
gallic acids, resin, starch, sugar, etc. It is official in two forms, namely — 

Colchici Cormus, Colchicum Corm, — the dried corm, about an inch long, 
white internally, grooved on one side, inodorous, taste sweetish, bitter and 
acrid. Is less active than the seed. Dose, gr. ij-viij [av. gr. iv.J 

Colchici Semen, Colchicum Seed, — about ^ inch thick, sub-globular, 
resembling black mustard seed but larger, very hard and tough, inodorous, of 
bitter and acrid taste. Dose, gr. j-v [av. gr. iij.] 

Preparations. 

Extractum Colchici Cormi, Extract 0/ Colchicum Corm, — made with Acetic Acid 
35 parts to 100 of the root, and sufficient water. Dose, gr. J- ij [av. gr. j.] 

Fluidextractum Colchici Seminis, Fluidextract of Colchicum Seed. Dose, ffjjj-v [av. 
IRiij] 

Vinum Colchici Seminis, Wine of Colchicum Seed, 10 per cent. Dose, T3}x-5j [av. 

Tinctura Colchici Seminis, Tincture of C. Seed, 10 per cent. Dose, njx- 5j [av. njfxxx.] 

Colchicina, Colchicine, — a white or yellowish, amorphous powder, of saffron-like odor 
and bitter taste, soluble in water and in alcohol. Dose, gr. t 'j-j- - [av. gr. xls-l I s suitable for 
hypodermic injection. 

Colchicine Salicylate (Unofficial), — is marketed in capsules, each capsule containing 
Colchicine, gr. t,^„ and natural Methyl Salicylate (Oil of Wintergreen), gr. iij. Dose, 1 
capsule every 2 hours, up to 10 or 15 daily. 

Laborde and Houde condemn all preparations made with acetic acid, also those made 
from the tubers and all wines. The best preparation is Colchicine, in granules or in a wine; 
or a strong tincture made from fresh seed with the shell on, the latter containing a very volatile 
but active oil. Of this seed oj to \ pint of highest proof alcohol, standing for 2 weeks. Of 
this 5v to water q. s. ad Oi, of which the dose is oss every 4 hours night and day, avoiding 
acids, until nausea, vomiting and purging set in. 

Incompatible with Colchicine are: Acids, Alkalies, and the Alkaloidal prccipitants (see 
page 5). 



246 colocynthis. 

Physiological Action and Therapeutics. 

Colchicum is emetic, diuretic and diaphoretic, a drastic purgative, a gastro- 
intestinal irritant and a cardiac depressant. In small doses it increases secre- 
tion, especially the urine and the sweat. In full doses its action is emeto-cathar- 
tic , producing profuse watery discharges, great nausea and extreme muscular 
feebleness. In large doses it is a powerful irritant of the gastro-intestinal tract, 
causing severe griping, choleraic discharges, lowered arterial tension and de- 
pression of the heart by reflex action over the distribution of the pneumo- 
gastric, — then great prostration, convulsions and collapse, death occurring from 
exhaustion, with consciousness preserved until carbonic acid narcosis sets in. 
The extent of its influence on the excretion of uric acid and urea is very much 
disputed, but it probably increases the flow of bile, and certainly unloads the 
portal circulation. 

Colchicum is a specific palliative in acute gout, in which it should be given 
with an alkali, and kept short of emeto-catharsis. It does not prevent relapses, 
and its power in this disorder is weakened by repetition. In ascites from ob- 
structive disease of the liver it is most effective, given in full doses to establish 
a profuse drain, with opium to sustain the heart. In acute cerebral congestion 
and in portal congestions it is well given as a drastic purgative. It is often 
used with marked success in acute rheumatism, but frequently fails, and in 
no case should it be continued long in this affection. It has given good results 
in the treatment of gonorrhea and chordee. The alkaloid is probably the 
best preparation for general use, and is admittedly superior to the other prep- 
arations in gout. The preparation known as Colchicine Salicylate is a solu- 
tion of colchicine in oil of wintergreen. It should prove to be a reliable remedy 
for gout and rheumatism, and also for many disorders in which the rheumatic 
diathesis is a factor. 

COLOCYNTHIS, Colocynth — is. the dried fruit of Citrullus Colocynthis, 
deprived of its rind. The plant is a native of Spain and Asiatic Turkey and 
belongs to the nat. ord. Cucurbitaceae. The fruit is of the size of a small orange 
white, light, spongy, inodorous, very bitter, containing many flat, brown seeds 
which should be rejected before the pulp is used. Its active principle is Colo- 
cynthin, C 56 H 84 23 , an amorphous but crystallizable bitter glucoside, readily 
soluble in water. It also contains Colocynthein^ a resin, and Colocynthitin, a 
tasteless, crystalline powder, soluble in ether but not in water, and devoid of 
purgative action. Dose, gr. ss-jss [av. gr. j.] 

Preparations. 
Extractum Colocynthidis, Extract 0} Colocynth. — Dose, gr. J-j [av. gr. ss.] 
Extractum Colocynthidis Compositum, Compound Extract 0} Colocynth, — contains 

of the preceding 16 parts, Aloes 50, Cardamom 6, Resin of Scammony 14, Soap 14, Alcohol 

10. Dose, gr. v-xx [av. gr. vijss.] 

Pilulae Catharticae Composites, Compound Cathartic Pills, — have of the preceding 8, 

Calomel 6, Resin of Jalap 2, Gamboge ii, Water to make 100 pills. Dose, j-iij [a v. ij pills.] 



CONll If. 247 

Pilulae Catharticas Vegetabiles, Vegetable Catharti Pills, — have of Compound Extract 
of Colocynth 6 Extract of Hyoscyamus 3, Resin of Jalap 2, Extract of Leptandra 1 \, Resin of 
Podophyllum ii, Oil of Peppermint 0.8, Water to make 100 pills. Dose, j-iij pills [av. ij.] 

Laville's Anti-Gout Remedy, — is a proprietary medicine prepared in France and pur- 
porting to be "a mixture of prepared Kino-colocynthinc." The published formula is as 
follows: Active principle of Colocynth 2 J, Quinine and Cinchonine 5, Spanish Wine Soo, 
AKohol 100, Water to 1000 parts; but there is good reason for believing that it contains Colchi- 
cine instead of Colocynthin. 

Incompatiblcs. 

Incompatible with Colocynth are: Alkalies, Ferrous Sulphate, Lead Sulphate, Lime- 
water, Mercuric Chloride, Silver Nitrate. 

Colocynth is classed among the tonic-astringent and resin-bearing pur- 
gatives. In moderate doses it increases peristalsis and the intestinal glandular 
secretions, producing bilious, watery evacuations with much colicky, griping 
pain. Its purgative action is specific, and may be obtained by its application 
to the skin over the abdomen. In large doses it is a violent irritant of the gastro- 
intestinal tract, and has frequently produced fatal gastro-enteritis. It is popularly 
supposed to be abortifacient, but this is true only of quantities sufficient to en- 
danger life. It is an indirect diuretic. 

Colocynth is too severe an agent to be administered alone for constipation, 
but it makes a useful factor in compound purgatives, as the compound cathartic 
pills. In cerebral congestion it may be used to produce rapid derivation, and 
in ascites to set up a profuse drain from the intestinal canal. In certain cases 
of chlorotic amenorrhea it stimulates the pelvic nerves and vessels with excel- 
lent results. There seems to be abundant evidence that in very small doses, 
n\, t Vj _ tV °f a tincture, Colocynth is an efficient remedy in colic, sciatica, ovarian 
and other neuralgias, as well as in the pain of glaucoma. These actions may 
be due to its two non-purgative principles, which may prove to possess powers 
not heretofore suspected, an example of which is seen in the cardiac influence 
of Convallaria, a drug which was formerly known only as a purgative and a 
diuretic. 



CONIUM, Hemlock, — is the full-grown, unripe fruit, of Conium macu- 
lalitm, the spotted hemlock, nat. ord. Umbelliferae. It contains 3 alkaloids, 
Confine, C 8 H 15 N, liquid and volatile, Methyl-coniine, C 8 H 14 NCH 3 , and Con- 
hydrine, C 8 H I7 NO, solid and volatilizable; also coniic acid and a volatile oil. 
Paraconiine is an artificial substance produced by the reaction between butyric 
aldehyde and an alcoholic solution of ammonia, and is isomeric with conii'ne 
but not identical with it. Dose, gr. j-v [av. gr. iij.] 

Fluidextractum Conii, Fluidextract oj Conium, — Dose, njjj-x or more [av. njjiij.] 

Coniina, Conii'ne, C 8 H 15 N (Unofficial), — an oily, limpid, volatile liquid, of acrid taste, 
alkaline reaction, and an odor comparable to that of the urine of mice. It is quickly decom- 
posed by heat, and if exposed to the air soon becomes inert. Dose, gr. ,,'(, — iV, or in minim 

3 - IP. ,',7-ij. Is too irritant for hypodermic use, unless carefully neutralized by acetic 
acid. The Hydrobromide in watery solution of gr. viij to the o, of this ttjjx = gr. \, is a good 
form for subcutaneous or stomachal administration, and may be given in doses of gr. ,'.,- to 
gr. j, as it is not actively toxic. • 



248 CONTUMi 

All the preparations of Conium are uncertain in action, as the active principle is very 
volatile. Any specimen must be carefully tested before deciding on its dosage, and if the 
polerful mouse-like odor of the drug is absent, the preparation is probably worthless. 

Incompatibles. 
Incompatible with Conium are: Vegetable Acids, Alkalies, Tannic Acid; with Coniine 
arc: Albumin, Aluminum salts, Alkaloidal precipitants (see page 5), Chromic Trioxide; Cop- 
per, Iron, Manganese, and Zinc salts. Physiologically incompatible are: Nux Vomica and 
its alkaloids, also Picrotoxin, and other tetanizers. 

Physiological Action and Therapeutics. 

The action of Conium is that of its principal alkaloid Coniine, which causes 
motor paralysis without loss of sensation or consciousness. It progressively 
paralyzes the motor nerves, the action commencing at the peripheral end-organs 
and extending upward, involving the nerve-trunks and finally the centres, but 
the muscular irritability remains unaffected. Methyl-conii'ne, on the contrary, 
stimulates the spinal cord, and produces the convulsions often seen in conium- 
poisoning. The sensory nerves are slightly affected, and the general sensi- 
bility is impaired, a feeling of numbness being experienced in the extremities. 

Gastric irritation is usually the first sensation produced by a full dose of 
Conium, nausea and vomiting being its symptoms. Then occur weakness of 
the legs, numbness and fatigue, drooping eyelids, diplopia, slightly dilated pupils, 
vertigo, impaired utterance, slow and labored breathing, and if the dose be 
lethal, paralysis of the voluntary muscles occurs, those of the lower limbs being 
first affected; speech and vision are lost, and finally death occurs from paralysis 
of the muscles of respiration. The heart is not affected and the mind remains 
clear but torpid and indifferent, until carbonic acid narcosis sets in. Muscular 
movement counteracts the effects of the drug to a great extent. 

Conium is believed to have been the state poison of the Athenians, by the 
juice of which Socrates and Phocion died. It is closely allied in its physio- 
logical action to Curare. 

Conium is indicated in diseases characterized by excessive motor activity. 
Large doses are required, as some physiological action is necessary. Children 
bear it well, their constant activity preventing its full action. In chorea and 
paralysis agitans it palliates, by depressing the motor nervous system. In 
acute mania and delirium tremens, to quiet motor excitement and prevent ex- 
haustion, it is remarkably efficient, especially when given conjointly with mor- 
phine. When pain and spasm are present, it will prove a useful agent; and 
in tetanus, blepharospasm, asthma, whooping-cough, and other spasmodic affec- 
tions it is frequently used with great benefit. The pain of cancer seems to be 
especially amenable to its influence when locally applied, and Coniine vapor 
is an admirable palliative of the tickling cough of phthisis and the irritability 
of the air-passages in acute bronchitis. In pneumonia and pleurisy the hypo- 
dermic use of Coniine to afford the organs rest by inducing a paretic state of 
the respiratory muscles has been followed by a marked decrease in the tem- 
perature and pulse-rate. 



cow U i um. • |i, 

CONVALLARIA, - is the dried rhizome and roots of Convallaria majalis, 
Lily of the valley, a stemless perennial of the nat. ord. Liliaceae, indigenous 

to Europe, northern Asia and the southeastern portion of the United States 
The preparations in the market vary in action, according to the quantity of the 
resin present, it being emeto-cathartic. Convallaria contains two glucosides, 
namely — Convallamarin, on whidi the cardiac action depends, and Convallarin, 
a crystalline, purgative principle, insoluble in water; also an acrid Resin which 
probably contains the latter glucoside. Dose, gr. ij-x [av. gr. vijss.] 

Preparations. 

Fluidextractum Convallarise, Fluidcxlract of Convallaria, — is the only official prepara- 
tion, and probably contains Convallarin, which is not present in aqueous preparations, being 
insoluble in water. Dose, nj>ij-x [av. gr. viij.] 

Extractum Convallarias, Extract of Convallaria, (Unofficial), — from the flowers and 
stalks with J of the leaves and root; is freely soluble in water and in alcohol. Dose, gr. ij-.xxx. 

Infusum Convallariae, Infusion of Convallaria, (Unofficial), — prepared from the 
flowers, leaves and stems 25 parts, in water 75. Dose, oss-ij. 

Convallamarinum, Convallamarin, C 23 H J4 Oi 2 (Unofficial), — an amorphous, white, 
hitter powder, freely soluble in water and in alcohol. Dose, gr. \-i). 

Physiological Action. 

Convallaria has long been known as a decided cathartic and a prompt and 
powerful diuretic, but its cardiac action has excited attention, and it is con- 
sidered a close analogue of Digitalis, while free from the so-called cumulative 
action which makes the latter drug so frequently a dangerous remedy. Prepa- 
rations of the root are powerfully emeto-cathartic, probably due to a preponder- 
ance of the resin. Those freed from this ingredient correspond in action to 
Convallamarin, stimulate the appetite without impairing digestion, increase peri- 
stalsis without producing catharsis, slow the heart and raise the arterial ten- 
sion, also slowing and deepening respiration. Lethal doses at first produce 
irregularity of the cardiac action and spasm of the respiratory muscles, high 
arterial tension and a very rapid pulse, — followed by lowered blood-pressure, 
very slow 7 and deep breathing, and finally arrest of the heart in systole. Its 
mode of action is by direct stimulation of the pneumogastric, the motor and 
sensory nerves retain their irritability, the muscles preserve their contractility, 
the cerebral functions and the pupil are unaffected. 

Convallarin is a drastic purgative in 3-grain doses. Convallamarin is an 
emetic even in small quantity, and the powdered root is sternutatory. 

Therapeutics. 
Convallaria is a heart-tonic like Digitalis, and is indicated in the same class 
of cases as the latter drug, with the advantage that having no cumulative action 
it is not dangerous to the heart in medicinal doses, and does not disturb the 
stomach or the functions of the cerebro-spinal axis. In doses of gr. xv-xxv 
of the extract it slows the action of the heart and increases the force of its con- 



250 COPAIBA. 

tractions, raises arterial tension, augments the force and volume of the respi- 
ration, and produces prompt diuresis without altering the composition of the 
urine. It is often a valuable remedy in mitral stenosis or insufficiency with 
venous stasis, dilatation of the heart, palpitation, vehement cardiac action or 
disordered rhythm, and in all valvular affections accompanied by dropsy and 
a weak heart. It has been used with benefit in pneumonia, typhoid fever, and 
renal dropsy. Its action is maintained for several days after its administration 
has been suspended. 



COPAIBA, Copaiba, — is an oleoresin derived from one or more South 
American species of Copaiba, nat. ord. Leguminosse, growing chiefly in the 
valley of the Amazon. It is a translucent, viscid liquid, of yellow color, aro- 
matic odor, acrid and bitter taste, sometimes fluorescent, soluble in alcohol, 
ether and chloroform. It is not a balsam as it contains no cinnamic acid. Its 
constituents are a Volatile Oil and a Resin in about equal proportions, the latter 
containing nearly 99 per cent, of Copaibic Acid. Dose, nix-xxx [av. n^xv.] 

Preparations. 

Oleum Copaibae, Oil oj Copaiba, C 10 H 16 , — a pale yellow liquid, of sp. gr. 0.895, bitter 
taste and neutral reaction, soluble in 2 volumes of alcohol. Dose, irgv-xv [av. njviij.] 

Mistura Copaibae Composita, Compound Copaiba Mixture, Lafayette Mixture (Un- 
official). — 1$. Copaiba? oj, Spiritus Athens Nitrosi oj, Liq. Potassas oij- Mix with 
constant stirring, then add: Tinct. Lavandulae Co. oj, Syrupi §ijss, Mucil. Dextrini (N. 
F.) q. s. ad oviij. Mix the whole thoroughly by shaking. Of this each o contains njvijss 
of Copaiba {National Formulary). Dose, 5j-iv. 

Incompatibles. 

Incompatible with Copaiba are: Mineral Acids, Caustic Alkalies, Calcium Hydrate, 
Magnesia, Water. 

Physiological Action and Therapeutics. 

Copaiba is a stimulant diuretic, diaphoretic, expectorant, and a gastro- 
intestinal irritant. Its taste is bitter and nauseous. In the stomach it causes 
heat, eructations, heaviness, frequently anorexia and diarrhea and if continued 
for any length of time gastro-intestinal catarrh and desquamative nephritis may 
result. The oil and resin diffuse into the blood and are excreted by the bron- 
chial mucous membrane, skin and kidneys, producing increased secretion at 
the points of elimination. The various secretions have the odor of the drug, 
especially the urine. In medium doses it increases the quantity of urine and 
its solid constituents, but large doses will cause scanty urine, containing albumin, 
casts and blood, with pain in the loins and other signs of renal congestion. On 
the skin it often produces itching and several forms of eruption. 

Copaiba has been largely used in gonorrhea after the acute symptoms have 
subsided, also in chronic cystitis, acute and chronic bronchitis, and in dropsies, 
particularly ascites. In all these affections it is a useful remedy, but its nauseous 
taste and irritant effects on the stomach are driving it out of fashion, especially 



COR] WHKI \i CRE0S0T1 If, 25 i 

iii private practice. One eminent surgeon declares not only thai it is useless in 
gonorrhea hut that it does more harm than good, often prolonging the disease 

beyond its natural limit. In psoriasis and urticaria, and in cutaneous affections 
characterized by torpid peripheral circulation, this drug has been administered 
internally with excellent results. In long-standing cystitis in the female Copaiba 
has been injected into the bladder with great benefit. The resin is the most 
active ingredient, especially for diuretic purposes. 

CORIANDRUM, Coriander, — is the fruit of Coriandrum sativum, a plant of the nut. 
ord. (JmbeUiferae. It contains a volatile and a fixed oil. Dose, gr. v-xx [av. gr. viijss.] 

Oleum Coriandri, Oil oj Coriander, — a volatile oil distilled from Coriander. A color- 
less liquid, of aromatic, hitter and pungent taste; soluble in 3 volumes of alcohol, forming a 
slightly turbid liquid neutral to litmus paper. Dose, njjij-v [av. njiij.] 

Coriander is stimulant, aromatic and carminative. It is used almost wholly as a flavor- 
ing to other remedies, or as a corrective against the griping effects of certain purgatives. Its 
flavor covers the taste of Senna and Rhubarb, and it is an ingredient of the official Confectio 
Senna. 

CORNUS, Dog-wood (Unofficial), — is the bark of the root of Cornus florida, a small 
tree of the nat. ord. Cornacca?, indigenous to the U. S. It contains a bitter principle named 
Cornin, which is crystallizable and soluble in water and in alcohol; also a resin and tannic acid. 

Cornus is a simple bitter, having stomachic and other qualities similar to those of Ca- 
lumba (which see). In addition it is possessed of considerable antiperiodic power, and has a 
good deal of reputation in the Southern States as a remedy in malarial fever, the physicians 
of that section considering it as next to quinine in efficiency. Heat destroys its active prin- 
ciple, consequently a decoction is a useless preparation. A fluidextract is on the market, 
the dose of which is njx- 5j- 

COTO, Coto Bark (Unofficial), — is the bark of some unknown tree growing in Bolivia. 
It contains an acrid, bitter principle, of yellow color, crystalline and soluble in hot water and 
in alcohol, named Coioin, C 2 2H 1S 8 ; also Piperonylic Acid, C s H 6 4 , and a volatile oil, resin, 
etc., but no tannin. Dose, gr. j-xv. 

Paracoto Bark, False Coto. — Its principle, Paracotoin, C 19 H ]2 O e , has a strong similarity 
to Cotoin therapeutically, but is less active. 

A fluidextract of the official strength is prepared, also a tincture (10 per cent.), which may 
be administered in doses of from ngj-xx. Cotoin is used in doses of gr. j-iv, and Paracotoin 
in somewhat larger quantities. 

The physiological action of Coto has not been studied, all that is known about it being 
that it is decidedly irritant to the skin and mucous membranes. After its internal adminis- 
tration the urine takes a dark-red color with nitric acid. Ferric Chloride blackens a dilute 
solution of Cotoin, but has no reaction with Paracotoin. 

The bark and both principles are highly recommended in diarrheas of various forms, 
especially those of phthisis, typhoid fever, and cholera. In Asiatic cholera Paracotoin has 
been used hypodermically in 3-grain doses with success. When there is any tendency to 
acute inflammation of the gastro-intestinal tract this agent must be used with caution. Small 
doses of the tincture (trjn'-v) are said to be very effective in the diarrhea of children. 

CREOSOTUM, Creosote, — is a mixture of phenols and phenol derivatives, 
chiefly Guaiacol and Creosol, obtained during the distillation of wood-tar, pref- 
erably that derived from the beech. It occurs as an almost colorless, or pink- 
ish, inflammable, oily liquid, of smoky odor, caustic taste, and neutral reaction; 
soluble in about 150 of water, and in all proportions in absolute alcohol, ether, 
chloroform, carbon disulphide, acetic acid, and fixed and volatile oils. It does 



252 CREOSOTUM. 

not coagulate albumin or collodion though Phenol does. It was named from 
its remarkable preservative power over meat (xpiac, flesh, otbteix, to preserve). 
Much of the commercial Creosote is an impure phenol, or a heavy oil distilled 
from coal-tar and containing phenol and cresyhc acid. Dose n\j-v [av. "liij] 
well diluted, in wine or whisky. Morson's beechwood creosote is the best for 
internal use. 

Aqua Creosoti, Creosote Water, — is a 1 per cent, solution, containing nearly 5 minims 
of Creosote in each fluid-ounce. Dose, 5j-5j[av. 5ij] 

Guaiacol, Guaiacol, C 7 H s 2 , — is one of the chief constituents of Creosote, and is pre- 
pared synthetically from catechol. It occurs as a colorless solid or liquid, of agreeable and 
aromatic odor, soluble in alcohol, ether, acetic acid and glycerin. Dose, njjv-xv [av. ttRviij], 
in capsule, pill, or whisky. 

Guaiacolis Carbonas, Guaiacol Carbonate, (Duotal), — occurs as an almost tasteless 
and odorless, white, crystalline powder insoluble in water. Dose, gr. v-xx or more [av. 
gr. xv], gradually increased to a maximum of ojss per diem. 

Unofficial Derivatives. 

Creosoti Carbonas, Creosote Carbonate, Creosotal, — is a patented product, prepared 
directly from beech-wood creosote instead of guaiacol, and is analogous to guaiacol carbonate. 
It occurs as a thick, brownish, inodorous oil, insoluble in water. Dose, tijjv-xx or more, 
gradually increased to a maximum of 90 minims per diem. 

Benzosolum, Benzosol, Benzoyl Guaiacol, — is prepared by heating Guaiacol with Ben- 
zoic Acid, and occurs in small, colorless, odorless, and almost tasteless crystals, practically 
insoluble in water. Contains 54 per cent, of Guaiacol. Dose, gr. v-xv. 

Guaialin, — is the benzoic acid ester 0} methylene-diguaiacol, and occurs as an odorless 
and almost tasteless greenish powder, which is said to contain Guaiacol 60 percent., Benzoin 
30 per cent., and Formaldehyde 7 per cent. Dose, gr. x-xv, up to ojss daily. 

Guaiaform, Geoform, — is a condensation product of Guaiacol and Formaldehyde, sol- 
uble in alcohol and in ether, insoluble in water, and claimed to contain over 95 per cent, of 
guaiacol. Dose, gr.x-xv. 

Thiocol, Potassium Guaiacol Sulphonate, — occurs as a white, micro-crystalline, odorless 
powder, readily soluble in water, and said to contain 60 per cent, of guaiacol. Dose, gr. vij- 
xxx, up to 5jss or even oiv daily. It may be used hypodermically. 

Incompatibles. 

Incompatible with Creosote or Guaiacol are: Acacia, Albumin, Nitric Acid, Oxidizers, 
also Cupric, Ferric, Gold and Silver salts. 

Physiological Action. 
Creosote is styptic, escharotic, antiseptic, anesthetic, expectorant, astrin- 
gent, and narcotic in overdose. Its action is practically the same as that of 
Phenol (see under that title), especially upon the nervous system, the heart, 
and the respiration; but it differs therefrom in not causing convulsions, and 
in increasing the coagulability of the blood, also in being much less toxic and 
in having a greater range of usefulness. It is rapidly absorbed and eliminated, 
its excretion occurring by the kidneys and the bronchial mucous membrane, 
which it stimulates, being quite a good expectorant. In small doses it seems 
to have a selective sedative influence on the terminal nerve-filaments in the 
gastric mucous membrane. In large doses it is a powerful poison, resembling 
Phenol in its symptoms, except that its nervous effects are even more marked. 



CREOSOTUM. 253 

It explodes when combined with silver oxide, unless previously diluted with an 
inert powder. 

Guaiacol, locally applied, is rapidly absorbed by the skin, and appears in 
the urine fifteen minutes after its application. Applied by painting it over 
the skin of the thigh, abdomen or chest, in quantity of 20 to 50 minims, it causes 
a rapid reduction of body temperature, and thereby the temperature in malarial 
fever, typhoid fever and pneumonia falls as much as 7 in the course of an hour 
or two, but soon rises again (Da Costa). This rapid antipyretic action is not 
accompanied by any marked disturbance of the nervous system or any signs 
of collapse, not even by a very profuse sweat, neither does there occur am- active 
chill, though slight chilliness is sometimes experienced. Guaiacol is said to 
be a powerful local anesthetic, equal in this respect to cocaine and much safer, 
as it can be injected in ten times larger doses without producing ill effects. For 
this purpose it is used in sterilized olive oil (1 in 10 or 20) hypodermically, and 
it is claimed that thereby perfect local anesthesia is obtained for the extraction 
of teeth, the removal of small tumors, and similar operations. Internally ad- 
ministered, the action of Guaiacol is similar to that of Phenol, and in overdose 
it may prove equally fatal. 

Therapeutics. 

Creosote, being a very complex substance of varying composition, has been 
almost entirely supplanted in therapeutics by Phenol for external use, and by 
Guaiacol for internal administration. As an astringent it has been employed 
in intestinal hemorrhage, gonorrhea and gleet, and generally in the same affec- 
tions as phenol. Externally it is a good application in eczema, pruritus, ulcers 
and scaly skin diseases, and it effectually relieves the pain of an exposed dental 
nerve if applied thereto. It is a good agent by inhalation in chronic bronchitis 
and gangrene of the lung, and it has been administered internally with decided 
benefit in abnormal fermentative processes in the stomach and intestines, in 
reflex nausea and vomiting, as from sea-sickness, and pregnancy; also as an 
aseptic expectorant in chronic basilar cavity, in which it seems to have greater 
efficacy than any other remedy, and in bronchitis, pneumonia, pulmonary gan- 
grene, carcinoma of the stomach, and diabetes. 

In pulmonary tuberculosis, when well borne by the stomach, and continued 
over a long period of time, it has probably proved more efficient than any other 
remedy. Its employment in this disease is based on the statement of Gutt- 
mann, that tubercle bacilli are destroyed by blood containing one part of creo- 
sote in 2000, and that even one-half that proportion arrests their development. 
This is denied by many observers, and later researches indicate that the good 
effects of this treatment are due to the formation of soluble compounds between 
the remedy and the toxic albuminous by-products of the tubercle bacillus, which 
are then eliminated from the blood. The commencing daily dose of Creosote 
or Guaiacol is 2 or 3 minims, largely diluted to prevent irritation, taken after 
meals, and increased by the addition of one minim daily until a maximum 



254 CREOSOTUM. 

daily dosage of 15 to 18 minims is reached, at which rate it should be continued 
for several months. Under this treatment cough is relieved, expectoration 
diminished, night-sweats are stopped, the fever is lowered, while body-weight 
and appetite are increased in most cases; and in many even the local conditions 
are decidedly improved, as shown by the physical signs. 

Creosote was advocated for phthisis by Reichenbach in 1833, and its use was revived by 
Houchard and Gimbert in 1877, since which time it has been tried and approved by a long 
list of authorities, including Jaccoud, Dujardin-Beaumetz, Dieulafoy, Germain See, Sommer- 
brodt, Von Brun, Guttmann, Douglas Powell, Burney Yeo, J. Solis-Cohen and many others, 
who all agree as to its utility, though differing as to its mode of action, its dosage, and the 
methods of administration. The number of cases dealt with by some of these observers is 
so considerable that there is at least strong prima jacie evidence in favor of this drug and its 
derivatives. Bouchard reported on 93 cases at first, and on more subsequently; Sommer- 
brodt's report included over 5,000 cases, treated during more than nine years; and Yon Brun 
dealt with 1,700 cases. Professor Sommerbrodt contends that it is possible to administer 
the quantity necessary to inhibit the growth of the bacilli, and believes that he did so in many 
cases. He had the most gratifying success with this medication, and states that the more 
creosote the patient could bear the better was the result. Of late years the tendency has been 
to administer Creosote or Guaiacol by hypodermic injection. Lepine uses creosote dissolved 
in oil, and finds that a much larger quantity can be used hypodermically than the stomach will 
tolerate. Picot injects a mixture of sterilized olive oil containing 1 per cent, of Iodoform and 
5 per cent, of Guaiacol, beginning with 1 Cc. of the mixture and increasing the dose to 3 Cc. 

Guaiacol is preferred by many for internal administration instead of creo- 
sote, being the principal ingredient of the latter, and of more definite chem- 
ical composition, though nearly or quite as irritant to the stomach. It may 
be given in mixture with wine or brandy, in capsules, or hypodermically in 
combination with cod-liver oil. When neither of these agents agrees with the 
patient, useful and efficient substitutes are their carbonates, known by the 
respective trade-names Duotal and Creosotal, in doses of 4 to 6 grains, gradu- 
ally increased to gjss per diem. These preparations are well borne as they do 
not irritate the gastric mucous membrane or disturb the digestion. Creosotal 
is highly recommended in acute pulmonary inflammations by many clinicians, 
especially in pneumonia. It has been used with asserted success in typhoid 
fever, and Duotal achieved much notoriety in the treatment of that disease, by 
reason of the claims made for it by Dr. Woodbridge as an abortive remedy, 
which have not been sustained by the experience of others. 

The antipyretic power of Guaiacol, when painted on the surface of the 
body, has been utilized in the treatment of several diseases accompanied by 
hyperpyrexia. In typhoid fever Montagnon applied 10 or 15 drops with a brush 
whenever the temperature exceeded 102 F. the application being followed by 
a profuse perspiration, the temperature fell, and in a few hours a large quantity 
of urine was passed. The action lasted about two hours, and the treatment 
was renewed about every three or four hours with excellent results, none of 
the patients suffering a relapse. Similar results have been obtained in the py- 
rexia of malarial fever and pneumonia, and this employment of the drug is 
claimed to promote the absorption of pleuritic effusions in a remarkable man- 
ner. Only pure guaiacol should be used, as an inferior quality produces a very 
grave cutaneous irritation. By other clinicians it is mixed with glycerin before 



CROCl S CI Bl B \- 255 

application, in the proportion of 1 pari to 8 of the latter, or even in equal quan 
tiiy, and it is claimed that thereby no inconvenience is experienced. This 
application of Guaiacol is also decidedly anesthetic in effect, and has been util- 
ized in orchitis, epididymitis, torticollis, neuralgic headache, labor-pains, the 

chest-pains of tuberculous subjects, tooth-ache, sciatica, rheumatism, and other 
painful affections. In laryngeal tuberculosis the application of a 20 per cent, 
solution at first, gradually increased to full strength, has given very great satis 
taction. 

Benzosol contains Guaiacol in the proportion of 54 per cent. In the intes- 
tinal canal the latter is probably set free by the action of the alkaline secretions, 
as benzosol is excreted by the urine in the form of guaiacol and benzoic acid 
combinations. Compared with guaiacol, this agent has the advantage of be- 
ing almost tasteless; hence it can be given in large doses without the digestive 
disturbance and disagreeable eructations produced by the parent substance 
when administered in liquids, and without the local irritant effect caused by the 
latter in capsules. In doses of 4 grains, gradually increased to 12 grains, thrice 
daily, it is said to have given as good results as creosote in the treatment of pul- 
monary tuberculosis. 

Thiocol is more palatable than the other preparations of creosote or guaiacol, 
and can be administered by the mouth or hypodermically in full dosage. It 
is said to be non-toxic and readily assimilated, to cause no injurious effect on 
the blood, and to produce a striking increase in the body weight. It is used 
with benefit in diarrhea, pneumonia, and all forms of tuberculosis. 



CROCUS, Saffron (Unofficial), — The stigmas of Crocus salivas, a plant of the nat. ord 
Irideoe, cultivated in Europe, containing a volatile oil and coloring matter. So-called American 
Saffron is not Crocus but the flowers of Carlhamus tinctorius. True Saffron is expensive, as it 
requires about 60,000 flowers to furnish one pound of the stigmas. Dose, gr. v-xx, in infusion. 

Saffron Tea, much used in domestic practice, is an infusion of Carthamus tinctorius, the 
Safflower. 

Crocus is a stimulant aromatic, having some antispasmodic and anodyne qualities. The 
hot infusion produces diaphoresis, probably by virtue of the hot water alone. It is said to 
have caused death with narcotic symptoms. On the continent of Europe it is employed as a 
stimulant and emmenagogue, but in this country its only use is as a coloring agent. The mis- 
called Saffron Tea noted above is used in domestic practice for measles and other exanthemata. 



CUBEBA, Cubeb, — is the dried unripe but fully-grown fruit of Piper Citbeba, 
a plant of the nat. ord. Piperaceae, cultivated in Java. It contains a Volatile 
Oil, which is official, an acrid resin composed in part of Cubebic Acid, also a 
fatty oil, gum, and Cubebin, which is an insoluble, neutral, odorless and taste- 
less body. The volatile oil may be separated into Cubebene a camphor, and 
Cubeben a liquid portion. The active principles are the volatile oil and cubebic 
acid, both of which are contained in the oleoresin. Cubeb should be kept whole 
and not pulverized until wanted for use. Dose of the powdered drug, gr. x- 
5j [av. gr. xv.] 



256 CUNDURANGO — CUPRUM. 

Preparations. 
Fluidextractum Cubebae, Fluidextract oj Cubeb. Dose, ngv-xxx [av. njxv.] 

Oleoresina Cubebae, Oleoresin oj Cubeb, — extracted by alcohol. Dose, ign-xx [av 
igjvijss.] 

Trochisci Cubebae, Troches oj Cubeb, — each contains of the Oleoresin 2, Oil of Sassafras 
1, Extract of Glycyrrhiza 25, Acacia 12, and Syrup of Tolu q.s. to form 100 troches. Dose, j-iij. 

Oleum Cubebae, Oil oj Cubeb, — is the volatile oil, a colorless or pale greenish-yellow 
liquid, warm, aromatic taste, odor of cubeb and neutral reaction. Is soluble in an equal 
volume of alcohol. Dose, ttjjv-xx [av. irjjviij.] 

Cubeb belongs to the pepper family, and like black pepper is an aromatic 
stomachic and a stimulant diuretic in small or medium doses, but large doses 
derange digestion and may act as a gastro-intestinal irritant. Its constituents 
are eliminated by the bronchial mucous membrane, the skin and the kidneys, 
stimulating and disinfecting the genito-urinary passages, increasing the bron- 
chial mucus, sweat and urine, and frequently causing an urticarial or vesicular 
eruption. It increases the action of the heart and the vascular system, stimu- 
lates the venereal appetite, and promotes the menstrual discharge. 

Cubeb is particularly useful in affections of the bladder and urethra. It 
is used in the acute stage of gonorrhea, in chronic cystitis, prostatorrhea and 
chronic bronchitis with excellent results. The powder is a good application 
in hay-fever, chronic nasal catarrh and follicular pharyngitis, blown on to the 
mucous membrane by an insufflator. It may also be smoked in cigarettes 
with temporary relief in cases of acute nasal catarrh with "stuffed" nasal pas- 
sages. In some subjects the continued use of cubeb produces nausea, hem- 
orrhoids, hematuria, and severe headache. The troches are a useful prepara- 
tion in chronic irritability of the fauces, pharynx and air-passages, and are much 
employed by singers and public speakers for their tonic effect on these parts 
and for the relief or prevention of hoarseness. 



CUNDURANGO, Condurango, (Unofficial), — is the bark of Gonobulus Condorango, 
nat. ord. Asclepiadeae, a native of Columbia and Ecuador. A fluidextract is on the market, 
the dose of which is itjjxx- 5 j, or more. 

Cundurango is an astringent bitter, also a stomachic tonic and sedative. In South 
America it is employed as an alterative remedy in syphilis, and at one time it was supposed 
to be curative in gastric ulcer, in which its only value is as a sedative to the gastric mucous 
membrane, relieving the vomiting, pain, and bleeding. It is efficiently used for the relief 
of catarrh and hyperesthesia of the stomach. Its active principles are two glucosides, which 
in dogs cause ataxia and incoordination, increased motor activity, and finally convulsions, 
death occurring after 12 to 72 hours. 



CUPRUM, Copper, Cu, — is widely distributed in nature, and exists in 
minute quantity in many articles of food, also in the human body, especially 
in the blood, the liver, and the brain. Though its salts are actively poisonous, 
the metal itself is inert, but is oxidized and dissolved by fruit acids and salt 
water, hence the danger of using copper vessels for some cooking purposes. 
The Sulphate is the only official salt. 



ITPKUM. 257 

Suits and Preparations of Copper. 

Cupri Sulphas, Copper Sulphate, CuS0 4 + 5H 3 0, — blue, translucent crystals, i-fllor- 
escent, of nauseous, metallic taste and acid rea< tion, very soluble in water, soluble in 400 of 
alcohol. Its solution is blue by transmitted light, green by reflected light. Dose, as an emetic, 
gr. ij-v [av. gr. iv.] every 10 or 15 minutes, — as an astringent, gr. §-$ [av. gr. ',.] 

Alkaline Cupric Tartrate Volumetric Solution, Fchling's Solution, — the official re- 
agent for glucose, is prepared as follows: (1) Dissolve 34.64 grammes of pure Cupric Sul- 
phate in water, to measure exactly 500 cubic centimeters. (2) Dissolve 173 grammes of 
Potassium and Sodium Tartrate and 75 grammes of Potassium Hydroxide in water to measure 
exactly 500 cubic centimeters. Keep the two solutions in small, rubber-stoppered bottles, 
separate; and for use, mix exactly equal volumes of the two at the time required. One cubic 
centimeter of the mixed solution reduces 0.005 gramme (gr. T l j) of anhydrous glucose. 

Cuprum Ammoniatum, Ammoniattd Copper (Unofficial), — is made by triturating 3 
parts of Ammonium Carbonate with 4 of Cupric Sulphate until effervescence has ceased, 
then drying. A deep azure-blue powder of ammoniacal odor, a styptic, metallic taste, and 
alkaline reaction, soluble in water. Dose, gr. J— j. 

Cupri Arsenis, Copper Arsenite, — is described under Arsenum, page 159. 

Cuprol (Unofficial), — is a chemical compound of Copper and Nucleinic Acid, containing 
6 per cent, of copper. It is used externally in 5 to 10 per cent, aqueous solution, containing \ 
per cent, of Chloretone. 

Incompatibles. 

Incompatible with Cop per Sulphate sue: Alkalies, Ammonium Acetate, Arsenic Trioxide, 
Arsenites, Calcium Chloride, Carbonates, Ferric Acetate, Glucose in alkaline solution, Iodides, 
Lead Acetate, Lime-water, Mercuric Chloride, Potassium Tartrate, Phosphates, Silver 
Xitrate. Sodium Borate, Vegetable astringent infusions and tinctures; with Ammoniated 
Copper are: Acids, Alkalies, Lime-water. 

Physiological Action. 
The salts of Copper are gastro-intestinal irritants, producing a metallic 
taste, nausea with greenish-colored ejecta, purging of blood and mucus, con- 
stricted fauces, depressed heart action, hurried respiration and fever. Or, as 
with Arsenic, gastro-enteritis may not occur, but instead profound nervous 
symptoms, as headache, defective coordination, coma and convulsions. The 
symptoms of chronic poisoning are bronchial irritation and catarrh, gastro- 
intestinal catarrh, colic with diarrhea [Lead produces colic with constipation], 
dysentery, nausea, emaciation, anemia, salivation, and a green line (sulphide) 
along the margin of the gums in those who do not clean their teeth. The ner- 
vous symptoms above mentioned are also usually well marked. The liver 
becomes atrophied from irritation of its connective tissue and fatty degeneration 
of the hepatic cells. The lungs are congested, even pneumonic consolidation 
may be set up, the metal seeming to have an affinity for the pulmonary paren- 
chyma. These effects are often produced by the inhalation of cuprous fumes, 
and by eating acid fruits cooked in a copper vessel. Brass-founding is known 
to cause various forms of disease, as gout, chronic nephritis, progressive paresis 
of the legs, tremor, muscular wasting, and locomotor ataxia. A group of symp- 
toms known as "brass-founders' ague," has also been noticed. The fit of ague 
is ushered in by languor and depression, then follow prostration with pallor, 
cold sweats, and chills, which may even amount to rigors, with chattering of 
the teeth, precordial anxiety, headache, nausea and muscular pains. The on- 
set of vomiting arrests the symptoms and usually is followed by sleep, front 



258 CUPRUM. 

which the patient awakens almost well. It is not clear whether these symp- 
toms are due to copper or to zinc, both of which enter into the composition of 
brass, and some investigators contend that_they are not to be credited to copper, 
but to its impurities, lead and arsenic. 

Copper Sulphate is a simple, irritant emetic, producing prompt and con- 
tinued vomiting with but little nausea or depression. In small doses it is a 
nerve-tonic, and is astringent to the gastro-intestinal tract. Externally applied 
in solution it is a useful stimulant and astringent to diseased mucous surfaces, 
and is mildly caustic if used in substance. The Acetate is possessed of the 
same general action as the sulphate. Its local action is stimulant and escharotic. 
The impure acetate (verdigris) is a violently irritant poison. Ammoniated 
Copper has no special action other than that of the sulphate. 

Therapeutics. 

The Sulphate is a prompt and efficient emetic, and is so used in croup and 
narcotic poisoning. In phosphorus poisoning it forms a comparatively insolu- 
ble phosphide of copper besides producing emesis. Fifteen or twenty grains 
may be dissolved in §iv of water, and a teaspoonful or more, according to age, 
given every ten minutes until vomiting is produced. In acute diarrhea and 
chronic dysentery it is the best metallic astringent in doses of gr. J with opium, 
and in gastro-intestinal catarrh it is equally efficient. Locally, it is used with 
benefit in throat affections, gonorrhea, granular lids and corneal ulcers, indolent 
granulations and chronic inflammation of mucous membranes. In most of 
these affections weak solutions (gr. J to \ to the 5) are best, but in granular 
conjunctivitis the smooth crystal may be rubbed quickly over the surface once 
daily. 

In various nervous diseases, as epilepsy, chorea, and hysteria, the salts of 
copper are sometimes beneficial, the Ammoniated Copper being considered 
the most efficient preparation in these cases. In Germany a tincture of the 
Acetate was formerly official, and has been used successfully in the treatment 
of pneumonia. Ammoniated copper has been highly recommended for facial 
neuralgia, but requires pushing to the production of some physiological action. 
Ointments or lotions of the Acetate are useful applications in eczema, herpes, 
tinea sycosis, mentagra and herpes circinatus. Villate's Solution has been suc- 
cessfully used as a local injection for the cure of caries. It is composed of 
Copper Sulphate, Zinc Sulphate, of each 15 parts, Liquor Plumbi Subacetatis 
30, Vinegar 200. The solution is thoroughly injected into the sinuses leading 
to the carious bone. 

Copper Sulphate is advocated for the purification of drinking water. It 
has been shown that certain organisms which pollute public water supplies are 
effectually destroyed by one part of this salt in ten million parts of water, and 
that one part in fifty millions of water destroys most alga? in a few hours; also 
that in the proportion of 1 to 100,000 it is fatal to cholera and typhoid germs 



CURARE. 259 

in 4 or 5 hours. As § of a grain can be ingested daily without the slightest harm, 
this treatment of drinking water is not injurious, for it would require the daily 
ingestion of two gallons of water so treated to obtain this quantity of the salt 
(Moore). Dr. Doty funis that a mixture of copper sulphate and calcium oxide 
(unslaked lime) in ten parts of water gives a precipitate which is one of the most 
efficient deodorants and disinfectants. 

Cuprol in 5 to 10 per cent, solution with £ per cent, of chloretone is a prac- 
tically painless astringent and stimulant of the healing process. It has been 
used with satisfaction in blepharitis, conjunctivitis, and other affections in which 
an astringent effect is desired. 



CURARE, Woorara (Unofficial), — is a vegetable extract obtained from 
various members of the Strychnos family, also from Panllinia curare and other 
plants: It is used in S. America as an arrow-poison under the names Caroval 
and Vao. Its active principle is the very poisonous alkaloid Curarine, C 18 H 35 N. 

The dose of Curare is gr. }^-\ hypodermically, — of Curarine, gr. ^JiT'Tffir hypodermi- 
cally, or gr. ils-jg by the stomach, but as the samples vary greatly in activity they should be 
tried on some inferior animal before being administered to man. 

Incompatibles are: all Caustic Alkalies, as they destroy the alkaloid. Physiologically 
incompatible are: Strychnine, Atropine. 

Physiological Action and Therapeutics. ' 
Curare is a paralyzer of the voluntary muscles, affecting them through the 
end-organs of the motor nerves. It does not at first act upon the brain or spinal 
cord, but if life be prolonged by artificial respiration the cord, sensory nerves 
and even the muscular tissue become affected. The heart, at first quickened, 
becomes depressed, the blood-pressure is lowered, the eyelids droop, the eye- 
balls protrude, vision is disordered, intestinal peristalsis and sensibility to stimuli 
are greatly increased, and an artificial glycosuria (curare-diabetes) is set up. 
The limbs are paralyzed first, death occurring by paralysis of respiration. The 
absorption of the drug by the stomach is very slow, as its active principle passes 
with difficulty through animal membranes, and its elimination, which takes 
place by the kidneys, being more rapid and complete than that of any other 
agent, no marked effect may be produced when it is administered internally. 
When hypodermically injected its action is very prompt. The urine of a curar- 
ized animal will poison another, and that of the second animal will paralyze 
a third. Compared with other motor depressants Curarine and Confine par- 
alyze the end-organs of the motor nerves, Gelsemine paralyzing the motor cen- 
tres. 

Curare is chiefly used for experimental purposes on the lower animals. It 
has an historical interest from its having been the means by which Bernard 
demonstrated the existence of contractility as an essential endowment of mus- 
cular tissue. It has been used with some success in spasmodic nervous affec- 
tions, particularly in tetanus, both idiopathic and traumatic, in hydrophobia, 



260 CUSSO — DIGITALIS. 

chorea and epilepsy. It does not promise well as a therapeutic agent, but un- 
doubted cases of hydrophobia are reported by high authority as having been 
cured by this drug. 

CUSSO, Kousso, (Brayera) — is the dried female inflorescence of Hagenia abyssinica, an 
Abyssinian tree of the nat. ord. Rosacea. It contains tannic acid, a volatile oil, and a crystal- 
line principle named Koussin. Dose, oij-oj [av. oss.] 

Cusso has little or no effect except the nausea, vomiting, colic and slight diarrhea pro- 
duced by large doses. Its chief action is anthelmintic against both varieties of tapeworm, 
but it rarely expels the head of the parasite, and is very nauseous to the taste and difficult of 
retention by the stomach in the large doses necessary to efficiency. From oij to 5j of the 
flowers infused in giv of boiling water is the usual dose, which should be taken on an empty 
stomach and followed by a castor-oil or saline purge after 3 or 4 hours. An emulsion of a 6 per 
cent, infusion with castor-oil. yolk of egg, a few drops of ether and oil of anise with 10 to 20 
drops of the Oleoresin of Aspidium, is more agreeable and efficient than the infusion alone. 

CYDONIUM, Quince Seed (Unofficial).— is the seed of Cydonia vulgaris, a tree of the 
nat. ord. Rosacea?, native in Crete and Austria, and cultivated elsewhere. The seeds placed 
in water swell up, forming a mucilaginous mass. The mucilage is the only constituent of 
importance and is contained in the epithelial cells. It is named Cydonin, and is considered 
to be a compound of gum and cellulose. 

Mucilago Cydonii, Mucilage of Cydonium (Unofficial), — is prepared by macerating 2 
parts of Cydonium in 100 of Distilled Water. Dose, indefinite. 

Cydonium is of value for its mucilage, which is used as a bland, demulcent application 
in conjunctivitis, abrasions of the skin, and fissures of the mucous membranes, and as a vehicle 
for injections in gonorrhea. Internally it maybe used as a soothing remedy for the throat, 
stomach, or intestines. The preparation known as Bandoline, used as a hair-dressing, is 
identical with mucilage of cydonium. 

CYPRIPEDIUM, — is the dried rhizome and roots of Cypripedium pubescens, the 
Ladies' slipper, or of C. parviflorum, the moccasin-plant, or American valerian (nat. ord. 
Orchidaceae). It contains a volatile oil, a volatile acid, resins, and tannin. 

Fluidextractum Cypripedii, Fluidextract of Cypripedium. — Dose, n^x-xxx [av. njjxv.] 
Cypripedin (Unofficial), — is an impure alcoholic extract. Dose, gr. ss-ij. 
Cypripedium is antispasmodic, tonic, stimulant and diaphoretic, possessing the same 
general properties as Valerian, whence one of its common names, American valerian. It is a 
popular remedy in some parts of the United States for nervous hyperesthesia unaccompanied 
by organic lesions, and especially in morbid sensibility of the eye. It is reported to have 
even cured epilepsy, and is said to be highly useful in neuralgia, hysteria, nervous headache 
and insomnia. 

DAMIANA (Unofficial), — the leaves of Turnera aphrodisiaca, a plant of the nat. ord. 
Turneraceas, growing in Mexico and Lower California. Several varieties of so-called Damiana 
are in the market, but the true leaf is of a light-green color, small, lanceolate, and dentate 
along the margin. It contains a volatile oil and a resin. Dose, 5 j daily. 

Damiana is said to be a powerful aphrodisiac in cases of sexual atony, but the published 
reports of its use vary greatly as to its efficacy. It is probably a stimulant diuretic, a bitter 
tonic, and a purgative in sufficient doses. Besides its use as an aphrodisiac Damiana has 
been administered with benefit in some forms of cerebral exhaustion and general atony of 
the nervous system, also in sick headache and in some few cases of paralysis. It forms the 
chief stock in trade of the numerous charlatans who fill the daily papers with advertisements of 
' ' manhood-restorers. ' ' 

DIGITALIS, Digitalis, — is the dried leaves, collected from plants of the 
second year's growth, at the commencement of flowering, of Digitalis purpurea, 



DIGITALIS. 261 

the purple foxglove, a plant of the nat. ord. Scrophulariacese, which grows 
wild in Europe, and is cultivated in this country, often in private gardens for 
its beautiful spike of purple flowers, and largely by the Shakers for the drug 
market. Dose, gr. ss-ij [a v. gr. j.| 

The British Phar. formerly directed that the official drug shall consist of "the dried leaf, 
collected from the wild, indigenous plant, when about two-thirds of the flowers are expanded." 
Much of the leaf found in our shops is of very poor quality, a large proportion being inert; 
but whether this is due to our Pharmacopoeia not restricting the official drug to the wild plant, 
or to careless treatment in gathering and drying, is not definitely known. When the leaves 
are imperfectly dried a process of decomposition sets in, which destroys the active principles, 
and may produce new and poisonous ones. A similar decomposition is said to occur when- 
ever the tincture of Digitalis is mixed with watery or syrupy solutions. It is a fact that Digi- 
talis is one of the most unreliable drugs, in respect to the physiological activity of any particu- 
lar sample or preparation. The seeds are known to contain the active principles in much 
greater proportion than the leaves, but they are never used. 

Constituents 0) Digitalis. 
The supposed active principle of Digitalis was first designated by the term 
Digitalinum (Digitalin), under which name a substance was official in the 
l". S. Phar. and a process was given therein for its extraction, until the revision 
of 1880, when it was omitted. It was an amorphous product, of complex com- 
position, and did not represent Digitalis. In 187 1 Nativelle received the Orfila 
prize from the French Academy for the discovery of a crystalline principle in 
Digitalis, which he named Digitaline. This was supposed to be the active 
principle of the plant, until Roucher (1872) and Schmiedeberg (1875) found 
it to be a complex body consisting of a mixture of Digitalin and Digitoxin. 

Schmiedeberg's latest analysis is now accepted as the most accurate determination 
yet obtained of this vexed question. He enumerates five principles as contained in Digitalis, 
namely — 

Digitalin, a granular glucoside, soluble in alcohol, almost insoluble in water, sparingly 
soluble in ether or chloroform; possesses in a high degree the medicinal action of digitalis; 
the active ingredient of Homolle's French Digitaline and the Digitalin formerly official in the 
U. S. and Br. Pharmacopoeias. 

Digitoxin, a crystalline principle, perhaps an alkaloid; soluble in alcohol, slowly in 
chloroform, sparingly in ether, quite insoluble in water; the most toxic of all the constituents, 
but uncertain, cumulative and dangerous in its action; the principal constituent of Nativelle's 
prize Digitaline. 

Digitalein, an amorphous glucoside, soluble in both water and alcohol, insoluble in 
ether or in chloroform. Its action on the heart is non-cumulative and it causes no irritation 
when subcutaneously injected. 

Digitonin, a crystallisable glucoside resembling Saponin, soluble in water, insoluble in 
cold alcohol, in ether or in chloroform. It is probably the diuretic agent. 

Digitin, a crystalline body, insoluble in ether or chloroform, scarcely soluble in water, 
more readily in alcohol. It is physiologically inert. 

The first three are cardiac stimulants and are highly poisonous. Digitonin is a direct 
depressant of the heart and antagonizes the stimulant action of the others. All five are non- 
nitrogenous, and except Digitoxin and Digitin are glucosides. Digitalis contains no alkaloid 
unless Digitoxin be considered one. 

Official Preparations. 
Fluidextractum Digitalis, Fluidextract of Digitalis, — Dose, TTjjss-iij [av. njjj.] 
Extractum Digitalis, Extract 0/ Digitalis, — prepared by evaporating the fluidextract 
to a pilular consistence. Dose, gr. J— ss [av. gr. i.] 



262 DIGITALIS. 

Tinctura Digitalis, Tincture oj Digitalis, — 10 per cent., in diluted Alcohol. Dose, 
njjv-xx [av. ttjjxv.] 

Infusum Digitalis, Infusion o) Digitalis, — Digitalis i£, Alcohol 10, Cinnamon Water 
15, Boiling Water 50, Water to 100. Dose, 5j-iij [av. 3ij-] Notice that the dose is in 
drachms, not in ounces. The British infusion has less than J the strength of the above and 
is given in doses of 3ij— iv. In France a cold infusion is preferred, 5 grains of the powdered 
drug being macerated in 4 ounces of cold water for 8 to 12 hours and then filtered; dose oss 
every two hours. 

Unofficial Preparations. 

Digitalinum, Digitalin, — is the complex product of the process formerly official in the 
U. S. and Br. Phar. Dose, gr. ?,'(,— /o- 

Homolle's or Qu6venne's Digitalin, — is much used in France in form of granules. 
Consists chiefly of Digitalin with a little Digitoxin, and possesses the action of the leaves. 
An amorphous, yellowish-white powder or small scales, intensely bitter, inodorous, but irri- 
tant to the nostrils. Dose, gr. fa, equal to about gr. jss of the powdered leaves. 

Nativelle's Digitaline, — consists largely of Digitoxin, and is cumulative in action. Light, 
white, crystalline tufts of needles, of very bitter taste; soluble in alcohol, insoluble in water. 
Dose, gr. j^jrfa in pill. 

Digitalinum Verum, — is the distinguishing name given by Kiliani to Schmiedeberg's 
Digitalin, which he believes to be the best form in which to prescribe Digitalis. Its composi- 
tion is definite, it is obtainable commercially in a sufficiently pure condition, it possesses the 
medicinal action of Digitalis on the heart, is non-cumulative, and is soluble in 100 parts of 
50 per cent, alcohol, and in 1000 of water. Dose, gr. 3-^ every 2 or 3 hours. 

Digitalinum Germanicum, German Digitalin (Merck), — is a mixture of the Digitalin 
of Kiliani, with Digitalein, Digitoxin, and certain inert principles. It occurs as a white pow- 
der, soluble in water and in alcohol. Dose, gr.-f— £, thrice daily. 

Digitoxinum, Digitoxin,- — is crystalline, soluble in alcohol, insoluble in water, and is one 
of the most powerful poisons known. Dose, gr. 7 \g. 

Digalen, Soluble Digitoxin (Cloetta, 1904), — is chemically identical with Schmiedeberg's 
crystalline Digitoxin. Used hypodermically 2 to 4 times in doses of mg 0.25 (gr. -j--^) it pro- 
duces the physiological effects of digitalis within 24 hours, viz. — increased blood-pressure, 
marked diuresis, and at times showing of the pulse. Dose, gr. ranTo- 

Incompatibles. 

Incompatible with Digitalis are: Acids, Alkalies, Alkaloidal precipitants (see page 50), 
Cinchona infusion, Ferrous Sulphate, Lead Acetate, Tannic Acid, Vegetable astringents, 
Syrupy and Aqueous solutions. Physiologically incompatible are: Aconite, Chloral Hydrate, 
Cocaine, Glonoin, Muscarine, Saponin, Scoparin, Strychnine. 

Physiological Action. 

Digitalis is a cardiac and vascular stimulant, a diuretic in certain condi- 
tions, an emetic to some persons, hemostatic, anaphrodisiac, excitomotor and 
at last a paralyzant. In over-doses it irritates the mucous membranes, causing 
sneezing, gastric disturbance, nausea, vomiting, colic and purging, the dis- 
charges being of a grass-green color. In such doses it lowers temperature, prob- 
ably by lessening the blood-supply to the tissues, produces headache, irregular- 
ity of the cardiac action, vertigo, and an appearance of vibratory fringes of color 
around objects. Even in moderate doses it frequently causes hallucinations 
and delirium. 

Digitalis slows the action of the heart but increases its force at the same 
time. It stimulates the cardiac muscle and its inhibitory apparatus, and also 
stimulates the vaso-motor centres, contracting the arterioles and thereby greatly 



DIGITALIS. 263 

raising arterial tension. The continued use of lull doses dilates the Mood- 
vessels, exhausts the irritability o\ the cardiac motor ganglia, and anally par- 
alyzes the eardiae muscle itself. The recumbent posture must he maintained 
when Digitalis is given for its full eardiae effects. Its final effect on striped 
muscular tissue is to lessen the contractile power, causing great weakness and 
languor. Under its influence the excretion of urea is at first increased, but 
soon decidedly diminished. It lessens the sexual appetite and impairs the vene- 
real function. Lethal doses lessen the reflexes by stimulation of Setschenow's 
centre, and paralyze the muscles and the peripheral nerves, motor and sen- 
sory. Respiration, at first slowed, becomes rapid and feeble; cyanosis, coma 
and convulsions follow, finally death by sudden paralysis of the heart, which is 
arrested in systole. 

It has been conclusively shown that in many cases of pneumonia Digitalis 
failed to influence the pulse, the result probably of the partial paralyzant in- 
fluence of high body-temperature upon the vagus centre and endings in the 
heart, thus weakening the inhibitory apparatus to such a degree that the drug 
awakens no responsive increase of inhibition. In cases with but moderately 
high pyrexia the characteristic action of the drug is not interfered with. 

Compared with Aconite, both that drug and Digitalis slow the heart, but 
otherwise their actions are antagonistic. Aconite at first stimulates and soon 
relaxes inhibition and depresses the cardiac motor ganglia, — Digitalis increases 
inhibition and stimulates the cardiac muscle. Both drugs finally paralyze the 
heart, Aconite by direct depression of its motor ganglia, Digitalis by over- 
stimulation of the cardiac muscle. Under Aconite the heart is arrested in dias- 
tole, under Digitalis in systole. The arterial tension is lowered by Aconite 
but is raised (at first) by Digitalis. Aconite acts quickly, Digitalis very slowly, 
— a fact which makes the latter drug of little value in poisoning by the former. 

During the use of this drug for any length of time the muscle of the heart 
is so strained by over-stimulation that on suddenly assuming the erect position 
the cardiac energy may fail, more especially if the doses are administered too 
close together to admit of the elimination of one before the ingestion of the 
next. This is the explanation of the so-called cumulative action of Digitalis, 
which is not now generally recognized in the sense in which the term was for- 
merly applied. Another explanation is that it may stop its own excretion, by 
arresting the renal circulation and the secretion of urine through extreme con- 
traction of the renal vessels, and thus may really accumulate in the blood. 

The diuretic action of Digitalis is not yet fully understood. All authorities 
agree that this action is exercised indirectly through the circulation, but many 
differ in regard to its details. One theory is that the constituent principle 
Digitalin contracts the bloodvessels all over the body, while others (Digitoxin 
and Digitalei'n or perhaps Digitonin) dilate the renal arteries. The effect of 
this, together with the increased force of the ventricular contractions caused 
by the drug, is to greatly raise the general arterial tension and consequently 



264 DIGITALIS. 

to increase the bloodpressure in the glomeruli; while the rapidity of the renal 
circulation is increased and its volume augmented by the strengthening of the 
cardiac contractions and the dilatation of the afferent renal vessels. If this 
explanation be true, no other drug possesses such double power, and so far as 
vascular action is concerned Digitalis is the ideal diuretic. Another theory 
is that when a small dose is given, or during the first stage of a large dose, the 
renal arteries contract as do the other arteries of the body, but they are the 
first to dilate under the continued influence of the drug, which then acts as a 
diuretic. It is generally conceded that Digitalis has some diuretic power in 
health, but that this is slight compared with the diuresis produced by it in cases 
of dropsy, especially when due to cardiac disease. Much uncertainty exists 
as to its effect upon the constituents of the urine, some maintaining that it in- 
creases the elimination of urea, others that this is diminished, and still others 
that it is at first increased and afterwards diminished. It is slowly absorbed, 
and slowly eliminated by the kidneys. 

Therapeutics. 

The employment of Digitalis in disease is chiefly based on its powers of 
giving rest and tone to the heart, and stimulating the action of the kidneys. 
The forms of heart disease in which it is indicated are the affections of the 
auriculo-ventricular orifices, namely, mitral and tricuspid disease, whether re- 
gurgitant or obstructive in character. It is contra-indicated in aortic disease, 
except for special symptoms, and is injurious in fatty degeneration of the cardiac 
muscle. Its particular sphere of usefulness is mitral regurgitation, especially 
when accompanied by venous engorgement of the lungs, the right heart, the 
liver, kidneys and subcutaneous tissues. In such cases its action is shown to 
striking advantage, ameliorating all the symptoms by assisting the flow of blood 
in the veins. By prolonging the diastole, it gives the heart some amount of 
rest, and affords time for the dilated auricle to empty itself through the incom- 
petent orifice; and by strengthening the contraction of the left ventricle, it causes 
the better approximation of the mitral flaps, consequently less regurgitation 
occurs, less venous engorgement, and the propulsion of more blood into the 
arterial system. If it also acts as a diuretic, as it usually does in these cases, 
the diuresis will tend to remove the edema; and the general improvement in 
the circulation produced by it will relieve the cardiac pain and distress, the 
dyspnea and cyanosis. The less a case of mitral regurgitation approaches the 
edematous type, the less good will Digitalis do as a rule. In mitral constric- 
tion, Digitalis is usually of great assistance, the lengthened diastole giving more 
time for the blood to pass through the narrowed orifice, and the increased force 
of the auricular contraction helping in the same direction. 

In tricuspid regurgitation or constriction, Digitalis is beneficial in the same 
manner as in disease of the mitral valve. It is particularly useful in dilatation 
of the right side of the heart with incompetence of the tricuspid. The rational 



DIGITALIS. 265 

symptoms which indicate its use are — rapid and feeble cardiac action, low- 
arterial tension, cough, dyspnea, pulsating jugulars, a dusky face, scanty and 
high-colored urine and general dropsy. 

In aortic regurgitation, Digitalis is generally injurious; the prolonged dias- 
tole caused by it giving more time for the blood to regurgitate through the 
imperfectly closed orifice, thus increasing the danger of fatal syncope. It may 
do good if compensatory hypertrophy has not set in, if the heart is feeble and 
its action rapid, or when there is but little blood regurgitating, or when there 
are reasons, such as the coincident presence of aortic obstruction, for wishing 
to strengthen and regulate the contraction. In any case, the dose administered 
should be a small one, and its effects should be carefully watched. In aortic con- 
striction, Digitalis is generally contra-indicated, especially when this lesion is 
accompanied by aortic regurgitation, as is usually the case. It may be of ser- 
vice, however, when the force of the heart-beat requires strengthening; or when, 
as a result of the obstruction, mitral dilatation has set in, with much regurgi- 
tation and the consequent venous and pulmonary engorgement. It should not 
be used in aortic stenosis with compensatory hypertrophy, in simple hypertrophy 
when compensated, in pericarditis or in fatty degeneration of the heart, except 
temporarily for some special indication. 

In the irritable heart of soldiers Digitalis is often curative, and palpitation, 
cardiac failure and venous engorgement are well treated by it. In exophthalmic 
goitre it has apparently benefited some cases, when used over a long course of 
treatment; but, as a rule, this affection is not amenable to its influence. 

Digitalis is not a suitable diuretic in Bright's disease, though it has been 
used with benefit in the early stage of the acute form. If its action produces 
dilatation of the renal arteries it is questionable practice to increase the circu- 
lation in any acutely inflamed organ; while on the other hand the arterial ten- 
sion is always raised in such cases, and this drug only aggravates that condition. 
In chronic Bright's disease it is still more injurious, for the same reason, the 
arterial tension being already very high in that affection. It may be useful 
in cases of renal cirrhosis, when the cardiac hypertrophy has failed to overcome 
the peripheral resistance, and consequently there is dilatation of the left ven- 
tricle and the left auriculo-ventricular orifice, with the resulting mitral regurgi- 
tation. In such cases, a diuretic pill is frequently of service, consisting of 
digitalis leaves in powder, calomel and squill, a grain of each, made into pill 
with extract of hyoscyamus. 

Digitalis is always an uncertain diuretic unless the heart is diseased; yet 
it has rendered good service in renal dropsy as well as in the cardiac form. Its 
contractile power over the arteries may so predominate as to arrest the renal 
circulation, and stop the secretion of urine, hence it is well to administer at 
the same time an agent which causes dilatation of the renal vessels, as sodium 
nitrite. Contrary to theory it has been employed with benefit in the early stage 
of scarlet fever, and when the kidneys strike work in that disease. As a hemo- 



266 DIOSCOREA. 

static it may be used in hemorrhage from a large surface, in the hemorrhagic 
diathesis, hemoptysis, and menorrhagia. As an antipyretic it has been used 
in fevers, in the first stage of pneumonia, and in other inflammations, but a 
reaction is setting in against this employment of so powerful an agent, which 
by over-stimulation may act as a heart-depressant. In rheumatic fever it lowers 
the temperature, shortens the duration of the disease, and is particularly indi- 
cated for cardiac complications. It was formerly much used in delirium tre- 
mens, in congestive headaches, acute mania and other congestive conditions 
of the brain, but generally without much benefit. In spermatorrhea of the 
plethoric it may be well combined with potassium bromide, and when this 
affection is complicated with an atonic condition, shown by feeble erections, 
frequent emissions, and cold feet and hands, it is a serviceable anaphrodisiac. 
Finally, Digitalis is said by high authority to be particularly adapted to blondes 
and persons of sanguine and indolent temperament. Sometimes the vomiting 
caused by it is so severe as to prevent its use. 

Administration. 
Of the four active principles contained in this plant, namely — Digitalin, 
Digitoxin, Digitale'in and Digitonin, the first two are soluble in alcohol and 
practically insoluble in water, the third is soluble in both menstrua and the 
fourth is insoluble in alcohol but is freely soluble in water. Consequently all 
alcoholic preparations of Digitalis contain the first three principles and all 
aqueous ones contain the last two. In action the first three are very similar, 
producing the characteristic effects of the plant, while Digitonin is directly 
poisonous to the cardiac muscle, decreasing its contractile power. This prin- 
ciple produces dilatation of the arteries, generally antagonizes the action of 
the other constituents, and perhaps irritates the renal epithelium. When, 
therefore, the cardiac action of Digitalis is desired, the tincture should be em- 
ployed, given on sugar or bread, prohibiting the ingestion of any aqueous fluid 
within 20 minutes, either before or after swallowing it. If the diuretic action 
is required, the proper preparation is the infusion. The latter preparation may 
be employed hypodermically, and very small doses so administered have been 
found efficient when larger ones given by the stomach have failed to act. An 
infusion for this purpose has the strength of 3 parts of the leaf in 100 of water, 
and its hypodermic dose is 15 minims twice or thrice daily. 



DIOSCOREA, Wild Yam, Colic-root (Unofficial), — is the rhizome of Dioscorea villosa, 
a creeping plant of the nat. ord. Dioscoraceae, indigenous to the eastern U. S. It contains an 
acrid resin, and is reported to be expectorant and diaphoretic in action, as well as stimulating 
to the intestinal canal, and in large doses to cause general neuralgic pains with erotic excite- 
ment. It is used with success in bilious colic; and in the cramps of cholera morbus, spas- 
modic hiccough, dysmenorrhea and noctornal emissions of sthenic type it is said to be very 
efficient. A powdered extract named Dioscorein is on the market, the dose of which is gr. 
j-iv. A fluidextract made according to the pharmacopoeial rule may be administered in 
doses of njjxv-xxx. 



DITA BARK — DUB0IS1V. 267 

DITA BARK (Unofficial), — is the bark of Alston in scholaris, a tree of the oat. ord Apo- 
icete, growing in the Philippine Islands. It contains two active alkaloids, Ditaine and 
Ditantine, the former of which has an action identical with that of Curare. The hark is con- 
sidered tonic and antiperiodic, and is used in the East as a reined) for intermittcnis. It may 
he given in doses of dj-iv, in powder or as a Suidextract. 

The Australian bitter bark, Alstonia constricta, yields an alkaloid Alsloninc, which re- 
sembles quinine in many respects. A tincture of the bark has slight diuretic anil diaphoretic 
action, and has been used with benefit in influenza. 

DROSERA, Sundew (Unofficial), — a fluidextract of Drosera rotundijolia, the round- 
leaved Sundew, is said to have been successfully used in phthisis pulmonalis. It is certainly 
a most useful agent in whooping-cough and other spasmodic coughs; especially when marked 
by violent paroxysms, the cough being loud and harsh, and followed by bleeding from the 
nose or mouth, and perhaps by vomiting of the contents of the stomach. The expressed juice 
has been applied to warts and corns, for the purpose of curing them. Dose of the fluidex- 
tract, tnjv-xx. 

DUBOISIA (Unofficial), — is the leaf of Duboisia myoporoides, an Aus- 
tralian tree of the order Solanaceae. It contains a poisonous alkaloid, Duboisine, 
which is believed to be identical with Hyoscyamine; also Hyoscine, Pseudo- 
kyoscyamine, and other alkaloids. Another species, Duboisia Hopwoodii, con- 
tains Piturinc, an alkaloid which is practically identical with Nicotine. 

Unofficial Preparations. 
Extractum Duboisia?, Extract 0} Duboisia, — Dose, gr. $-£. 
Tinctura Duboisiae, Tincture oj Duboisia, — Dose, irtfv-xx. 
Duboisinae Sulphas, Duboisine Sulphate (Langenberg's), — Dose, gr. xijo^V 
Incompatibles are the same as for Belladonna (see page 172). 

Physiological Action and Therapeutics. 

The actions of Duboisia are in all respects similar to those of its congener, 
Belladonna, except that Duboisine is more soluble in water than Atropine, is 
less irritant to mucous membranes, and more prompt in mydriatic action, but 
its effects are of shorter duration. It is also less of a cerebral excitant and 
more of a calmative and hypnotic. On man its action is said by some author- 
ities to be more powerful than that of Atropine, but less powerful on frogs. 
If administered before meals it disorders the ensuing digestion, but does not 
so act if given while digestion is in progress. 

Duboisine is highly praised for its sedative action in the mental excitability 
of the insane, in the treatment of the morphine habit and in paralysis agitans. 
In doses of gr. y^ to -^ of the sulphate, administered hypodermically twice 
daily, it induces quiet and refreshing sleep and is not dangerous. When given 
in larger doses it may produce vertigo, nausea or even syncope, but no fatal 
cases from its moderate use have been reported (Massant). Its sedative effect 
is at the same time the most persistent and also that of which the patient first 
acquires a tolerance. Of 22 cases in which the calmative effect was at first 
decided, a tolerance was acquired in eight. In such cases the sedative action 
of the drug may be restored by ceasing its continuous administration and length- 



268 DULCAMARA. 

ening the interval between the doses (De Montyel). It has been well employed 
in puerperal mania, and may be used instead of Atropine in many conditions, 
especially in the night-sweats of phthisis, respiratory neuroses and cardiac 
failure. It is employed as a mild mydriatic by eye surgeons, its advantages 
over Atropine being its more rapid action in paralyzing accommodation and 
effecting mydriasis, the shorter duration of its effects and the slight degree of 
conjunctival irritation produced by it. 

DULCAMARA, Bittersweet (Unofficial), — the young branches of Sol anion 
Dulcamara, the woody night-shade, a shrub of the nat. ord. Solanaceae, grow- 
ing in Europe and N. America. It contains the glucoside Dulcamarin, a peculiar 
principle named Picroglycion, and the alkaloid Solanine, C 42 H 87 N0 15 , which 
is found also in other species of Solanum, namely, 5. tuberosum (potato), 5. 
Lycopersicum (tomato), and 5. nigrum (black night-shade). Solanine is of 
bitter taste and alkaline reaction, crystallizing in minute prisms, which are 
soluble in 125 of boiling alcohol but very insoluble in water. It is a narcotic 
poison, but exists in very small quantity in the plant. 

Unofficial Preparations. 

Fluidextractum Dulcamarae, Flaidextract oj Dulcamara, — Dose, 3ss-jss. 

Decoctum Dulcamarae, Decoction oj Dulcamara, — may be made of 10 per cent. 
strength and given in doses of § j — i j . 

Physiological Action and Therapeutics. 

Dulcamara is but imperfectly understood. In overdoses it has produced 
nausea and vomiting, vertigo, convulsive muscular movements, pruritus, ery- 
thematous eruptions on the skin, and languid circulation with a dusky color 
of the face and hands. In children who have eaten the berries there have been 
observed signs of severe enteralgia, abdominal tenderness, nausea, thirst, heat 
in the throat and chest, great prostration, rapid pulse, quick and painful respi- 
ration. In very large doses it is a narcotic poison, causing paralysis by de- 
pression of the central nervous system, with lowered activity of the heart and 
respiration. It is believed by some authorities to be anaphrodisiac, diaphoretic 
and diuretic. 

Dulcamara was formerly used in a variety of affections, as herpetic dis- 
eases, chronic rheumatism, gout, and jaundice. It is now chiefly employed 
in obstinate scaly skin diseases, as psoriasis and pityriasis, in which it is unques- 
tionably serviceable. It is also serviceable in the diarrhea of children when 
produced by exposure to cold and damp, in mania with strong venereal pro- 
pensities, in chronic bronchitis and in whooping-cough. As a diaphoretic it has 
been used with benefit in rheumatic and venereal disorders, and is often bene- 
ficial in nasal, pulmonary and vesical catarrhs. It is- said to be particularly 
useful in affections of a rheumatic or catarrhal nature when caused by exposure 
to damp weather. 



EC 1 1 ! \ \rr \ I'l VSTICA. 260 

ECHINACEA (Unofficial), — is Echinacea angustifolia, Black Sampson, or 
Nigger-head, a plant with narrow Leaves, and purple cone-shaped flowers, found 
in the prairies west of the Mississippi river. Its properties are anesthetic, anti- 
septic and alterative, it improves the appetite and digestion, is stimulant and 
nutritive to the nervous system, and seems to be specifically antagonistic to all 
organic infections of the blood, as acute sepsis, pyemia, and serpent venom. 

Extraordinary accounts are reported of the efficacy of this drug in poison- 
ing by rattlesnake venom, in which a strong tincture is used both locally and 
internally with invariable success; also for the bites of tarantulas, spiders, 
scorpions, the stings of wasps and other insects. It has a high reputation for 
tetanus and pyemia, and has given great satisfaction in dyspepsia, ulcerative 
stomatitis, and ulcerations of the gastro-intestinal tract. In typhoid fever it 
modifies the symptoms and lowers the temperature. It has proved of positive 
value in septicemia, uremia, boils, carbuncles, abscesses, glandular inflamma- 
tions, and cerebro-spinal meningitis. In diphtheria it is believed to antagon- 
ize the action of the toxin in the blood. In medicinal doses it has no toxic or 
other undesirable effects, and it is eliminated perfectly. Dose of a strong tinc- 
ture oss-jss; of a fluidextract, ti^xx-xxx every 2 hours. (Ellingwood) . 



ELASTICA, Rubber, (Caoutchouc) , — is the prepared milk-juice of several 
species of Hevea (nat. ord. Euphorbiacese) , known in commerce as Para Rub- 
ber. It is very elastic, insoluble in water, dilute acids, or dilute solutions of 
alkalies, soluble in chloroform, carbon disulphide, oil of turpentine, benzin and 
benzol. When pure, or nearly pure, it floats on water. 

Rubber is a hydrocarbon, and may be combined with sulphur by the aid 
of heat (vulcanized), which process, long continued, converts it into hard rub- 
ber. It is used in the fabrication of catheters, bougies, pessaries, court plaster, 
bandages, elastic stockings, tubing, etc. An analogous substance is — 

Gutta-percha (Unofficial), — the concrete exudation of Isonandra gulta, a large tree of 
the nat. ord. Sapotaceae, growing in the Malay peninsula and adjoining islands. It occurs 
in tough but somewhat flexible pieces, of grayish or yellowish color, plastic above 140 F., 
soft at 212 F., insoluble in water or alcohol, soluble in chloroform, oil of turpentine, carbon 
disulphide, benzin and benzol. It contains a hydrocarbon, Gutta, C 10 H 16 (80 per cent.), 
two resins named Fluavil and Albau, also a volatile oil, salts, fat and coloring matter. 

Liquor Gutta-perchas, Solution of Gutta-percha (Unofficial), — Gutta-percha 9, Car- 
bonate of Lead io, in Chloroform 91. Used as a protective application to eruptions and slight 
wounds, the evaporation of the menstruum leaving behind a thin adhesive and non-irritating 
pellicle. 

Traumatical (Unofficial), — is the name given to a 10 per cent, solution of Gutta-percha 
in Chloroform, which forms on drying a permanent, unirritating, adhesive, flexible and non- 
contractile skin for the treatment of skin affections and slight wounds. It forms an excellent 
basis for the application of Chrysarobin to psoriasis. 

Gutta-percha has neither physiological action nor therapeutics, being used for its physical 
qualities alone. In surgical practice it has several applications, making a good material for 
splints, as it can be softened in hot water and adapted to any surface while pliable. From 
it are manufactured pessaries, specula, stethoscopes and other instruments. The solution 
may be used as a protective covering for excoriations and slight wounds, to prevent pitting 
in small-pox, and to paint over the line of suture after post-mortem examinations. 



270 ELATERIXUM — ERGOTA. 

ELATERINUM, Elaterin, C 20 H 28 O 5 , — is a neutral principle extracted 
from Elaterium, a substance deposited by the juice of the fruit of Ecballium 
Elaterium, the squirting cucumber, a European plant of the nat. ord. Cucur- 
bitacea?. Elaterin occurs in small, colorless scales or prisms, of bitter taste 
and neutral reaction, insoluble in water, soluble in 337 of alcohol and in solu- 
tions of the alkalies. Dose, gr. ^j- T V [av. gr.^.] 

Trituratio Elaterini, Trituration of Elaterin, — Elaterin 10, Sugar of Milk 90, thor- 
oughly mixed by trituration. Dose, gr. \- j [av. gr. ss.] 

Elaterin is the most powerful of the hydragogue cathartics, causing pro- 
fuse, watery stools, and when given in large doses great prostration and gastro- 
intestinal irritation, nausea and vomiting. In the lower animals it does not 
produce purgation, but profoundly impresses the nervous system, causing ir- 
regular breathing, convulsions and death. Its chief use is to produce free watery 
discharges in ascites, anasarca, uremia and cerebral disorders, but while the 
most efficient agent we possess for this purpose it must be used with great caution 
in the aged and feeble, as its action is very depressant. 

Aside from its action on the excretory functions of the bowels and kidneys, 
Elaterium excites absorption of fluid from the tissue spaces, and has removed 
edema when administered in non-purgative doses. It is no longer official by 
reason of its variable quality. 



ERGOTA, Ergot, {Ergot 0} Rye), — is the sclerotium (compact mycelium 
or spawn, intermediate fibrous stage) of Claviceps purpurea (class Fungi), re- 
placing the grain of Rye, Secale cereale (nat. ord. Gramineae). It occurs in fusi- 
form, curved, grain-like bodies, of purplish-black color, peculiar, heavy odor, 
and oily, disagreeable taste. It should be only moderately dried, preserved 
in a close vessel, and have a few drops of chloroform dropped upon it from 
time to time, to prevent the development of insects. When more than one year 
old it is unfit for use. Dose, gr. x-^j [av. gr. xxx.] 

Composition of Ergot. 
The composition of Ergot and the nomenclature of its supposed constituents 
are subjects upon which there exists a great diversity of opinions, and about 
which there is nothing settled. According to Robert, it contains three active 
principles, viz. — Ergotinic Acid, a nitrogenous glucoside, which has no ecbolic 
action but affects the nervous system, the heart and the respiration; Sphacelinic 
Acid, a non-nitrogenous resin, which stimulates the vaso-motor centre and causes 
uterine contraction; and Cornutine, an alkaloid, found in very small quantity, 
and believed to be the ingredient which causes the convulsions. Ergot also 
contains Trimethylamine, Tannic Acid, and a fixed oil. 

Jacobj found in Sphacelinic Acid a toxic resin named Sphacclotoxin, which differs from 
all other poisons in producing gangrene of various organs, especially in fowls and pigs. It 



GOTA. 271 

induced abortion in pregnant animals and caused ataxia and other nervous symptoms in 
fowls. 

Tanret's Ergotinine lias been proved to have no action on the uterus. The Ergotin of 
Bonjean, Wiggers and Tanret is not a fixed compound, but a mixture. The Ecboline of Wig- 
gers is also a mixture. The Sclerolinic Acid of Dragendorf is said by many authorities to act 
on the uterus, but this is positively denied by many others. It is probably a very uncertain 
preparation, and is said to be really a mixture of sphacelinic acid and coroutine. 

Preparations. 
Extractum Ergotae, Extract of Ergot, — Dose, gr. ij-x [av. gr. iv.] 
Fluidextractum Ergotas, Fluidextract oj Ergot, — Dose, njjx- 3j [av. njxxx.] 

Vinum Ergo tag, Wine of Ergot. — has of the fluidextract 20 per cent. Dose, 5j-iv 
[a v. 5ij] 

Ergotin (Unofficial), — is the name of several watery extracts found on the market, and 
varying much in action from each other and from the parent drug. That made by Squibb 
has about the same strength as the official extract, and represents the general powers of Ergot. 
It may be used hypodermically in doses of gr. J-gr. v. The Ergotin of Bonjean is an aqueous 
extract, very variable in quality and frequently inert. 

Injectio Ergotae Hypodermica, Hypodermic Injection of Ergot (B.P.),— is a 33 per 
cent, solution of the extract, in distilled water, with about 1 per cent, of Phenol. It should 
be recently prepared. Dose, hypodermically, Ttjmj-x. 

Ergone (Unofficial), — is the trade name of a fluid extract from which the inert, irritant, 
and depressant principles are said to have been removed as much as possible. It contains 
Chloretone as a preservative. Dose, njx- 3j- 

Ergoapiol (Unofficial), — is the trade name of a mixture of Ergot and Apiol, used in dys- 
menorrhea and other disorders of the menstrual function attended by pain. Dose, 1 capsule 
four times daily. 

Incompatibles. 

Incompatible with Ergot preparations are: Tannic Acid and other alkaloidal precipi- 
tants (see page 5), also Caustic Alkalies, Metallic Salts. Physiologically incompatible with 
its action on the circulation are: Aconite, Amyl Nitrite, Lobelia, Tobacco, Veratrum. 

Unofficial Analogue. 

Ustilago Maydis, Corn Smut, — is a fungus growing on maize. It contains a volatile 
alkaloid, Secaline, which is supposed to be identical with trimethylamine, and an acid prin- 
ciple resembling one of the constituents of ergot. Dose of the fluidextract, 5ss-ij. 

Physiological Action. 

Ergot is a powerful vaso-constrictor, a cardiac sedative, a motor excitant, 
and a stimulant of involuntary muscular tissue. It is hemostatic, ecbolic, 
anhidrotic, and convulsant. After a full dose there is at first a brief fall of the 
blood-pressure, due to the depressant action of the drug on the heart; but the 
vessels soon contract throughout the body, the blood-pressure is greatly raised, 
and the blood-supply being decreased an arterial ischemia results. This effect 
is generally believed to be due to stimulation of both the vaso-motor centre in 
the medulla, and the unstriped muscular fibres in the walls of the vessels, but 
some authorities hold that it is caused by the centric action alone. A very 
large dose depresses both the heart and the vaso-motor centre, the primary 
fall of blood-pressure continues, and progressive paralysis of the cardiac and 
vaso-motor apparatus results. 

Ergot causes powerful contractions of the parturient uterus by stimulating 
the spinal centres presiding over that organ. This action is not so constant 



272 ERGOTA. 

on the impregnated but not parturient womb, and though it often produces 
abortion it frequently fails to initiate uterine contraction in pregnant women. 
It arrests post-partum hemorrhage by laterally closing the blood outlets in 
spite of the increased pressure in the vessels. It increases intestinal peristalsis, 
blanches the intestinal vessels, and lessens the secretion of the urine, saliva, 
sweat, and milk. 

The phenomena produced by Ergot are divided into two classes, accord- 
ing as the drug is taken in large quantity for a short lime, or in small doses 
for a considerable period. In a large dose it acts as a gastro-intestinal irritant, 
causing nausea and vomiting, gastralgia, colic, thirst, and purging. It slows 
the heart, raises the arterial tension greatly, dilates the pupils and produces 
pallor, vertigo and frontal headache. It stimulates the contraction of unstriped 
muscular fibre, especially affecting the sphincters and causing contraction of 
the sphincter of the bladder, making micturition difficult if not impossible. 
It produces cerebral and spinal anemia, a great fall of the body-temperature, 
coldness of the surface, tetanic spasms, and violent convulsions. A very large 
dose is necessary to cause these results, and as much as |iij of the fluid extract 
has been given daily for a week or more, without producing any marked effect. 

Chronic Ergotism occurs in two forms, the convulsive and the gangren- 
ous, — either usually excluding the other. The convulsions are tetanoid spasms 
of the flexor muscles, the uterus, the intestinal fibres, and the muscles of respi- 
ration, ending in coma and death by asphyxia. The gangrenous form begins 
with coldness and numbness of the limbs, formication of the skin all over the 
body, loss of sensibility and abolishment of the special senses, bullae of blood and 
ichor, followed by dry or moist gangrene of the lower extremities, buttocks and 
other parts, epileptiform convulsions, coma and death. Autopsies show changes 
in the posterior columns of the cord, resulting probably from spinal anemia. 

Experiments with the various derivatives of Ergot show that no one of its 
constituents possesses the power of the drug itself. Its actions on the circu- 
lation and the uterus are ascribed to Sphacelotoxin, its convulsant action to 
Cornutine, and its effect on the heart and the stomach to Ergotinic Acid. 

The properties of Ustilago, so far as examined, resemble those of ergot 
and nux vomica combined. It is a spinal excitant and exalts sensibility and 
reflex action, producing tonic convulsions on irritation of the skin. It slows 
the heart by stimulation of the pneumogastric, dilates the pupils, causes mus- 
cular paresis and death by tetanus of the respiratory muscles or by exhaustion. 
Experiments on its reputed oxytocic action have not substantiated the claims 
made for it in this respect, though it is said to have produced abortion in cows 
which had eaten the diseased grain. 

Therapeutics. 
The most familiar use of Ergot is to promote uterine contraction in pro- 
tracted labor due to inertia of the womb, but as it produces continuous (tetanic) 



F.RGOTA. 273 

com rait ions instead of the intermittent natural ones, it is dangerous when 
there is much resistance in front of the child, the probable results being rupture 
of the uterus or severe laceration of the perineum, and stoppage of the placental 
respiration of the fetus. Towards the end of the second stage, when the head 
is beginning to emerge at the vulva, is the proper time for its administration, 
if used at all, in order to promote firm uterine contraction, thereby prevent- 
ing post-partum hemorrhage, promoting the expulsion of the placenta, and 
guarding against puerperal infection by closing the uterine lymph-spaces and 
thus opposing a barrier to the entrance of infectious material. It is used in 
many uterine affections, as chronic metritis, subinvolution, congestive dysmen- 
orrhea, hemorrhages, fibroids, and polypi, to produce firm contraction and pro- 
mote the absorption of inflammatory products. It is efficient in many cases 
of amenorrhea in plethoric subjects, and in the atonic type of spermatorrhea. 

Ergot is extensively employed in all forms of hemorrhage in which no direct 
styptic application can be made, and even when such is possible it is a useful 
hemostatic adjuvant. It is particularly efficient in uterine hemorrhages, pur- 
pura hemorrhagica, and in venous, capillary, and atonic arterial bleeding; but 
may be injurious in active arterial hemorrhage. Hemorrhoids are well treated 
by its local application, but in this affection it should not be used internally as it 
promotes venous congestion. In aneurism it aids coagulation by slowing the 
blood current, and in cardiac hypertrophy without valvular lesion it acts well 
by slowing the heart. In diabetes insipidus full doses of Ergot are often cura- 
tive, and it has been used with benefit in diabetes mellitus. In epilepsy it in- 
creases the efficiency of the bromides, and often gives good results. It is very 
efficient in enlargement of the spleen, and is said to have even cured leukemia. 
In conjunctivitis, gonorrhea, and inflammations of mucous membranes gener- 
ally, it is of striking benefit, if used both locally and internally. It is an excel- 
lent remedy in acute and chronic dysentery, chronic diarrhea, mania due to 
cerebral hyperemia, headache and migraine of congestive form, myelitis, spinal 
congestion, cerebro-spinal meningitis, lax sphincters of the rectum and bladder, 
and incontinence of urine from paralysis of the sphincter vesicae. 

Hypodermicallv, the aqueous extract dissolved in water and free from al- 
cohol or any other irritating substance, is in many cases much more prompt 
in action than when given internally, especially if injected near the seat of the 
affection. This is particularly true in post-partum and other hemorrhages, 
prolapse of the rectum, chronic metritis and subinvolution of the womb, uterine 
fibroids, varicocele and varicose veins. When so administered it will frequently 
contract the sphincter of the bladder so as to produce retention of urine and 
necessitate the use of the catheter. 

Ustilago has been used in uterine inertia during labor, in doses of 3j-ij of 
the fluidextract, and is said to increase the severity, frequency, and duration 
of the expulsive efforts, while not causing so prolonged a contraction as ergot 
docs. 

10 



274 ERIGERON — EUCALYPTUS. 

ERIGERON, Fleabane (Unofficial), — is the flowering plant Erigeron canadense, a plant 
of the nat. ord. Composite, growing in N. America. It contains a Volatile Oil, which is offi- 
cial, also tannic acid and a bitter extractive. 

Oleum Erigerontis, Oil oj Fleabane, — a pale yellow liquid, becoming darker by age and 
exposure to air, of peculiar and persistent odor, pungent taste and neutral reaction, readily 
soluble in alcohol. Dose, njx-5ss[av. ttjjxv.] 

Oil of Erigeron has the same action as Oil of Turpentine but is less irritant and less effi- 
cient. It has considerable reputation as a hemostatic, especially in menorrhagia and intes- 
tinal hemorrhage of passive form, as in typhoid fever. It is used with benefit in diarrhea and 
dysentery, and in hemoptysis without fever or other evidence of irritation it is a valuable 
remedy. 



ERIODICTYON, the dried leaves of Eriodictyon calijornicum, the Yerba Santa, a Cali- 
fornia shrub of the nat. ord. Hydrophyllaceas. They contain an acrid resin and an aromatic 
Volatile Oil. Dose, gr. v-xxx [av. gr. xv.] 

Fluidextractum Eriodictyi, Fluidextract 0} Eriodictyon, — Dose, ttjjv-xxx [av. njfxv.] 
Eriodictyon is expectorant, and covers the taste of Quinine in a remarkable manner, for 
which purpose it is combined in mixture with Glycyrrhizin, under the title Velatine, a pro- 
prietary preparation. It is used with fair success in bronchial and laryngeal affections, 
also in asthma. Combined in syrup with Grindelia it is very efficient for coughs. 

EUCALYPTUS, Eucalyptus,— the dried leaves, collected from the older 
parts of the tree, of Eucalyptus Globulus or blue gum-tree, nat. ord. Myrtaceae, 
a native of Australia, now grown in California and Italy. They contain tannic 
acid, a resin, a fatty acid and a Volatile Oil. The latter consists of three different 
oils which distil over at various temperatures, the first product being the offi- 
cial substance Eucalyptol, which by the action of phosphoric acid is converted 
into Eucalyptene, a substance allied to Cymene, and Eucalyptolen. Dose, gr. 
X-3J [av. gr. xxx.] 

Preparations. 

Fluidextractum Eucalypti, Fluidextract oj Eucalyptus, — is three-fourths alcohol. 
Dose, tijx-5J [av. njxxx.] 

Oleum Eucalypti, Oil oj Eucalyptus, — the volatile oil, is distilled from the fresh leaves 
of Eucalyptus. Is soluble, in all proportions, in alcohol, carbon disulphide, or glacial acetic 
acid. Dose, ttjjv-xx [av. njviij.] in emulsion or capsules. 

Eucalyptol, Ci H 18 O, — is an organic oxide (cineol) obtained from the volatile oil; a 
colorless liquid, of aromatic, camphoraceous odor, and pungent, cooling taste; soluble in all 
proportions in alcohol, carbon disulphide and glacial acetic acid. Dose, njuij-x, [av. nj>v.] 

Incompatible with Eucalyptol is Potassium Permanganate. 

Sanosin (Unofficial), — is a mixture of Sulphur, Charcoal, and pulverized Eucalyptus 
leaves, impregnated with the Oil of Eucalyptus. The fumes of this preparation w-hen burn- 
ing are used in Germany as an inhalation in pulmonary tuberculosis, with reported germicidal 
effect upon the bacilli. 

Physiological Action. 
The taste of Eucalyptus is warm, aromatic, bitter and camphoraceous. It 
increases the flow of saliva, the gastric juice and the intestinal secretions, and 
in small doses promotes appetite and digestion, increases the heart's action 
and lowers arterial tension. In large doses it produces eructations, indigestion, 
diarrhea, nausea and vomiting, lowered temperature, great muscular weakness, 
and if continued will irritate and congest the kidneys, and induce a feverish 



EI 0NYM1 S. 275 

state with symptoms of cerebral congestion and great ('(institutional disturbance. 

In toxic dosos it is a narcotic poison, and a fatal dose causes paralysis of respi 
ration by direct action on the respiratory centre in the medulla. 

Eucalyptus is powerfully antiseptic and destructive to low forms of life, 
a stimulating expectorant and an efficient diaphoretic. By some authorities 
it is believed to reduce the size of an enlarged spleen and to possess anti-ma- 
larial properties by absorbing noxious germs as well as by draining the soil of 
its water, and by its aseptic emanations purifying the atmosphere in its vicinity. 
It is largely cultivated in malarial districts for these properties, and is reported 
to have rendered habitable a portion of the deadly Roman Campagna. 

Eucalyptus is eliminated by the skin, the bronchial mucous membrane and 
the kidneys. It imparts its odor to the breath and the urine, and is more or 
less irritant at the points of its elimination. 

Therapeutics. 
Eucalyptus is an efficient stomachic in atonic dyspepsia and chronic gastric 
catarrh, and is used in intestinal catarrh, and in conditions of the intestinal 
canal which favor the development of worms. In chronic catarrhal conditions 
of the genito-urinary organs, the broncho-pulmonary mucous membrane and 
especially the bladder, it is very useful, acting as a stimulant and disinfectant 
to the mucous membranes. It is equally beneficial in chronic bronchitis and 
bronchorrhea, in cachectic states generally and in convalescence from acute 
diseases. In epidemic influenza (grippe) the oil has been used internally with 
good results, and sprinkled on blotting-paper placed in offices and stores has 
seemed to act as a prophylactic on persons employed therein. In hysteria, chorea 
and asthma it is beneficial, in the latter affection being advantageously smoked 
in cigarettes with stramonium or belladonna leaves. In malaria as a recon- 
structant it is better than quinine, and it has considerable utility in obstinate 
intermittents where it is desirable to stop the use of cinchona preparations. 
As an antiseptic it is highly valuable in dilute solution for application to ulcers 
and as a substitute for phenol on gauze in the antiseptic treatment of wounds. 
It is used in dilute solution locally, as a stimulating disinfectant in stomatitis, 
and in the subacute stages of pharyngitis and tonsillitis. An aqueous prepa- 
ration is highly recommended as a vehicle for alkaloids in solution for hypo- 
dermic use, to prevent the development of the penicillium which rapidly destroys 
the alkaloid. 

Sodium Glycocholate is an excellent cholagogue, and stimulates the digestion of fats in 
marked degree. Its dose is gr. ij-v, thrice daily. 

EUONYMUS, Euonyrmis, — is the dried bark of the root of Euonymus atropurpureus, 
Wahoo, nat. ord. Celastracea, native in the United States. It contains a bitter principle 
Euonymin, also Asparagin, Euonic Acid, resins and a fixed oil. Dose, gr. v-xv [av. gr. vijss.] 

Extractum Euonymi, Extract of Euonymus, — Dose, gr. j-v [av. gr. ij.] 

Fluidextractum Euonymi, Fluidexlract of Euonymus, — Dose, lTjfv-xv [av. TTRviij.] 



276 EUPATORIUM — FERRUM. 

Euonymin (Unofficial), — the eclectic preparation, consists of the fixed oil and resin, 
and is given in doses of gr. ss-v. 

Euonymus is classed with Rhubarb, Jalap, Aloes, etc., as a tonic-astringent and resin- 
bearing purgative. It is said to be also diuretic and expectorant and a very efficient chola- 
gogue. Its cathartic action is similar to that of Rhubarb, but milder. It has been employed 
with benefit in some cases of dropsy, also in habitual constipation, torpid liver, and pulmonary 
affections. In overdoses it will set up considerable gastro-intestinal irritation. 

EUPATORIUM, Eupatorium, {Thorough-wort, Boneset) — the dried leaves and flow- 
ering tops of Eupatorium perjoliatum, an American plant of the nat. ord. Compositae. It 
contains a neutral, bitter principle, named Eupatorin, tannic acid, a volatile oil, etc. Dose, 
gr. x- 5j [av. gr. xxx.] 

Fluidextractum Eupatorii, Fluidextract oj Eupatorium,- — Dose, iTgx-5j [av. tijxxx.] 
Eupatorium is a bitter tonic and efficient diaphoretic, also in full doses emetic and 
aperient. It has been supposed to have antiperiodic and teniafuge powers. A warm infu- 
sion (Boneset tea) is a popular diaphoretic in remittent and typhoid fevers, also at the onset 
of an attack of acute catarrh or general cold. As a bitter tonic it may be used with advantage 
in dyspepsia and general debility. Its common name is derived from its supposed power to 
relieve the bone pains of dengue, the "break-bone fever." 

Another variety of Eupatorium, E. purpureum, Gravel-root, is reputed to have decided 
power over the uric acid diathesis. 

EUPHRASIA, Eye-bright (Unofficial), — is a plant of the nat. ord. Strophulariaceae, 
growing in Europe and the U. S., containing Euphrastic Acid, tannin, etc. It was formerly 
of great repute in various eye-affections, and may be of utility as a mild astringent in catarrhal 
conjunctivitis. Its chief value, however, is to abort an attack of acute nasal catarrh with 
lachrymation, for which purpose a few drops of the tincture every two hours is said to be 
remarkably efficient. In hay-fever it is of decided utility in mitigating the catarrhal symp- 
toms, and in the acute coryza of measles it will be found an excellent remedy. A tincture of 
the fresh plant (1 in 10) should be used, and given in doses of njrj-v. 

FEL BOVIS, Ox-gall, (Fel Tauri), the fresh bile of Bos Taurus, the ox,— is a dark- 
green, viscid liquid, of peculiar odor, bitter taste, and neutral or faintly alkaline reaction. It 
contains Sodium Glvcocholate, Sodium Taurocholate, Cholesterin and coloring matter. 

Fel Bovis Purificatum, Purified Ox-gall, — 3 of Ox-gall and 1 of Alcohol evaporated to 
pilular consistence after standing 24 hours. Dose, gr. v— xv [av. gr. vijss.] 

Bile is tonic, antiseptic and purgative. It assists in the emulsification of fats, and stimu- 
lates the absorbent powers of the mucous membrane. In the stomach it neutralizes the 
gastric juice, precipitates the pepsin, and is apt to cause nausea annd vomiting. It is found 
to act well in stimulating the resolution of hypertrophies when locally applied to the part, as the 
mammae and tonsils, also for pannus. It is used as a laxative in constipation when the secre- 
tion of bile is deficient, but has no advantages over other purgatives. 

FERRUM, Iron, Fe, — is metallic Iron in the form of fine, bright, and 
non-elastic wire. 

Ferrum Reductum, Reduced Iron, — is metallic Iron in fine powder, ob- 
tained by reducing the Sesquioxide by hydrogen at a dull red heat. It is a 
fine, gray-black, lustreless powder, odorless, tasteless, and insoluble in water 
or alcohol, but soluble in dilute sulphuric acid with evolution of nearly odor- 
less hydrogen gas. Dose, gr. ss-ij [av. gr. j ], after meals. 

Salts oj Iron and their Preparations. 

Ferri Carbonas Saccharatus, Saccharated Ferrous Carbonate, — has at least 15 per 
cent, of ferrous carbonate. A greenish-gray powder, of sweetish taste at first, changing to 



l'IKKI'M. 



277 



ferruginous. Partially soluble in water, but soluble in dilute hydrochloric arid with evolution 

of ("0 3 . Anion, — slightly stimulant to the digestive tract. Dose, gr. ij-x [av. gr. [v.] 

Massa Ferri Carbonatis, Mass of Ferrous Carbonate, ( Vallet's Mass) —Ferrous Sulphate 
100, Sodium Carbonate 46, Honey 38, Sugar 25, Syrup and Distilled Water, each, to make 
100 parts. Has 42 per cent, of Ferrous Carbonate. An astringent, non -irritant, ferruginous 
tonic Dose, gr. j-v, [av. gr. iv] after food. 

Pilulae Ferri Carbonatis, Pills of Ferrous Carbonate, (Ferruginous Pills, Chalybeate 
Pills, Bland's Pills) — made by mixing Ferrous Sulphate, about 2k grains for each pill, with 
Potassium Carbonate, Sugar, Tragacanth, Althasa, Glycerin and Water. Dose, j-iij [av. ij.] 

Mistura Ferri Composita, Compound Iron Mixture. (Griffith's Mixture), — has of Fer- 
rous Sulphate 6, Myrrh iS, Sugar 18, Potassium Carbonate 8, Spirit of Lavender 60, Rose- 
water to 1000. Is really a solution of the Carbonate formed by reaction between the two 
principal constituents. An excellent chalybeate. Dose, 5ij-vj fav. gr. iv.] 

Ferri Chloridum, Ferric Chloride, (Perchloridc oj Iron) FeCl,,+ i2H 2 0, — orange-yellow, 
[uescent pieces, of styptic taste and acid reaction, freely soluble in water, alcohol or ether. 
Vtion, — strongly astringent, hemostatic. Dose, gr. ss-jss [av. gr. j.] 

Liquor Ferri Chloridi, Solution oj Ferric Chloride, — an aqueous solution of the preceding, 
containing 29 per cent, of the anhydrous salt, with some free HC1. Action is strongly 
astringent and styptic. Dose, njtj-iij [av. ngjss.], well diluted. Creuse's Tasteless Solution, 
is an agreeable preparation; it has Liquoris Ferri Chloridi oj, Acidi Citrici gr. 544, Sodii 
Carb. gr. 1000 or q. s., Aquas Destil. 3 j, Alcoholis, q. s. Dissolve the citric acid in trie water, 
heat to the boiling point, gradually adding the sodium carbonate until the acid is neutralized; 
mix with the iron solution and add alcohol up to a total of oiv. Dose, irjjxx-xxx, diluted. 

Tinctura Ferri Chloridi, Tincture oj Ferric Chloride, — a hydro-alcoholic solution of 
Ferric Chloride, containing about 13.3 per cent, of the anhydrous salt, corresponding to about 
4.6 per cent, of metallic iron. Has of the preceding solution 33 in Alcohol to make 100. A 
bright, brownish liquid, of ethereal odor, styptic taste and acid reaction. Is used in Mistura 
Ferri et Ammonii Acetatis. One of the best preparations of Iron. Action, — ferruginous 
tonic. Dose, njjv-xv [av. itjjviij.] in water, syrup or glycerin. 

Ferri Citras, Ferric Citrate, — garnet-red, transparent scales, slowly soluble in water, 

in alcohol. Action, — mildly stimulant. Dose, gr. ij— vj [av. gr. iv.] 

Ferri Hypophosphis, Ferric Hypo phosphite, — a white or grayish-white powder, odor- 
tasteless, slightly soluble in water, freely so in HC1 or in a solution of sodium citrate. 
V lion, ferruginous tonic. Dose, gr. j-v [av. gr. iij.] 

Pilulae Ferri Iodidi, Pills oj Ferrous Iodide, — made with Reduced Iron, Iodine, Licorice, 

Sugar, Acacia and Water, covered with a coating of Balsam of Tolu in Ether. "Blancard's 

rills'' differ from these only in being covered with a coating of reduced iron to protect the 

interior from oxidation, but it also protects them from the solvent action of the gastric juice. 

. 1 or 2 pills [av. ij], thrice daily. 

Syrupus Ferri Iodidi, Syrup of Ferrous Iodide, — is a syrupy liquid containing 5 per 
cent, of ferrous iodide. Action, — ferruginous tonic. Dose, jijv-xxx [av. rtjxv.] 

Ferri Hydroxidum, Ferric Hydroxide (Hydrated Ferric Oxide) Fe(OFf) 3 — is a brown- 
red magma, wholly soluble in HC1 without effervescence. Should be freshly prepared by 
mixing together Solution of Ferric Sulphate 100, Ammonia Water 138, and Water to 300 
grammes. It is the chemical antidote for Arsenic. Dose, 3j in water, frequently repeated. 

Ferri Hydroxidum cum Magnesii Oxido, Ferric Hydroxide with Magnesium Oxide 
(Ferric Hydrate with Magnesia), — is a more convenient and more efficient antidote for 
\r>enic than the preceding, as the excess of the alkaline precipitant is non-irritant, and is 
itself an Arsenic antidote. The two following solutions should be kept ready: (1) Solution 
of Ferric Sulphate 40 Cc. in Water 125 Cc. (2) Magnesium Oxide, 10 grammes rubbed up 
with Water 750 Cc. in a bottle of 1000 Cc. capacity. When wanted, shake the latter to a 
homogeneous magma, add it to the former gradually, and shake them together to a uniform, 
smooth mixture. Should be given in large doses ( §iv) and frequently repeated. 

Ferri Phosphas Solubilis, Soluble Ferric Phosphate, — bright-green, transparent scales, 
of acidulous, saline taste, soluble in water, not in alcohol. Used as an adjuvant to laxative 
pills to prevent the after reactionary constipation. Dose, gr. j— vj [av. gr. iv.] 

Ferri Pyrophosphas Solubilis, Soluble Ferric Pyrophosphate, — green, transparent 
5, of acidulous taste, soluble in water but not in alcohol. Is almost tasteless and unirri- 
tating, and non-constipative. Dose, gr. ij— v. [av. gr. iv.] 

Ferri Sulphas, Ferrous Sulphate, FeSO.,4- /H 2 0, — large, pale, bluish-green prisms, 



278 J-'ERRL.M. 

efflorescent, of saline, styptic taste, and acid reaction, soluble in water, insoluble in alcohol. 
Is chiefly used to make the Dried Sulphate and other preparations. Dose, gr. j-v [av. gr. iij.] 

Ferri Sulphas Exsiccatus, Exsiccated Ferrous Sulphate, — a grayish-white powder, 
nearly soluble in water, consisting of the preceding salt, heated gradually until it ceases to 
lose weight. The most astringent and irritating ferrous salt, but an excellent one in small 
doses. Dose, gr. ss-iij [av. gr. ij.] in pills. 

Ferri Sulphas Granulatus, Granulated Ferrous Sulphate, — is the same salt as the 
Sulphate, precipitated by alcohol from solution in dilute sulphuric acid. Dose, gr. ss-v 
[av. gr. iij.] 

Liquor Ferri Subsulphatis, Solution of Ferric Subsulphate, {Monsel's Solution) — is 
an aqueous solution of chiefly Basic Ferric Sulphate; a dark, reddish-brown, almost syrupy 
liquid, of very astringent but not caustic taste, and acid reaction, mixing with water and alcohol 
in all proportions without decomposition. Is but slightly irritating and powerfully astringent, 
chiefly used locally as an astringent and hemostatic, but may be given internally in doses of 
HRJ-v [av. njjiij ] well diluted. 

Liquor Ferri Tersulphatis, Solution of Ferric Sulphate, — is an aqueous solution of 
Normal Ferric Sulphate, Fe 2 (S0 4 ) 3 , containing 36 per cent, of the salt. Has the properties 
described for the preceding. Used to make other preparations of Iron. 

Compound Iron Salts and their Preparations. 

Liquor Ferri et Ammonii Acetatis, Solution oj Iron and Ammonium Acetate, (Basham's 
Mixture) — prepared with Tincture of Ferric Chloride 4, Diluted Acetic Acid 6, Solution of 
Ammonium Acetate 50, Aromatic Elixir 12, Glycerin 12, Water to 100. An excellent and 
very pleasant preparation, having some diuretic and diaphoretic powers. Dose, 5 ij-vj 
[av. 3iv ], well diluted. 

Ferri et Ammonii Citras, Iron and Ammonium Citrate, — transparent, garnet-red 
scales, deliquescent, readily soluble in water, insoluble in alcohol. Dose, gr. ij-vj [av. gr. iv.] 

Vinum Ferri, Wine oj Iron, — has of Iron and Ammonium Citrate 4 per cent. Dose, 
3j-iv [av. oij-] 

Ferri et Ammonii Sulphas, Ferric Ammonium Sulphate {Ammonio-jerric Alum, — pale, 
violet crystals, efflorescent, of styptic taste and slightly acid reaction, soluble in 3 of water, 
insoluble in alcohol. Is the least astringent of the sulphates of iron, but more so than any of 
the salts formed by vegetable acids. Dose, gr. iij-xv [av. gr. vijss.] 

Ferri et Ammonii Tartras, Iron and Ammonium Tartrate, Ammonio-jerric Tartrate, — 
transparent, reddish-brown scales, slightly deliquescent, of sweetish and slightly ferruginous 
taste, very soluble in water, insoluble in alcohol. Contains an equivalent of about 25 per 
cent, of Ferric Oxide, and has but slight irritant qualities. Dose, gr. ij-vj [av. gr. iv.] 

Ferri et Potassii Tartras, Potassio-jerric Tartrate, — transparent, garnet-red scales, 
slightly deliquescent, of sweetish and slightly ferruginous taste, very soluble in water, insol- 
uble in alcohol. Is the least disagreeable in taste of all the iron preparations, and but slightly 
astringent and not constipating. Dose, gr. ij-vj [av. gr. iv.] 

Ferri et Quininae Citras, Iron and Quinine Citrate, — thin, transparent, yellowish-brown 
scales, slowly deliquescent, of bitter taste, slowly soluble in water, slightly soluble in alcohol. 
Contains n\ per cent, of dry quinine. Action, astringent and stimulant to the digestive tract. 
Dose, gr. iij-v [av. gr. iv.] 

Ferri et Quininae Citras Solubilis, Soluble Iron and Quinine Citrate, — thin, transparent 
scales, of greenish, golden-yellow color, rapidly soluble in cold water, partly soluble in alcohnl. 
Dose, gr. iij-v [av. gr. iv.] 

Vinum Ferri Amarum, Bitter Wine oj Iron, — has of the preceding 5 parts, Tinct. 
Aurantii Dulcis 6, Syrup 30, White Wine to 100. Dose, 5j-iv[av. oij-] 

Ferri et Strychninae Citras, Iron and Strychnine Citrate, — transparent, garnet-red 
scales, deliquescent, readily soluble iri water, slightly so in alcohol. Contains 1 per cent, of 
Strychnine. Action, — astringent and stimulating. Dose, gr. j-iij [av. gr. ij.] 

The Glycerite, Elixir, and Syrup of the Phosphates of Iron, Quinine and Strych- 
nine are described under Phosphorus. 

Syrupus Hypophosphitum Compositus, Compound Syrup oj Hypophosphites, — has 
of Ferric Hypophosphite 2} per cent., and is described under Phosphorus. 

Pilulae Aloes et Ferri, Pills oj Aloes and Iron, — are described under Aloes. 



ii i:i;i \i. 27c; 

Unofficial Preparations oj Iron. 

Ferratin, Acid Albuminate oj Iron, — is a patented preparation, claimed to be the charac- 
teristic iron compound of the liver, but this is denied by competent authority. It is artificially 

red from albumin, is insoluble in water and dilute acids, but is soluble in water having a 
slight alkaline reaction. It causes no digestive disturbance, and has given good results in 
anemia, chlorosis, and allied affections. Dose, gr. jss-viij. 

Ferri Albuminas, Iron Albuminate, — a cinnamon-brown powder, soluble in water acidu- 
lated slightly with HC1. Dose, gr. x-xxx, in simple aqueous solution, or in pill. 

Ferrinol, — is a combination of iron and nucleinic acid. It occurs in the form of a brown 
der, and contains about 6 per cent, of iron. It is not acted on by the gastric juice and 

does not irritate the stomach, but is absorbed entirely from the small intestine. Dose, gr. iij-v, 

thrice daily. 

Hemogallol, — is Hemoglobin deoxidized by pyrogallol. It occurs as a reddish-brown 
powder, insoluble in water and in alcohol. It is claimed to be the nearest to blood iron of any 
of the organic iron preparations, and to be readily assimilated without disagreeable effects of 
any kind. Dose, gr. iv-viij, thrice daily, i hour before meals. 

Ferri Bromidum, Ferrous Bromide, FeBr 2 + 3H 2 0, — a yellow salt, of styptic taste, un- 
-, deliquescent and very soluble. A syrup was official in the Br. Ph. which had about 4 J 
grains of the bromide in each fluid-drachm. Dose of the syrup, 5ss-j. 

Ferrum Dialysatum, Dialyzed Iron, — is a 10 per cent, solution of Ferric Oxychloride 
in water. A reddish-brown liquid, free from astringent, styptic taste, but a very feeble chalyb- 
eate. Is used as a chalybeate, and as an antidote to Arsenic, but is not considered an eligible 
preparation. Dose, njjx-xxx. 

Ferri Malas, Ferrous Malate, — is a combination of the juice of sour apples and powdered 
iron, much esteemed in Germany, where it is official and is given in tincture, Tinctura Ferri 
Pomatum (Ph. Ger.), the dose of which is ttjxv-xxx. 

Peptomangan, Liquor Mangano-ferri Peptonatus, — is described under Manganum. 

Mistura Ferri Laxans, Laxative Iron Mixture, — Ferri Sulph. gr. ij, Magnesii Sulph. 
3j, Ac. Sulph. Dil. rrryij, Spt. Chlorof. ittjxx, Aq. Menth. Pip. ad 5j. Dose, 5j- 

Mistura Ferro-salina, Ferro-saline Mixture, — Magnesii Sulph. oj, Potassii Bitart. 3j, 
Ferri Sulph. Exsic. gr. x, Aquas quart j. Dose, a wineglassful. 

Syrupus Ferri et Mangani Iodidi, Syrup of Iron and Manganese Iodide, — is a pale, 
straw-colored liquid, containing a little sulphate of potassium, and in each fluid o has 50 
grains of the mixed iodides in the proportion of Iron Iodide 3 parts to 1 of Manganese Iodide. 
Dose, Tn;x-xxx. 

Syrupus Ferri et Mangani Phosphatis, Syrup of Iron and Manganese Phosphate, — 
as used by Dr. Simpson, of Edinburgh, contains in each 5 of syrup 2 grains of Iron Phosphate 
and 1 grain of Manganese Phosphate. Dose, 3j- 



Incompatibles. 

Incompatible with Metallic Iron are: Hydrogen Dioxide, Oxidizers, Potassium Chlorate, 
Potassium Permanganate; Salts of Antimony, Copper, Bismuth, Lead, Mercury, and Silver. 
With Ferrous Salts are: Alkalies, Carbonates, Chromates, Chlorates in acid solution, Ferri- 
cyanides, Gold salts, Hydrogen Dioxide, Mercuric salts, Phosphates, Permanganates, Sulphides, 
Tannic Acid, Silver Salts. With Ferric Salts are: Acacia, Albumin, Alkalies, Apomorphine, 
Aloin, Benzoates, Carbonates, Creosote, Balsam of Peru, Benzoin in alcoholic solution, Di- 
uretin, Gallic Acid, Gelatin, Guaiac, Guaiacol, Hydriodic Acid, Hypophosphites, Hypo- 
sulphites, Iodides, Morphine; Oils of Bay, Cloves, Cinnamon, Pimento, Thyme, and Winter- 
green; Pyrogallol, Resorcin, Salol, Salicylates, Sulphides, Sulphites, Tannic Acid, Vegetable 
infusions and decoctions. 

Incompatible with the Tincture of Ferric Chloride are: Acacia, Albumin, Alkalies, Car- 
bonates, Gelatin, Lime-water, Magnesium Carbonate, Piperazin, Vegetable decoctions, in- 
fusions, and tinctures. With Ferrous Sulphate are: Alkalies, Carbonates; Chlorides of Am- 
monium, Barium, and Calcium; Gold and Silver salts, Lead Acetate, Lime-water, Piperazin, 
Po'assium Iodide, Potassium Nitrate, Rochelle salt, Sodium Borate, Tannic Acid, Vegetable 
astringent infusions. 



280 FERRUM. 

.Votes on the Preparations. 

The blandest iron preparations are those which are insoluble or but spar- 
ingly soluble in water; as metallic iron, ferrous carbonate, ferric hydroxide 
and ferric hypophosphite. Of the aqueously soluble compounds, those which 
are salts of the vegetable acids, and the mixed salts ferric phosphate and ferric 
pyrophosphate, are more or less bland, especially the citrate, the tartrate and 
the phosphate, which are purely bland. The iron salts of the strong mineral 
acids are irritant and astringent or styptic in varying degree; the iodide and 
bromide are irritant but not very astringent, ferrous sulphate and the ammonio- 
ferric sulphate are powerfully astringent but not styptic; and ferric chloride, 
ferric nitrate and ferric sulphate are powerfully astringent and styptic. In over- 
doses the astringent salts are irritant poisons and may produce fatal results 
if in sufficient volume and concentration of solution. The per-salts (ferric) 
are the most actively irritant. The ferrous salts are the most readily absorbed 
and tolerated, are less irritant and astringent than the ferric salts, and are the 
most suitable ones for prolonged administration. 

The Oxides and Carbonates possess the hematinic action of iron with but 
slight astringency, and are therefore employed to restore the quality of the blood 
in cases of anemia, chlorosis and amenorrhea with tendency to dyspepsia and 
constipation. Ferrum Reductum is one of the best preparations for internal 
use, but it causes sulphuretted or phosphoretted eructations which are dis- 
agreeable. The Subcarbonate is little more than the red oxide, but in the massa 
ferri carbonatis oxidation is prevented by the sugar. The Hydroxide is used 
only as an antidote in arsenical poisoning. 

The Vegetable Acid Salts are the least irritant to the stomach, but are also 
the least efficient as chalybeates. They may be administered in white wines, 
or with alkalies and vegetable acids in effervescent mixtures. The Mineral 
Acid Salts are characterized by their astringent and corrugating action on the 
tissues, and are used locally as hemostatics, the solution of the subsulphate 
being preferred for topical use as it is powerfully styptic but not corrosive. 
The pyrophosphate is easily assimilated, readily soluble and devoid of irritant 
qualities. The tincture of the chloride is one of the most efficient prepara- 
tions for internal use, and is most agreeable in the form of Creuse's tasteless 
solution. Other Compounds contain iron in combination with other active 
agents, as the preparations of the iodide and bromide, those with quinine and 
strychnine. These preparations are generally used for a twofold purpose, 
namely to relieve anemia and to act upon the specific ailment upon which the 
anemia depends. The Albuminate contains 5 per cent, of ferric oxide and 
is considered by many practitioners to be the most readily assimilated of all 
the iron preparations. Ferratin and other organic iron preparations are claimed 
to be devoid of irritant qualities, and to be fully efficient chalybeates. 



FERRUM. 2S1 

Physiological Action. 

Metallic Iron is not inert, for in the stomach it acquires molecular activity 
through its oxidation. It is a normal constituent of the blood (1 part to 230 
of red corpuscles), and is also found in the bile, lymph, chyle, gastric juice, in 
the pigment of the eye, in the milk and in the urine. Occurring in the blood, 
the tissues generally and many of the healthy secretions, also in most of the 
foods upon which the body is nourished, it may be considered a food rather 
than a medicine, though it has many medicinal uses. Administered internally 
in small doses it acts as a stomachic and general tonic, promotes appetite and 
digestion and improves the quality of the blood, increasing the number of the 
red corpuscles. 

In large doses or in small ones long continued it is directly unfavorable to 
digestion, nausea and vomiting being caused by the soluble preparations. Its 
per-salts are actively irritant, and some, as the iodide, chloride, nitrate and sul- 
phate, are active poisons, highly astringent to the tissues and very injurious 
to the teeth. Locally the iron salts of the mineral acids are more or less con- 
stringent and irritant to the mucous membranes and the tissues, acting as as- 
tringents and hemostatics by virtue of their power to coagulate albumin. The 
tincture of the chloride is considered diuretic. 

Absorbable iron preparations administered to a healthy person, or for a 
long time in disease, exert but little influence, and give rise to few and slight 
clinical symptoms. A sense of tension and fulness of the head, dull pains, 
discomfort, also a hard and quickened pulse, constitute usually the only ob- 
vious derangement. When given, however, to a person suffering from anemia 
or chlorosis the morbid symptoms expressive of deficient hemoglobin subside 
and the patient soon improves in health and strength. The action of iron is 
to cause an increase of the hemoglobin of the red blood corpuscles either by 
its direct conversion into an ingredient of hemoglobin, or by stimulating the 
functional activity of the hematopoietic organs, or perhaps by both means 
combined. This power of enriching the red blood corpuscles with hemoglobin 
is essentially the whole constitutional action of iron. About 40 to 50 grains are 
estimated to be present in the tissues of a healthy adult, but only about jj to 
$ of a grain is daily supplied by the ordinary dietary. This amount of intake 
is sufficient to preserve the iron equilibrium, about the same quantity being 
excreted daily, chiefly in the feces and to a slight extent in the urine. 

In the stomach all iron preparations are changed to the chloride by the 
HC1 of the gastric juice, and in the duodenum to an alkaline albuminate. The 
greater portion is carried on through the intestinal canal, where it is converted 
into a sulphide, which blackens the feces; a part, however, is absorbed by the 
intestinal epithelium in solid form and perhaps in solution. After reaching 
the blood by way of the lymph channels, this small quantity of absorbed iron 
is deposited in the spleen, where it may undergo some changes, is again taken 
up by the blood and deposited in the liver and perhaps in the bone marrow. 



282 FERRUM. 

In the liver the originally inorganic iron is converted into higher forms and 
eventually into hemoglobin, ferratin being probably one step in the series. When 
there is no deficiency of iron in the system the liver slowly yields its store to 
the blood again, to be carried to the cecum and large intestine, by the epithe- 
lium of which it is finally excreted. 

The doctrine of Kletzinsky, Bunge and others, concerning the non-absorp- 
tion of iron, though often shown to be erroneous, is occasionally resuscitated 
by writers and teachers of medicine. Briefly stated, this doctrine is as follows: 
That the iron existing in food-stuffs as a constituent of nucleo-albumin is the 
only source of iron supply to the system for the formation of hemoglobin. That 
no iron compound administered by the stomach is absorbed, but after conver- 
sion to a chloride by the gastric juice the only function of iron so administered 
is to chemically satisfy the hydrogen sulphide and other sulphur compounds 
in the intestinal canal, thereby protecting the ingested food-iron from attack 
by these sulphur compounds and permitting it to enter the system. Against 
this theory have been urged the facts that no metal replaces iron in the treat- 
ment of chlorosis, though others would similarly satisfy the sulphur compounds; 
that iron is curative in chlorosis when injected hypodermically, and that the 
sulphide administered so as to reach the intestines unchanged acts as well as 
other iron preparations. Furthermore, it has been shown that ordinary prepa- 
rations of iron given internally are absorbed; also that anemia is not neces- 
sarily accompanied by intestinal putrefaction; while it has never been demon- 
strated that hydrogen sulphide is invariably present in the intestinal canal of 
chlorotic subjects. 

Therapeutics. 
The chief indication for the internal administration of Iron is anemia, when 
plethora, hemorrhage or fever exist it is contraindicated. It should always be 
given after meals, and occasionally suspended for a time, to avoid deranging 
the stomach. It is generally considered useless to prescribe iron in any form 
until after constipation has been relieved and a regular action of the bowels 
established. When the appetite and digestion are improved by Iron it will 
do the greatest amount of good, many authorities holding that the principal 
benefit derived from its use, even in anemia, is due to its stimulating action upon 
digestion and the primary assimilation. The sulphate is one of the most effi- 
cient salts and is well used in combination with aloes when any intestinal tor- 
por exists, especially as it increases the cathartic power of the latter drug, econ- 
omizing it, and conferring upon it a permanence of action, which alone it does 
not possess. In chlorosis, pseudo-leucocythemia, chorea of anemic girls at the 
age of puberty, epilepsy and neuralgia of the anemic, amenorrhea and other 
menstrual disorders of the same class of subjects, and in acute rheumatism of 
pale, cachectic persons, the chalybeates are generally very efficient remedies, 
especially the tincture of the chloride. The same preparation is extensively 
employed in erysipelas and diphtheria with good results, and in albuminuria 



FICIS FCENICT I 1 M. 

with chronic disease of the kidneys it is a useful chalybeate diuretic. In many 
cardiac diseases of the anemic, fatty heart, weak heart, dilatation, and mitral 
disease, ferruginous preparations are often of signal advantage. In the syphilitic 
cachexia, chancroid, and sloughing phagedena, the iodide gives good results, 
particularly when the subject is one of debilitated constitution. In the noc- 
turnal incontinence of children the syrup of the iodide is one of the most effi- 
cient remedies. In all chronic affections of the respiratory organs, when hem- 
orrhage is not existing or threatened, the iron, quinine and strychnine phos- 
phate is used with much benefit. In passive hemorrhages, especially when 
due to anemia, the tincture of the chloride is very effective, and in all active 
bleeding the solution of the subsulphate locally used is a prompt and efficient 
hemostatic. A weak solution of the latter preparation (33 ad ,5\iij), used in the 
form of spray, is one of the most serviceable astringents in obstinate epistaxis, 
and in hematemesis the same solution may be swallowed in small quantities 
at short intervals. In chronic diarrhea and dysentery the solution of the sub- 
sulphate is an efficient astringent, and a weak solution of the chloride is used 
as a rectal injection in tropical dysentery and against thread-worms. The 
sulphate is much employed as a cheap disinfectant for sewage, its action being 
to precipitate the proteids, which carry down the bacteria mechanically. The 
hydroxide is the most effective antidote in arsenical poisoning, as it forms with 
arsenic trioxide an almost insoluble compound. The solutions used in its prepa- 
rations should be kept on hand and mixed only when wanted for use. Hemo- 
gallol has been used with satisfaction in all anemic conditions, especially those 
which are part of the suboxidation affections, as Bright's disease and diabetes 
mellitus; also in anemic cases with feeble digestion, and in children, even the 
weakest and those of the most tender age. 



FICUS, Fig, — is the partly dried fruit of Ficus Carica, the fig-tree, nat. ord. Moraceas, a 
native of trie shores of the Levant, but cultivated in Southern Europe and in other warm 
countries. Figs contain about 62 per cent, of grape sugar, also gum, fat, etc., and are a con- 
stituent of the official Confectio Sennas. 

Figs are demulcent, laxative and nutritious. They are used in their fresh state as an ali- 
ment, but if eaten in quantity may produce flatulence, enteralgia and diarrhea. They are 
chiefly used as an article of diet in habitual constipation, but may be employed as an ingre- 
dient of demulcent decoctions, and locally as a poultice to gum-boils. 

FCENICULUM, Fennel, — is the dried fruit of Fceniculum vulgare, a European culti- 
vated plant of the nat. ord. Umbelliferae. It contains a volatile oil, which is a constituent of 
Pulvis Glycyrrhizae Compositus, and Spiritus Juniperi Compositus. Dose, gr. v-xx [av. 
gr. xv.] 

Oleum Fceniculi, Oil of Fennel, — the volatile oil, a light yellow-colored liquid, having 
the odor of fennel, a warm taste and neutral reaction, soluble in alcohol. Dose, Tijjij— v [av. 
TRiij] 

Aq ta Fceniculi, Fennel Water, — contains 2 parts of the oil in 1000 of distilled water. 
Dose, 3j-oj[av. 5iv.] 

Fennel is an aromatic stomachic and a mild stimulant. It is chiefly used as an agreeable 
carminative in flatulence and colic, and as a corrigent to Senna, Rhubarb, and other disagrec- 
medicines. An infusion is often used as an enema to expel flatus in infants. 



284 FORMALDEHYDE. 

FORMALDEHYDE, Formic Aldehyde, Formyl, CH 2 0— is a gaseous 
aldehyde obtained by the oxidation of methyl alcohol. It has a low specific 
gravity, mixes readily with air, and is soluble in water and in alcohol. It does 
not affect the color or structure of clothing or other fabrics in common use. 
The official preparation is — 

Liquor Formaldehydi, Solution oj Formaldehyde, — commercially known as Formalin, 
is an aqueous solution, containing not less than 37 per cent., by weight, of absolute formalde- 
hyde. It is miscible in all proportions with water and alcohol. One part by volume added 
to 40 of water makes a 1 per cent, solution of formaldehyde. To prevent polymerization it 
should be mixed with an equal quantity of a saturated solution of boric acid, or a 2 per cent, 
solution of borax, or with glycerin. 

Official Derivative. 

Hexamethylenamina, Hexamethylenamine, QH 12 N 4 , commonly known under the 
trade name Urotropin,— is a condensation product obtained by the action of ammonia upon 
formaldehyde. It occurs in colorless, odorless crystals, readily soluble in water, and in 10 of 
alcohol, decomposed by diluted sulphuric acid, liberating formaldehyde. Dose, gr. j-x [av. 
gr. iv], up to 3j daily, in water or carbonated water. 

Unofficial Preparations. 

Glyco-formalin, — has of Formaldehyde 30, Glycerin 10, Water 60, the glycerin pre- 
venting the polymerization of the gas and the formation of paraform. 

Paraform, C 3 H 6 3 , — is the solid polymeric form of formaldehyde, which it gives off 
when slowly heated. It occurs as a colorless, crystalline powder, of stable constitution, insol- 
uble in water. 

Unofficial Compounds. 

Numerous compounds of Formaldehyde with other substances are marketed under 
various trade names, the most important of which are as follows: — 

Amyloform, — is a combination of Formaldehyde with starch, and is used as an anti- 
septic dusting powder. 

Citarin, — is sodium anhydro-methylene citraje, a white powder, of pleasant , acidulous 
taste, freely soluble in water. It liberates formaldehyde in the blood and thereby forms 
soluble combinations with uric acid. Dose, gr. xv-xxx, 3 or 4 times daily. 

Dextroform, — a combination of formaldehyde and dextrin, is soluble in water and in 
glycerin, and is used as an antiseptic dressing. 

Forman, — is a mixture of formaldehyde, menthol, and hydrochloric acid, used by in- 
halation for acute nasal and laryngeal catarrh. 

Glutol, — is prepared by the action of formaldehyde on gelatin, and is used as an antiseptic 
surgical dressing. 

Helmitol, — the methylene-citronate of hexamethylenamine {urotropin), occurs as a white, 
crystalline powder, readily decomposed by alkalies, soluble in water up to 7 per cent., and 
gives off formaldehyde more readily than urotropin. It is used as a urinary disinfectant in 
doses of gr. xxx, up to 5j or oij daily. 

Ichthoform, — a combination of formaldehyde and ichthyol, is described under the title 
Sulphur. 

Igazol, — a combination of formaldehyde, paraform, and iodine, is used in Italy by inhala- 
tion and also internally in pulmonary tuberculosis. 

Tannoform, — a condensation product of formaldehyde and tannic acid, is described on 
page 70. 

Thymoform, — a product of the combination of formaldehyde and thymol, is soluble in 
alcohol, ether, chloroform, and olive oil; insoluble in water and in glycerin. It is used as an 
antiseptic dressing. 

Incompatibles. 

Incompatible with Formaldehyde are: Albumin, Alkalies, Ammonia, Bisulphites, Gelatin, 
Iron preparations, Phenvlhydrazine; Salts of Copper, Gold, and Silver, Tannic Acid. 



FORM Al niUN hi , 

Physiological Action and Therapeutics. 

Formaldehyde is powerfully antiseptic and disinfectant, ranking next below 
Mercuric Chloride as a germicide, and above it in being but slightly toxic to 
the higher animals. A solution of i in 20,000 kills most bacteria if the contact 
is prolonged, and a 1 per cent, solution destroys all pathogenic spores within 
an hour. It is probably the most reliable disinfectant for general use, when 
employed in connection with moist air. It is largely used for the disinfection 
of instruments, furniture, clothing and rooms; the gas being disengaged by 
heating the solution or paraform, or by the partial combustion of methyl alcohol 
in special lamps. To thoroughly disinfect a room, it should be made as air- 
tight as possible, the gas then introduced through the key-hole of the door, 
and the room kept closed for ten hours. The amount of the solution required 
is about five ounces for each 1000 cubic feet of space. Clothing and bed-linen 
should be unfolded and hung loosely on a line in the room, so that the gas may 
have free access to the fabrics. As a deodorant it is very efficient, entirely re- 
moving the smell of sulphuretted hydrogen, and destroying the peculiar methyl- 
mercaptan odor of fecal matter. 

Formaldehyde is intensely irritant to mucous membranes, a minute quan- 
tity in the atmosphere causing violent irritation of the conjunctivae and the 
lining of the respiratory tract, with stinging and prickling in the nose and throat, 
tears, salivation, and catarrh. In concentrated solution it coagulates albumin 
and gelatin, and applied to the skin it produces a leathery condition which 
may pass into a localized necrosis without suppuration, leaving the surface 
with the appearance of a recently healed wound. It is much too irritant to 
be generally available as a surgical antiseptic, the application of a 1 per cent, 
solution to an ulcerated surface causing intense and prolonged pain. It is 
used however by surgeons in tuberculous joints and abscesses, infected wounds, 
suppurating buboes, and infectious inflammations of mucous membranes. 
Solutions of 1 per cent, strength are sufficiently strong for most local purposes, 
and when sprayed above the patient's head by a steam-atomizer for 20 minutes 
thrice daily have proved highly efficient in whooping-cough and chronic bron- 
chitis: Weaker solutions (£ per cent.) are used as gargles and mouthwashes 
and for the irrigation of cavities, and stronger ones (2^ per cent.) for psoriasis, 
lupus and other skin diseases. Solutions of 1 part in 2,000 or 3,000 are recom- 
mended for local application in the septic abrasions of the cornea ending in 
hypopyon ulcers, which form so large a part of ophthalmological work in manu- 
facturing communities. 

Internally the aqueous solution produces in animals nausea and vomiting, 
followed by quick respiration, narcosis and coma, and in the rabbit convul- 
>ions and opisthotonos. Small doses raise the blood pressure, but a toxic one 
depresses the circulation, and acts on the blood, changing the form of the cells, 
and causing immediate coagulation on exposure, with separation of a dark red 
serum. The injection of 250 Cc. of a 1 in 2000 solution into the arm produced 



286 FRANGULA — FUCUS VESICULOSUS. 

in one case bloody and albuminous urine. It causes less severe symptoms 
when given hypodermically than when taken by the stomach in the same quan- 
tity. Large doses may be injected subcutaneously, and though painful will 
not give rise to systemic effects. A portion of the absorbed gas passes through 
the tissues unchanged, and is excreted in the urine. It has been used by the 
stomach to prevent fermentation in chronic gastritis and gastrectasis; also by 
inhalation and intravenous injection in pulmonary tuberculosis, with doubt- 
ful results. The injection of the aqueous solution is said to have proved cura- 
tive in a case of sarcoma of the naso-pharynx, and applied locally to have caused 
marked improvement in lupus of several years' standing. The intravenous 
injection of a i to 5,000 solution in puerperal septicemia was followed in one 
case, Barrow's, by prompt reduction of the temperature from 108 F. to 95 , 
and eventual recovery, but proved futile in other cases, and has not received 
professional approbation. 

Formaldehyde solutions are used for the hardening and preservation of 
pathological material and cadavers, but have many disadvantages. The em- 
anations from such preparations are irritant to the hands and the respiratory 
mucous membrane, and a body injected with formaldehyde is too rigid for pur- 
poses of demonstration. 

Hexamethylenamine (Urotropin) is decomposed in the organism, for- 
maldehyde being set free and being eliminated in the urine. Ordinary medic- 
inal doses cause no general effects as a rule, but in susceptible persons it may 
cause gastric and renal irritation, with hematuria, hemoglobinuria, and albumin- 
uria, also diarrhea, abdominal pain, a measly rash, headache, tinnitus aurium, 
and strangury. It is an excellent urinary and intestinal antiseptic, and possesses 
considerable pow r er as a solvent of uric acid, the excretion of which it promotes. 
It is particularly efficient as an alterative and diuretic in the treatment of cystitis, 
pyelitis, and phosphaturia. 

Citarin is indicated in all forms of the uric acid diathesis, including lithemia, 
gout, rheumatoid arthritis, and renal uratic calculi. It is administered in aque- 
ous solution well diluted, in this form making a pleasant acidulous drink. 

FRANGULA, Frangula, {Buck-thorn), — is the bark, collected at least one year before 
being used, of Rhamnus Frangula, the alder buckthorn, a European shrub of the nat. ord. 
Rhamnaceae. It contains several principles, of which the only important one is Frangulin, 
or Rhamnoxanthin, a lemon-yellow, odorless and tasteless glucoside, insoluble in water and 
but sparingly so in alcohol or ether, and thought to be identical with Cathartin, the active 
principle of Senna. Another species of the genus Rhamnus is described under the title Rham- 
nus Purshiana. Dose, gr. x-xxx [a v. gr. xv.] 

Fluidextractum Frangulae, Fluidextract oj Frangula. — Dose, njfx-xxx [av. tiRxv.] 
Frangula-bark when fresh is a violent irritant to the gastro-intestinal tract, producing 
vomiting, purging, and much pain. The old dried bark is a safe purgative without irritant 
qualities, and is much used in the constipation of pregnancy, and other conditions requiring 
purgation. The fluidextract is the best form for administration. 

FUCUS VESICULOSUS, Bladder-wrack, Sea-wrack (Unofficial),— is a perennial 
plant of the nat. ord. Alga?, growing on the shores of the Atlantic and Pacific Oceans as a sea- 



G U BANUW GE1 SI MU'M. 2X7 

weed. It has .1 flat leaf, with a midrib throughout its Length, and small sphericaJ vesii li i, 
oiled with air, in the leaf, li contains mucilage ami much Soda in saline combination, also 
[odine, but less of the latter than other alga: growing in deeper water. \ decoction of the 

fresh plant is the best form for administration. 

Fucus Vesiculosus is one of a number of marine plants which are used in various parts 
of the world as food for man and tattle and as manure. The species under consideration is 
considered alterative and tonic, and has been employed in goitre, glandulai and joint enlarge- 
ments and psoriasis, hut especially to produce absorption of adipose tissue in the obese. An 
extract is sold under the title "Anti-fat." 



GALBANTJM (Unofficial), — is a gum-resin obtained from Ferula galbanif.ua, an Asiatic 
plant of the nat. ord. Umbcllifene, and probably from other allied plants. It occurs in minute 
tears, agglutinated into a hard mass, of balsamic odor and acrid, bitter taste. It contains a 
Volatile Oil isomeric with Turpentine, a Gum, and a mixture of Resins which yield by dry 
distillation a blue oil and Umbcllijcron, a tasteless substance in satiny crystals. Dose, gr. 
x-xx, in pill or emulsion. 

Galbanum is stimulant, expectorant and antispasmodic, acting much like Ammonia and 
Asafetida, and usually given with either of these substances. It is used in chronic bronchitis 
and catarrh of mucous membranes generally, in amenorrhea and chronic rheumatism. 



GATJLTHERIA, Wintergreen (Unofficial), — is the leaf of Gaultheria procumbens, an 
American evergreen plant of the nat. ord. Ericaceae. Its active principle is the Volatile Oil, 
which is official. It also contains Tannic Acid, Arbutin, Ursone, Ericolin, etc. 

Oleum Gaultheriae, Oil of Gaultheria, — is the volatile oil, a liquid of peculiar and aro- 
matic odor, sweetish, warm taste, and a slightly acid reaction. It is readily soluble in alcohol, 
and consists of Methyl Salicylate 90 per cent., and Gaultherilene, a hydrocarbon, 10 per cent. 
Dose, ttjjv-xxx [av. ttlfxv.] It is nearly identical with the Volatile Oil of Betula. 

Spiritus Gaultheriae, Spirit of Gaultheria, — has of the oil 5 per cent., dissolved in alcohol. 
Used for flavoring. Dose, njx— 5j [av. njjxxx.] 

Gaultheria is stimulant and slightly astringent. Its chief value is as one of the sources 
of the oil named after it, which is also found in the sweet birch, and many other plants, and, 
containing so large a proportion of Methyl Salicylate or Methylsalicylic Acid, is powerfully 
antiseptic and antipyretic. In large doses it is irritant to the stomach, in one case oj having 
caused death by violent gastritis. 

Oil of Gaultheria is used successfully as a substitute for Salicylic Acid in many conditions, 
especially in rheumatic and gouty disorders. The plant has been used as an emmenagogue 
and a galactagogue, but its principal employment is in the form of the spirit as an agreeable 
flavoring agent. 



GELSEMIUM, Gelsemium, (Yellow Jasmine), — is the dried rhizome and 
roots of Gelsemium sempervirens, a climbing plant of the nat. ord. Loganiaceae, 
with showy yellow flowers, which grows in the forests of the southern states, 
forming festoons from one tree to another. It contains a volatile oil, a resin 
and two alkaloids, Gelsemine, which forms crystalline salts and is only slightly 
active, and Gelseminine, which is amorphous and highly toxic. Dose, gr. 
ss-ij [av. gr. ]'.] 

Preparations. 

Fluidextractum Gelsemii, Fluidextract of Gelsemium, — -Dose, njjss-ij [av. njrj.] 

Tinctura Gelsemii, Tincture of Gelsemium, — strength 10 per cent. Dose, njjv-xv [av. 
nr.viij.] 

Gelsemina, Gelsemine, (Unofficial), — as it occurs in commerce is a mixture of the alka- 
loids in varying proportions, and owes its activity to its contained Gelseminine, of which none 
could be found in some samples. Dose, gr. -%$-$-$■ 



288 GELSEMIUM. 

Incompatibles. 

Incompatible with Gelsemium preparations are: Caustic Alkalies, Tannic Acid and other 
alkaloidal precipitants (see page 5). Physiologically incompatible are: Morphine, Digi- 
talis, Ammonia, Alcohol, Xanthoxylum fraxineum. 

Physiological Action. 

Gelsemium is a motor and respiratory depressant, acting on the anterior 
cornua of the spinal cord and the respiratory centres. Later in its action it 
depresses sensation. Its symptoms resemble those of Conium very closelv, 
differing therefrom chiefly by indicating a more depressant effect on the general 
nervous system. In moderate doses it causes languor, slowing of the cardiac 
rate, enfeebled muscular action, impaired sensibility, drooped eyelids and 
slightly dilated pupils, with some diaphoresis. In toxic dose, as a teaspoonful 
of the fluidextract, it produces vertigo, diplopia, drooped eyelids and dilated 
pupils (paralysis of 3d nerve), labored respiration, slow and feeble heart, dropped 
jaw, staggering gait, extreme muscular weakness and almost complete anesthesia, 
profuse diaphoresis, loss of articulation, and death by asphyxia from paralysis 
of the centres of respiration, consciousness being preserved until C0 2 narcosis 
sets in. Convulsions, with backward movements, occur in many animals but 
not in man. Motion is affected before sensibility in warm-blooded animals, 
sensibility before motion in frogs. It does not irritate the stomach or affect 
the blood-pressure, though it slows the heart and lowers the body temperature. 
The effects of a moderate dose pass off in about three hours. Gelseminine is 
the active principle, being highly toxic and resembling Conii'ne in most of its 
effects. It is decidedly mydriatic when locally applied to the eye, acting prob- 
ably by paralyzing the oculo-motor nerve terminations. Gelsemine has a 
feeble strychnine action on frogs, but has no effect on mammals even in large 
quantity. 

Therapeutics. 

Gelsemium is indicated in all conditions of exalted nerve function, and 
contra-indicated whenever there is a weak heart. It is best used in cerebro- 
spinal meningitis, mania with great motor excitement and persistent insomnia, 
delirium tremens, many forms of sleeplessness, pneumonia and pleurisy if the 
heart be strong, coughs of convulsive and spasmodic character, neuralgia of the 
fifth nerve, remittent fever, after-pains, ovarian neuralgia, dysmenorrhea, ir- 
ritable bladder of women, and incontinence of urine from spasm of the vesical 
muscular fibres. In most of these affections the remedy must be pushed to the 
inducing of some physiological symptoms, but its action should not be carried 
beyond the production of drooped eyelids, diplopia and muscular debility. It 
has been used with varying success in intercostal neuralgia, myalgia, sciatica, 
spasmodic asthma, sick headache, eczema, pruritus and tetanus. Its especial 
field, however, is in remittent and typho-malarial fevers and cerebro-spinal 
meningitis. It is not suitable to low fevers and has not sufficient power a? a 
cardiac depressant to be of much use in sthenic forms. 



GENTIANA. 289 

There is much evidence for the claim, made for the alkaloid Gelseminine, 
of singular efficiency in antagonizing the menial condition occasionally mani- 
fested by an unusual degree of dread, in regard to some approaching ordeal, 
or ordinary trial of life; as, for example, that of a woman concerning her im- 
pending confinement, or of a student in reference to his examinations. In very 
many such cases, the use of the commercial gelsemine, in small doses frequently 
repeated (gr. T ^ T ter die), has seemed to remove the state of abnormal fear en- 
tirely. Gelseminine is sometimes used as a mydriatic and paralvzer of accom- 
modation, its effects passing off more rapidly than those of atropine. 



GENTIANA, Gentian, — is the dried rhizome and roots of Genitalia htlca, 
the yellow gentian, one of a numerous family of plants, nat. ord. Gentianaceae, 
giowing in the mountainous districts of Europe. An American species, G. 
Catesbai, blue gentian, is considered nearly equal in value to the official species. 
It contains an active, bitter glucoside, Gentopicrin or Gentianin, C 20 H 30 Oi 2 , 
which is crystalline and soluble in water; also an inert, amorphous body, Gen- 
tian ic or Gcnlcs ic Acid; gum, considerable sugar, and a trace of volatile oil, 
hut no tannin. Dose, gr. x-xxx [av. gr. xv.] 

Preparations. 
Extractum Gentianae, Extract oj Gentian, — aqueous. Dose, gr. j-v [av. gr. iv.] 
Fluidextractum Gentianae, Fluidextract of Gentian. Dose, trjx-xxx [av. njxv.] 
Tinctura Gentian* Composita, Compound Tincture oj Gentian, — Gentian 10, Bitter 
Orange Peel 4, Cardamom 1, Alcohol and Water to 100. Dose, oss-ij [av. oj-] 

Unofficial Preparations. 

Infusum Gentianae Compositum, Compound Infusion of Gentian, — -contains Gentian 
10, Bitter Orange Peel 2\, Coriander 2\, Alcohol 40, Water to 320. Dose, oj~ij- 

Mistura Gentianae Alkalina, Alkaline Mixture of Gentian, — Acidum Hydrocyan. Dilut. 
m'iij, Sodii Bicarb, gr. xv, Infusum Gentianae Co. to oj- One dose. 

Mistura Gentianae et Sennae, Mixture of Gentian and Senna, — Infusum Senna? 3iij, 
Tr. Cardamomi Co. 5j, Infusum Gentianae Co. ovj. One dose. 

Incompatibles. 

Incompatible with Gentian preparations are: Lead salts, Silver Nitrate. Iron salts are 
not chemically incompatible, for Gentian contains no tannic acid; but as they darken gentian 
preparations they are considered esthetically incompatible. 

Physiological Action and Therapeutics. 
Gentian is a simple bitter without astringency or aroma, its action corre- 
sponding to that of Calumba, but it is more apt to disagree with the stomach. 
In addition, like Cornus, a member of the same class, it has considerable re- 
pute as an antiperiodic and febrifuge. Gentian has been considered a valuable 
tonic throughout Europe from the earliest historical times. It is highly esteemed 
as a stomachic tonic in dyspepsia connected with the gouty diathesis, in hysteria, 
jaundice, and convalescence from acute diseases and from malarial fever. The 



290 GERANIUM — GLYCERINUM. 

compound tincture is an excellent vehicle for cod-liver oil, and the compound 
infusion is a good vehicle for the administration of mineral acids and neutral 
salts. 

GERANIUM, Geranium (Cranesbill), — is' the rhizome of the indigenous perennial 
Geranium maculatum, nat. ord. Geraniaceae. Its active constituents are tannic and gallic- 
acids. Dose, gr. v-xxx [av. gr. xv.] 

Fluidextractum Geranii, Fluidextracl of Geranium. — Dose, nj)v-5ss [av. njjxv.] 
Geranium is an efficient astringent, and its action corresponds with that of Tannic Acid. 
Having no unpleasant taste, it is a useful agent for infants and others having delicate stomachs, 
and is a very popular domestic remedy in many parts of the country. It is especially used in 
diarrheas, dysentery, cholera infantum, hemorrhages, relaxed conditions of mucous mem- 
branes, gleet and leucorrhea. 

GLYCERINUM, Glycerin, Glycerol, — is a liquid obtained by the decom- 
position of vegetable or animal fats or fixed oils, containing not less than 95 
per cent, of absolute glycerol, C 3 H 5 (OH) 3 , a triatomic alcohol existing in fats 
and fixed oils in combination with the fatty acids. 

Glycerin is a clear and colorless liquid, of syrupy consistence, hygroscopic, non-drying, 
odorless, of warm and very sweet taste, neutral reaction, soluble in water and in alcohol, in- 
soluble in ether, chloroform and fixed oils. It dissolves Tannin, Gallic Acid, Salicylic Acid, 
Bromine, Iodine, and Phenol, and with the aid of heat metallic salts, oxides and alkaloids. 
With strong Nitric Acid it forms Nitroglycerin, and it reduces Potassium Permanganate, 
Chromic Trioxide and Chlorinated Lime with great violence. An impurity frequently present 
in it is Acrolein, formed by the use of too high a degree of heat in its manufacture, and which 
is very acrid and poisonous. Glycerin is a constituent of the 6 Glycerites, Pilulae Phosphori, 
Mucilago Tragacanthae, Massa Hydrargyri, and several fluidextracts. Dose, 5j-ij, [av. oj-] 
diluted. The official preparations are: — 

Suppositoria Glycerini, Suppositories 0} Glycerin, — each suppository contains about J 
grain of Sodium Carbonate, 3 grains of Stearic Acid, and 46 grains of Glycerin. They are 
used per rectum in chronic constipation. 

Cataplasma Kaolini, Cataplasm 0} Kaolin, — contains of Glycerin 37^ parts by weight, 
Boric Acid 4J, Thymol J-, r , Methyl Salicylate \, Oil of Peppermint Jy, Kaolin 57!, intimately 
incorporated by the aid of heat to a homogeneous mass. Used as a poultice. This prepara- 
tion is similar to that sold as Antiphlogistine (see below). 

Glycerites of Tannic Acid, Starch, Boroglycerin, Hydrastis, Phenol, and of the Phos- 
phates of Iron, Quinine and Strychnine are described under the titles of their principal ingre- 
dients. 

Unofficial Preparations. 
Unna's Paste, — is a mixture of equal parts of Glycerin and Mucilage of Acacia, with 
which are incorporated various substances, such as zinc oxide, mercuric oxide, etc. 

Unna's Paint, — has of Glycerin 10, Gelatin 4, Zinc Oxide 4, and Water 10, incorporated 
together to form a mixture, which when cold resembles white rubber. 

Antiphlogistine, — is the trade name of a preparation very similar to Unna's Paint, and 
stated by its manufacturers to be "composed of Glycerin, Boric Acid, Salicylic Acid, Iron Car- 
bonate, Peppermint, Gaultheria, Eucalyptus and Iodine, combined with the base de-hvdrated 
Oxide of the Silicate of Alumina and Magnesia; which combination results in a chemical 
compound possessing antiseptic, anodyne, nutrient and antiphlogistic properties." It is used 
as a dressing or poultice. 

Glykaolin, — is a similar preparation to the preceding, but made by a different manu- 
facturer. It is a compound of Glycerin, Salol, and Aluminum Silicate. 

Glycozone, — is described under the title OxYGENirjM. 

Incompatibles. 
Incompatible with Glycerin are Acids (hot), Chromic Trioxide, Chlorinated Lime, Lead 
Oxide, Potassium Permanganate, Silver Nitrate. 



GLYCYRRHIZA. 



291 



Physiological Action \m> Therapeutics. 
Glycerin abstracts water from tissues with which it comes in contact, and 
unless pure is often very irritating to the skin. It is freely absorbed by the 

cutaneous ami mucous surfaces, and is decomposed in the system, passing out 
as formic and other acids. On the stomach it has no particular action, hut 
in large quantities it is laxative and is said to cause the solution of the red blood 
corpuscles and hemoglobinuria. The urine of persons using glycerin contains 
a body which acts like sugar in the copper and fermentation tests, but is not 
sugar. Glycerin is a good emollient and is considered nutritive by many au- 
thorities. It has been used as a substitute for cod-liver oil in wasting diseases, 
but with little benefit. It has been tried as a remedy in diabetes, but with un- 
satisfactory results so far as reported, except as a sweetening substitute for 
sugar in the dietary of those afflicted with that disease. It is said to be fatal 
to intestinal trichina?, and to be an efficient internal remedy in acne and flatu- 
lence. In chronic constipation excellent results are obtained from rectal en- 
emata of Glycerin, or from the official suppositories thereof. As a vehicle it 
is used for many drugs, and is a good ingredient of solutions for hypodermic 
use, promoting the solubility of many alkaloids and acting as an antiseptic. It 
has distinct but feeble power as a germicide and antiseptic, and is employed to 
preserve and aid the action of the digestive ferments, Pepsin and Pancreatin, 
also to prevent the decomposition of vaccine lymph. Locally it is valuable 
in many cutaneous affections as an emollient and softening agent. In acute 
coryza it gives relief if applied by a brush or as a spray to the nasal mucous 
membrane. It is used on cotton to the cervix uteri as a depleting agent, and 
mixed with an infusion of flaxseed as an enema to relieve tenesmus in acute 
dysentery. With tincture of Benzoin it is an excellent application to chapped 
hands or lips and fissured nipples. In the external auditory canal it is use- 
fully employed to soften cerumen, diminish the secretion of pus, deplete the 
tissues, and keep the surface moist. 

Unna's Paint and its imitations, the cataplasm of Kaolin and Antiphlogis- 
tine, are very efficient applications for inflammatory conditions of the skin, 
muscles and joints, also in pneumonia, pleurisy, peritonitis, acute rheumatism, 
chronic ulcers, sprains, and eczema with induration. The glycerin constituent 
has a dehydrating effect on the tissues, relieving tension and its consequent 
pain; and in deep-seated inflammations it causes a superficial hyperemia which 
decreases the congestion of the affected part. 

GLYCYRRHIZA, Glycyrrhiza, Licorice Root, — is the dried rhizome and 
root of Glycyrrhiza glabra, and of G. glandulijera, nat. ord. Leguminosas, na- 
tive in southern Europe and Asia, but largely cultivated in many other parts. 
It contains a yellow, amorphous glucoside, Glycyrrhizin, C 24 H 36 9 , also Gly- 
cyrrhizic Acid, Asparagin, sugar, resin, gum, etc. Glycyrrhizin when boiled 



292 GOSSYPIUM PURIFICATLM. 

with dilute acids yields glucose and a very bitter substance named Glycyrrhetin. 

Dose, gr. x-jjj [aw gr. xxx.] 

Preparations. 

Extractum Glycyrrhizae, Extract oj Glycyrrhiza, — is the commercial extract of the 
root, occurring in glossy-black rolls, of sweet, peculiar taste. Not less than 60 per cent, of it 
should be soluble in cold water. Dose, gr. x-xxx [av. gr. xv.] 

Extractum Glycyrrhizae Purum, Pure Extract oj Glycyrrhiza, — made with Aqua 
Ammoniae, Glycerin and Water, by percolation and evaporation. Dose, indefinite [av. gr. xv.] 

Fluid extractum Glycyrrhizae, Fluidextract oj Glycyrrhiza, — made with Glycerin, Aqua 
Ammoniae and diluted Alcohol. Dose, ngx-oj [a v. itjjxxx.] 

Mistura Glycyrrhizae Composita, Compound Mixture oj Glycyrrhiza, {Brown Mix- 
ture) — has of the Pure Extract 3 parts, Syrup 5, Acacia 3, Tr. Opii Camph. 12, Vinum Anti- 
monii 6, Spt. jEtheris Nitrosi 3, and Water to 100. Dose, 5j-5j [av. oij] 

Pulvis Glycyrrhizae Compositus, Compound Licorice Powder, — Senna 18, Glycyrrhiza 
23J, Oil of Fennel 0.4, Washed Sulphur 8, Sugar 50 parts. Dose, oss-ij [av. oj-] 

Trochisci Glycyrrhizae et Opii, Troches oj Glycyrrhiza and Opium, — each has of Ex- 
tract of Glycyrrhiza gr. ij, Powdered Opium gr. yV, Acacia, Sugar and Oil of Anise. Dose, 
j-ij every hour. 

Elixir Adjuvans, Adjuvant Elixir, — has of the Fluidextract of Glycyrrhiza 12, Aromatic 
Elixir 88, mixed and filtered. 

Glycyrrhizinum Ammonia turn, Ammoniated Glycyrrhizin, — is very sweet to the 
taste, readily soluble in water and in alcohol. Dose, gr. j-vj [av. gr. iv.]. Incompatible with 
it are: Mineral Acids, Alkalies, Metallic salts. 

Physiological Action and Therapeutics. 
Licorice is demulcent and mildly laxative. It has an agreeable taste, and 
increases the flow of saliva and mucus when slowly chewed or sucked, the 
increased secretions acting as emollients to the throat. It is used in many 
pharmaceutical preparations, covering the taste of senna, senega, hyoscyamus, 
turpentine, ammonium chloride, the bitter sulphates, and to some degree the 
bitterness of quinine. The powdered extract or root is used as an excipient 
in pills and troches. The compound mixture is an efficient expectorant, much 
employed in acute bronchitis and catarrhal laryngitis, but owing its power over 
cough mainly to the opium contained in it. The compound powder is a gentle 
laxative, of which senna is the most active ingredient. The troches are used 
for cough, but must be carefully prescribed for children, as each troche con- 
tains gr. ^ °f powdered opium. 



GOSSYPIUM PTJRIFICATUM, Purified Cotton,— is the hairs of the seed 
of Gossypium lierbaceitm, or of other cultivated species of Gossypiiim, nat. ord. 
Malvaceae, freed from adhering impurities and deprived of fatty matter. It 
is insoluble in ordinary solvents, but soluble in an ammoniacal solution of 
cupric oxide. Cotton-fibre is familiar in appearance to every one, but when 
examined microscopically it shows as flattened, hollow and twisted bands, 
spirally striate, and slightly thickened at the edges. It is a modification of 
Cellulose, C 12 H 10 O 10 , and corresponds therewith in all its ordinary chemical 
properties. 



GOSSYPIUM PTJRIFICA PI m 2o? 

Preparations oj the Cotton Plant. 

Gossypii Cortex, Cotton Root Bark, iliin bands or quilled pieces, brownish-yellow 
exteriorly, white interiorly, of slightly acrid and astringent taste. I >ose, gr. x- 7)j [av. gr. xxx.] 

Oleum Gossypii Seminis, Cotton-seed Oil, — the fixed oil expressed from the seeds and 
purified. Is yellow, odorless, of bland taste and neutral reaction, soluble in ether, but slightly 
soluble in alcohol. Is introduced into the Pharmacopoeia for the reason that it constitutes 

most of the "Olive Oil" sold in foreign-shaped bottles and under foreign-appearing labels. 
It is used in the official Liniments of Ammonia and Camphor. Dose, 7> j 5 ] [&V. 5lV.] 

Pyroxylinum, Pyroxylin, (Soluble Gun-cotton, Colloxylin)- is official for the purpose 
of making Collodium. It is prepared by macerating Cotton in a mixture of Sulphuric and 
Nitric Acids, washing, draining and drying. 

Collodium, Collodion, — made by dissolving Pyroxylin 4, in Ether 75 and Alcohol 25. 

Collodium Flexile, Flexible Collodion, — Collodion 92, Canada Turpentine 5, Castor 
Oil 3, mixed thoroughly. 

Collodium Stypticum, Styptic Collodion, — Ether 25, Alcohol 5, Tannic Acid 20, Col- 
lodion to 1 00. 

Collodium Cantharidatum, Cantharidal Collodion, (Blistering Collodion), — Canthar- 
ides 60, Flexible Collodion 85, Chloroform q. s. to 100. 

Physiological Action and Therapeutics. 

Cotton-root is believed to be an efficient emmenagogue and oxytocic by 
southern practitioners, also somewhat of a galactagogue, but experiments on 
pregnant animals have not confirmed this view of its action. The Oil of the 
seed is very bland and may be applied to all the purposes for which olive oil 
is used. Cotton itself, when freed from oily matter, is remarkably absorbent 
of water, and is a good agent for excluding air from injured surfaces. Pyrox- 
ylin is highly inflammable, and explosive at 300 F. Collodion is inflam- 
mable, and dries rapidly on exposure to the atmosphere by evaporation of its 
ether, leaving a transparent film of Pyroxylin on the surface to which it has 
been applied; which film, if the flexible collodion be used, does not contract 
on drying or readily crack, making it an excellent protective application. Styp- 
tic Collodion is a solution of tannin, and an excellent hemostatic. Cantharidal 
Collodion is a convenient blistering agent, suitable for cases where the patient 
is inclined to remove a blister if applied in the ordinary way. 

Purified Cotton is a valuable agent in surgical practice, being employed 
as an application in burns and scalds, erysipelas, and articular rheumatism, to 
exclude the atmosphere, allay pain, and when covered with oiled silk or rubber 
cloth to keep up local perspiration. It may be phenolated, borated or salicy- 
lated, by soaking in the respective solutions, and is then used as an antiseptic 
dressing for wounds, and ulcers. It is employed by the pharmacist in funnels 
to filter oils, and for the preparation of the official waters. 

Cotton-root bark is much employed by the negroes of the Southern States 
in decoction as a supposed abortifacient, oxytocic and emmenagogue. It is 
used in the south for intensifying uterine action in normal labor, also in dys- 
menorrhea and amenorrhea. A decoction, §iv in a quart of water boiled to 
a pint, is the favorite preparation, administered in wineglassful doses. 

Collodion is used as a protective covering for superficial burns, ulcers and 
wounds, slight cuts, cracked nipples, anal fissures, and erysipelas. For these 



294 GRANATUM — GRINDELIA. 

affections the flexible collodion should be used, but where it is desirable to 
produce pressure on the part the ordinary form is best, as it contracts with 
considerable force in drying. This property makes it highly useful in draw- 
ing the edges of wounds together, bringing pressure on buboes, incipient boils, 
and carbuncles. Styptic Collodion has many uses as a hemostatic and protec- 
tive which will suggest themselves, and the cantharidal form is a convenient 
epispastic for uneven surfaces, the therapeutics of which are detailed under 
Cantharis. 

GRANATUM, Pomegranate, — is the bark of the stem and root of Punka 
Granalum, a small tree of the nat. ord. Punicaceae, cultivated in subtropical 
countries. It contains tannic and punico-tannic acids, mannite and an active 
mixture of alkaloids named Pelletierine, which is soluble in water, alcohol, 
ether, chloroform, etc., and has strong basic properties. 

Preparations. 

Fluidextractum Granati, Fluidextract of Pomegranate. — Dose, ttjx- 5j [av. ttjjxxx.] 

Decoctum Granati, Decoction of Pomegranate (Unofficial) — dxvij of bark from the 

fresh root in oxvij of boiling water, boiled down to oxij and strained. Dose, §iv— vj every 

hour, preceded and followed in a few hours by a brisk cathartic. The decoction of the Br. 

Phar. is of I in 50 strength and is given in doses of oss-ij. 

Pelletierine Tannas, Pelletierine T annate, — is a mixture of the tannates of four alkaloids 
(punicine, iso-punicine, methyl-punicine, and pseudo-punicine), obtained from Punka Gra- 
natum. Dose, gr. iij-viij [av. gr. iv.], in powder, taken fasting and followed after 20 minutes 
by a full dose of Castor Oil. 

Physiological Action and Therapeutics. 
Granatum and its alkaloids are teniafuge, and very efficiently so, rarely 
failing to bring away the whole worm. The decoction is usually employed, 
but latterly Pelletierine has come into fashion, a proprietary form being sold 
as Tanrefs Pelletierine, in bottles containing one adult dose at three dollars 
each. The decoction in full doses causes nausea and vomiting, flatulence, 
purging, and sometimes cramps in the legs, giddiness, dimness of vision, gen- 
eral numbness of the limbs and increase of the quantity of urine. 

For the expulsion of tape-worm a mixed treatment by Pomegranate-root bark, Pump- 
kin seeds and Oleoresin of Male-fern is preferred by many practitioners. The following 
formula has proved very efficient : 1$. Granati 5 ij, Aquae Ojss, boiled to ovij; Pepinis oj> 
deprived of outer coats and beaten to a paste with fine powdered sugar; Oleoresinas Aspidii, 
gr. xxx, made into emulsion with Acacia and the above decoction of Granatum, then added 
to the paste of Pepo, and flavored with Syrups up to §ix. One-third of this to be taken in 
the morning after a light diet and a laxative on the previous day. If not successful the second 
and third portions may be taken at intervals of 3 hours. The worm should be passed sitting 
in a tepid sitz-bath, to prevent the expelled portion tearing off the head by its weight. 

GRINDELIA, — is the dried leaves and flowering tops of Grindelia robusta, 
or of Grindelia squarrosa, herbaceous perennial plants of the nat. ord. Compositae, 
indigenous to the Pacific slope of the United States and Mexico, where they are 
common along the coast and in the mountains, having yellow flowers, a bal- 



GUAIACUM. 295 

samic odor and a pungent, aromatic and bitter taste. They contain a resin, 
which is probably the active constituent, a fixed and a volatile oil, also Robustic 
Acid and an alkaloid named Grindeline. There is but one official preparation, — 

Fluidextractum Grindeliae, Fluidextract oj Grindelia, — is three-fourths alcohol and 
ains much resin. Dose, njx- 5j or more [av. itjxxx], every 3 or 4 hours, in sweetened 

water or milk, the mixture being well stirred to prevent the resin adhering to the glass. 

Physiological Action and Therapeutics. 

Grindelia has an acrid, bitter taste, and excites the secretion of saliva when 
chewed. Its principal action is that of an antispasmodic, but it is also a motor- 
depressant, somewhat expectorant and decidedly diuretic. Given in large doses 
to small animals it induces paralysis, beginning in the hind extremities and 
affecting the sensory nerve-trunks first, then the sensory side of the spinal cord, 
afterwards involving the motor nerve-trunks, and finally the spinal motor tract. 
It stimulates the cardiac inhibitory apparatus and the vaso-motor centre, slow- 
ing the heart and respiration, and raising the blood-pressure. In sufficient 
quantity it causes dilatation of the pupils, reduced cutaneous sensibility and 
sluggish reflexes, even narcotism in small animals. Its elimination occurs by 
the bronchial mucous membrane and the kidneys, both of which it stimulates, 
and in large doses it has produced renal irritation. 

Grindelia is chiefly employed as a palliative in spasmodic asthma and the 
dyspnea accompanying bronchitis. In several cases of recurring asthma in 
elderly persons 3ss of the fluidextract has afforded almost instantaneous relief, 
but has not prevented the return of the paroxysms. It is an efficient remedy 
in chronic bronchitis, especially that of the aged, also in whooping-cough and 
other spasmodic coughs, in hay fever and in the dyspnea of various pulmonary 
and cardiac affections, and has been employed with benefit in chronic cystitis. 
Locally, it is used with advantage as a lotion for the dressing of burns and blis- 
ters, in vaginitis and uterine catarrh, and to allay the pain of herpes zoster. In 
the proportion of 1 part of the fluidextract to 9 of water, as a sedative lotion, 
it is a very efficient application for the cutaneous irritation due to poison-oak 
or ivy, also in skin diseases attended with itching and burning sensations. 

GUAIACUM, Guaiac, — is the resin of the wood of Guaiacum officinale, 
or of G. sanctum, trees of the nat. ord. Zygophyllacese. It consists of three 
resins, Guaiaconic Acid, C 19 H 20 O 5 , 70 per cent., Guaiac Acid, C 6 H 8 3 , resem- 
bling Benzoic Acid, and Guaiarec Acid, C 20 H 26 O 4 ; also an indifferent resin. 
The wood also contains a yellow coloring matter, gum, etc., and yields, by 
destructive distillation, Guaiacol (see page 252). Dose of Guaiac, gr. x-xxx 
[av. gr. xv ] in wafer. The official preparations are — 

Tinctura Guaiaci, Tincture oj Guaiac, — 20 per cent. Dose, 3ss-jss [av. 3j ], in mucilage 
or syrups, as the resin is precipitated by water. 

Tinctura Guaiaci Ammoniata, Ammoniated Tincture oj Guaiac, — has of Guaiac 20, 
Aromatic Spirit of Ammonia to 100. Dose, v$x- oj [av. Ttjxxx.] 



296 GURJUN BALSAM — ELEMATOXYLOX. 

Incompatible with Guaiac are: Acacia, Acids (mineral), Chlorine-water, Chromic Tri- 
oxide, Ferric Chloride, Gold Chloride, Metallic salts, Potassium Permanganate, Spirit of 
Xitrous Ether. 

Physiological Action and Therapeutics. 

Guaiac is diaphoretic, expectorant and alterative; also laxative and pur- 
gative, according to the dose administered. Its taste is acrid and very disagree- 
able. Internally it is a local stimulant, producing salivation, an acrid sensa- 
tion in the throat, warmth in the epigastrium, increase of the gastric and in- 
testinal secretions and the flow of bile, and reflex stimulation of the heart. Its 
continued use causes gastric catarrh, and in large doses it is a gastro-intestinal 
irritant, causing vomiting, purging and severe congestive headache. Though 
a colloidal body it enters the blood, stimulates the liver and other excretory 
glands and the production of bronchial mucus, and causes increased circula- 
tion and diaphoresis. Sometimes it fails to act on the skin and is then mark- 
edly diuretic. 

Guaiac was first used as an antisyphilitic, employed in decoction and in 
large quantity, with a spare diet and external warmth. It acquired a great 
reputation in that disease during the 16th century, but it is now abandoned 
therefor except as an ingredient of the compound decoction of Sarsaparilla. 
It is an efficient remedy in tonsillitis, given in gss doses of the tincture in emul- 
sion with mucilage or yolk of egg, to abate the inflammation and abort the dis- 
ease. It has considerable reputation in neuralgic dysmenorrhea, amenorrhea, 
chronic rheumatism, gout, lumbago and sciatica. The ammoniated tincture 
in water makes a cleanly and not very disagreeable gargle. The reputation 
of Guaiac in many chronic and obscure complaints is due, partly to its purga- 
tive property and partly to its nastiness, a quality which is highly appreciated 
by many patients. 

GURJUN BALSAM, Balsamum Dipterocarpi, Wood Oil (Unofficial), — is an oleoresin 
obtained from incisions in various trees of the genus Dipterocarpus, growing in India. It is 
thick, opaque and grayish-brown by reflected light, soluble in chloroform and partly so in 
alcohol, ether and volatile oils, odor balsamic, taste bitter. It contains from 40 to 70 per 
cent, of a Volatile Oil, a Resin and Gurjunic Acid. Dose, itrx- 5ij, in emulsion, or in cap- 
sules. 

The properties of this balsam are similar to those of Copaiba, but it is less disagreeable 
and less apt to upset the stomach, also less actively diuretic. It has been used with good 
success in leprosy, given internally in full doses and used locally at the same time. Mixed 
with 4 parts of Lime-water it is well applied in chronic eczema, lupus and psoriasis. 

H^MATOXYLON, Log-wood, — is the heart-wood of Hamatoxylon campechianum, a 
tree of the nat. ord. Leguminosae, native of tropical America, but naturalized in the West 
Indies. It occurs in chips or powder of a dark brown-red color, often with a greenish lustre, 
and colors the saliva a dark pink when chewed. It contains Tannic Acid, and a sweet, crys- 
talline coloring principle named Hematoxylin, which is colorless when pure, but turns red on 
exposure to light. 

Extractum Haematoxyli, Extract of Hcematoxylon. Dose, gr. v-xx [av. gr. xv.J 
Decoctum Haematoxyli (Unofficial), — strength 1 in 17. Dose, oj-ij- 
Incompatible with liquid preparations of Ha-matoxylon are Acids, Ammonia, Alum, Cin- 
chona infusion, Copper Sulphate, Ferrous Sulphate, Lead Acetate, Opium, Tartar Emetic. 



u \M wii'i is BEDEOM \. 207 

;wood is mildly astringent, its properties depending on the Tannin contained in it. 
A> it is devoid of irritating qualities it is well adapted ti> the diarrheas and hemorrhages ol 

voting children. It (iocs not produce constipation ordisorderthe bowels, but colors the urine 
and stools blood-red, and has caused phlebitis. It has been used as a hemostatic in bleeding 
of the lungs, and in hemorrhages from the uterus and intestines, also as an astringent injec- 
tion in leucorrhea. 

HAMAMELIS, Witch-hazel, — is Hamamelis virgmiana, a shrub of the 
nat. ord. Hamamelidacea?, growing in the United States. The leaves contain 
about 8 per cent, of Tannic Arid, a bitter principle and probably some volatile 
matters, but the chemistry of the plant has not been fully studied. It is offi- 
cial in two forms, viz. — 

Hamamelidis Cortex, Hamamelis Bark, — the bark and twigs, of astrin- 
gent taste, somewhat bitter and pungent. Dose, gr. x-xlv [av. gr. xxx.] 

Hamamelidis Folia, Hamamelis Leaves, — the dried leaves, collected in 
autumn. Dose, gr. x-xlv [av. gr. xxx.] 

Preparations. 

Aqua Hamamelidis, Hamamelis Wafer, — has of the Bark ioo, macerated 24 hours in 
200 of Water, then distilled to 85 of distillate, to which 15 of Alcohol are added. Dose, 
5j-iij [av. 5ij.] 

Fluidextractum Hamamelidis Foliorum, Fluidextract of Hamamelis Leaves, — is 
made with glycerin, alcohol and water. Dose, Ttjxv-xlv [av. njxxx.] 

Hamamelin (Unofficial), — is an uncertain extract of very indefinite composition. Dose, 
g 1 "- j-ij- 

Distilled Extracts, so-called, but really Waters distilled from the bark, are sold by 
various manufacturers and are said by the vendors to contain the volatile principles of the 
plant. Pond's Extract is such a preparation, said to be made by distilling the bark with 
a very dilute alcohol, and is a proprietary medicine of uncertain composition. 

No trustworthy experimentation has yet been made with this drug. It is 
tonic, astringent, styptic and sedative, owing most of its properties to its tannin, 
but appears to possess some special influence over the venous circulation sim- 
ilar to that of Aconite on the arterial system. In full doses it may produce 
severe throbbing pain in the head. It is used both internally and locally with 
great benefit in hemorrhoids, particularly those of the bleeding variety, vari- 
cose veins and ulcers, varicocele, venous congestions and threatening local 
inflammations. It is recommended in hemorrhages from the nose, stomach, 
lungs, rectum and kidneys, in threatened abortion, and externally for sprains 
and bruises, foul ulcers, the pruritus of eczema, also in leucorrhea and gonorrhea: 
An ointment of Witch-hazel is found in the shops, and suppositories may be 
prepared extemporaneously by evaporating the fluidextract and incorporating 
the residue with cacao-butter. 

HEDEOMA, Hedeoma, — the dried leaves and flowering tops of Hedeoma pulegioides, 
Pennyroyal, nat. ord. Labiatae, a common plant in the United States. Dose, 5j-iij [av. o ij-] 

Oleum Hedeomae, Oil 0} Pennyroyal, — is the volatile oil, readily soluble in alcohol. 
Dose, itjy-v [av. ltjiiij.] 

Spiritus Hedeomae, Spirit 0} Pennyroyal (Unofficial), — contains 1 part of the oil in of 
alcohol. Used externally or as a spray. 

Hedeoma is a stimulant aromatic, also somewhat carminative and emmenagogue. Its 



298 HELLEBORUS. 

odor is extremely repulsive to insects, especially fleas and mosquitoes. In warm infusion 
it is a popular remedy for amenorrhea and flatulent colic. It may be used as a corrective 
with other medicines, and the spirit is well employed on the hands and face to keep away 
mosquitoes. The writer has known death by narcosis to result from an overdose of the oil 
taken to produce abortion. 



HELLEBORUS, Hellebore (Unofficial),— the rhizome and rootlets of Helle- 
borus niger, black hellebore, and Helleborus viridis, green hellebore, plants of 
the nat. ord. Ranunculaceae, natives of Europe. A third variety, Helleborus 
occidentalis, growing in Greece, is probably the true hellebore of the ancients. 
Its most important constituents are two glucosides, Helleborin and Hellebore'in, 
both crystalline and poisonous. 

Unofficial Preparations. 
Extractum Hellebori Nigri, Extract 0} Black Hellebore. Dose, gr. j-x cautiously. 
Fluidextractum Hellebori Nigri, Fluidextr. 0} Black H. Dose, ttjjij-xv. 
Helleborin, C 36 H 42 0|j, — insoluble in water, soluble in alcohol, and in chloroform. 
Helleboreiin, C 26 H 44 15 , — crystalline, very soluble in water, slightly so in alcohol, insol- 
uble in ether. Dose, gr. ^j— fV 

Pbtstsiological Action and Therapeutics. 

Black Hellebore is a drastic, hydragogue cathartic, and an emmenagogue. 
In overdoses it is a violent gastro-intestinal irritant, producing vomiting, hyper- 
catharsis, vertigo, cramps and convulsions, which may result fatally. Locally 
applied, the fresh root is violently irritant to the skin, producing inflammation 
and vesication. 

Helleborin is an active poison, acting on the tongue like Aconite, and on 
the nervous system as a narcotic, producing in animals paresis of motion and 
sensation, cerebral and spinal congestion, dilated pupils and death. It is less 
irritant than Hellebore'in to the mucous membranes. 

Hellebore'in is less actively toxic to animals, but is very irritant, producing 
conjunctivitis, sneezing, salivation, nausea, vomiting and purging. It affects 
the heart like Digitalis, small doses frequently repeated slowing its action, but 
large ones quicken it and then suddenly paralyze it through the pneumogastric 
nerve. Respiration is at first accelerated, then slowed and rendered laborious. 
Diuresis is a constant result, the kidneys and uterus are congested, gradual 
paralysis and severe convulsions follow, and death occurs by paralysis of the 
heart. 

Black Hellebore is an old remedy, having been highly esteemed by the early 
physicians in insanity, dropsies, worms, cutaneous affections and amenorrhea. 
It has gone out of fashion, but might be usefully employed in dropsies and as 
a revulsant in acute cerebral affections. Hellebore'in has come into notice as 
a substitute for Digitalis in cardiac affections, being of less bulk and more defi- 
nite composition. Its action on the heart is attained by doses much smaller 
than those necessary to produce its irritant effects on the gastro-intestinal canal. 



HOANG NAN iirut i is. 299 

lis solubility in water and the freedom with which it can be used hypodermi- 
iallv are important qualities to recommend it. 



HOANG-NAN, Hwang-Nao (Unofficial),— is the bark of Strychnos Gautheriana, Tropi 

, .it Hind-weed, a creeping vine of the nat. ord. Loganiacea:, found in the mountains of Tonquin. 
It contains the alkaloids Strychnine and Brucine, thus resembling in composition its congeners 
Nu\ Vomica and Ignatia, but differing from them, as they do from each other, in the propor- 
tional quantities in which the alkaloids are contained, — Brucine predominating in this plant, 
.is Strychnine does in the other two. 

Like the other members of the Strychnos family, Hoang-Nan is an active tetanizcr, its 
action generally corresponding to that of Nux Vomica. It was first brought into notice by 
the missionary fathers stationed in the French colonies in Asia, they having found its employ- 
ment general among the natives for leprosy and hydrophobia. Along the coast of Tonquin 
and Cochin-China, also in Pondicherry, Trinidad, and Venezuela, it has an established repu- 
tation in the two terrible diseases mentioned, also as a remedy for the bites of venomous ser- 
pents and other reptiles, scrofulous and syphilitic ulcers, and indolent sores. It has been used 
successfully for malarial fevers, in lieu of quinine, and is highly spoken of by Father Brossc, 
as a stimulant to the intellect, without producing any subsequent depression. 

The dose of the powdered drug is about gr. iij-v; of the aceto-alcoholic Extract, gr. \-\; 
and of the concentrated tincture, ttjj-v. 



HUMULUS, Hops, — the dried strobiles (fruit-cones) of Humulus Lupulus, 
a cultivated creeping plant of the nat. ord. Moracea?. Its constituents are a 
liquid volatile alkaloid named Lupuline, a volatile oil, which consists in part 
of Valerol and Trimethyl amine, the crystalline, bitter principle Lupulinic Acid, 
also wax, resin, and tannin. Except the last named, the constituents are most 
abundant in the glandular powder of the strobiles, which is named Lupulin. 
Dose, gr. x-xlv [av. gr. xxx.] 

Preparations. 

Fluidextractum Humuli, Fluidextract 0} Hops, — Dose, njv-xv [av. njjviij.] 

Infusum Humuli, Infusion 0} Hops (Unofficial), — §ss to the pint. Dose, oj-iv. 

Lupulinum, Lupulin, — is the glandular powder separated from the strobiles, of bright, 
brownish-yellow color, aromatic and bitter taste. The Volatile Oil exists in the Lupulin 
grains, and contains Valerol, which is changed by long exposure, giving a disagreeable odor to 
old hops. Dose, gr. v-xv [av. gr. vijss.] 

Oleoresina Lupulini, Oleoresin of Lupulin, — -an acetone extract. Dose, gr. ij-v [av. 
gr- iij.] 

Mineral acids and metallic salts are chemically incompatible with preparations of Hops. 

Humulus is a bitter tonic, and a feeble hypnotic, also somewhat diapho- 
retic, astringent and anaphrodisiac. It increases the cardiac action and the 
cutaneous circulation. After slight cerebral excitement it produces calm and 
a soporific disposition, especially if the solution administered be strongly alco- 
holic. The stomachic and tonic effects are due to the bitter principle, Lupu- 
linic Acid, and are found in bitter ale. The primary stimulant and secondary 
sedative effects are due to the volatile oil and are also possessed by ales and 
beer. 

Hops are used as a tonic and calmative in delirium tremens, in which a 
combination of the tincture with tincture of capsicum is very efficient and is 
an excellent substitute for alcohol. In dyspepsia of atonic form Humulus is 



300 HYDRANGEA — HYDRARGYRUM. 

an excellent stomachic tonic, and in nervous irritability the fluidextract may 
be used as a calmative and hypnotic, or the hop-pillow, which certainly exer- 
cises considerable influence, imaginary or otherwise. A poultice of hops is a 
favorite domestic application in inflammations and pain. Lupulin has been 
used with benefit in irritable bladder and alcoholism, and as an anaphrodisiac 
in the treatment of chordee, gonorrhea, spermatorrhea and other affections of 
the genito-urinary organs. 



HYDRANGEA (Unofficial), — is the root of Hydrangea arborescens, a plant of the nat. 
ord. Saxifragacea?, growing in the southeastern states. It is a white, tough root, containing 
gum, albumin, starch, resin, and a ferrous salt, with other salts. Dose, 5ss-5ij. best in 
fluidextract. A decoction of the root may be prepared and used in doses of oj-ij- 

Hydrangea has been long used by the Cherokee Indians in calculous affections, and 
reports of cases by competent observers show that it is of unquestionable utility in this class 
of disorders, promoting the removal of gravel from the bladder, and relieving pain during the 
passage of renal concretions through the ureters. Large doses produce vertigo, oppression of 
the chest, and considerable cerebral disturbance. 



HYDRARGYRUM, Mercury, (Quicksilver), Hg, — is a shining, silver- 
white metal, fluid and slowly volatile at ordinary temperatures, solidifies at 
— 39 F., boils at 675 F., volatilizes at a temperature below that of visible red- 
ness, is odorless and tasteless, soluble in nitric acid, insoluble in ordinary sol- 
vents. It is obtained from its native sulphide (cinnabar), but occurs also in 
globules disseminated through the ore. 

Preparations oj Mercury. 

Hydrargyrum cum Creta, Mercury with Chalk, {Gray Powder) — has of Mercury 38, 
Honey 10, Prepared Chalk 57, Water q. s., shaken, triturated together, dried to 100, and then 
reduced to a uniform gray powder. Dose, gr. ss— x [av. gr. iv.] 

Massa Hydrargyri, Mass of Mercury, (Blue Mass, Blue Pill) — has of Mercury 33, 
Licorice 10, Althaea 15, Glycerin 9, Honey of Rose 33. Each grain contains gr. J of Mercury. 
Dose, gr. ss-x [av. gr. iv.] 

Unguentum Hydrargyri, Mercurial Ointment — Mercury 50, Lard 25, Suet 23, Oleate 
of Mercury 2, triturated together, until globules of Mercury cease to be visible under a lens 
having a magnifying power of ten diameters. 

Unguentum Hydrargyri Dilutum, Blue Ointment, — has of the preceding 67 with 
Petrolatum 33, thoroughly mixed. 

Emplastrum Hydrargyri, Mercurial Plaster, — has of Mercury 30, Oleate of Mercury 1, 
Hydrous Wool Fat 10, Lead Plaster 59. 

Chlorides and their Preparations. 

Hydrargyri Chloridum Corrosivum, Corrosive Mercuric Chloride, (Bichloride 0} Mer- 
cury, Corrosive Sublimate) HgCl 2 , — heavy, colorless crystals, of acrid, metallic taste, and 
acid reaction; soluble in 16 of water and in 3 of alcohol, in 2 of boiling water, 1.2 of boiling 
alcohol, 4 of ether and in about 14 of glycerin. Dose, gr. -5^— T V [av. gr. ^j.] 

Hydrargyri Chloridum Mite, Mild Mercurous Chloride, (Subchloride oj Mercury, 
Calomel) HgCl, — a heavy, white, impalpable powder, odorless and tasteless; insoluble in 
water, alcohol or ether. Is an ingredient of Pil. Cathartics Co. Dose, gr. Ty'p— gr. v. The dose 
depends on the effect desired; [av. laxative, gr. ij; alterative, gr. j.] 

Hydrargyrum Ammoniatum, Ammoniatcd Mercury, (While Precipitate, Mercuric 
Ammonium Chloride) HgXH,Cl, — is a white, insoluble powder, odorless and tasteless. Only 
used externallv. 



HYDRARGYRUM. ^or 

Unguentum Hydrargyri Ammoniati, Ointment of Ammoniatad \der6ury, {White 
\pitate O»M//ne»0 — Ammoniated Mercury to, White [Petrolatum 50, Hydrous Wool 
F.u 10. 

I )xides and their Preparations. 

Hydrargyri Oxidum Flavum, Yellow Mercuric Oxide, II^o, an orange-yellow, aea 1 
impalpable powder, odorless and tasteless, insoluble in water or alcohol, but wholly soluble 
in nitric or hydrochloric acid. Used to prepare: — 

Unguentum Hydrargyri Oxidi Flavi, Ointment of Yellow Mercuric Oxide, strength 
1 to 9. 

Oleatum Hydrargyri, Oleate of Mercury, — hasofthe Yellow Oxide 25, Distilled Watei 
35, Oleic Acid to 100. 

Hydrargyri Oxidum Rubrum, Red Mercuric Oxide, (Red Precipitate) HgO, —a heavy, 
orange-red, crystalline powder, having the same properties as the yellow oxide, from which 
it differs only in being crystalline, and in a less minute state of subdivision. Dose, gr. ,.,',, --,'„. 

Unguentum Hydrargyri Oxidi Rubri, Ointment of Red Mercuric Oxide, — strength 1 in 
10. 

Lotio Hydrargyri Flava, Yellow Wash, (Unofficial), — prepared by adding Corrosive 
Sublimate gr. xviij to Lime-water o\, producing the yellow oxide; a favorite application for 
syphilitic sores. 

Lotio Hydrargyri Nigra, Black Wash (Unofficial), — prepared by adding Calomel gr. xxx 
to Lime-water 5*. producing the black oxide. 

Iodides and their Preparations. 

Hydrargyri Iodidum Rubrum, Red Mercuric Iodide, (Biniodide of Mercury) Hgl 2 , — a 
scarlet-red, crystalline powder, almost insoluble in water, soluble in 130 of alcohol, in solu- 
tion of potassium iodide or of mercuric chloride. Prepared by double decomposition be- 
tween Potassium Iodide 5, and Mercuric Chloride 4 parts. Dose, gr. 3*5—^5 [av. gr. .^.] 

Liquor Arseni et Hydrargyri Iodidi, Solution of Arsenous and Mercuric Iodide, (Dono- 
van's Solution), — see page 159. 

Hydrargyri Iodidum Flavum, Yellow Mercurous Iodide, (Protiodide of Mercury) Hgl, — 
a dull green or greenish-yellow powder, insoluble in alcohol or ether and almost so in water. 
Dose, gr. T \-$ [av. gr. i.] 

Acid Combinations and their Preparations. 

Hydrargyri Benzoas, Mercuric Benzoate (Unofficial), — a white, crystalline, tasteless 
powder, slightly soluble in water, but readily soluble in a solution of common salt. Dose, 
hypodcrmically, gr. J-J, once daily. 

Liquor Hydrargyri Nitratis, Solution of Mercuric Nitrate, — a liquid containing in 
solution about 60 per cent, of Mercuric Nitrate, with about n per cent, of free Nitric Acid. 
Prepared from the Red Mercuric Oxide 40, by Nitric Acid 45, and Distilled Water 15. Used 
as a caustic. 

Unguentum Hydrargyri Nitratis, Ointment of Mercuric Nitrate, (Citrine Ointment), — 
Mercury 7 dissolved in Nitric Acid 17J, adding Lard 76. 

Unguentum Hydrargyri Nitratis Rubrum, — Red Ointment of Mercuric Nitrate, 
Brown Citrine Ointment, (Unofficial) — differs from the official ointment only in being made with 
Cod-liver Oil, which gives it a brown color, and a more agreeable odor. 

Hydrargyri Salicylas, Mercuric Salicylate (Unofficial), — a white, tasteless powder, 
insoluble in water or alcohol, but readily soluble in a solution of sodium chloride or any of 
the halogen salts. Dose, gr. J-gr. j in pill; hypodermically gr. J in Paraffin oil irjfj. 

Hydrargyri Subsulphas Flavus, — Yellow Mercuric Subsulphate, Basic Mercuric 
Sulphate, Turpeth Mineral, (Unofficial), — a heavy, lemon-yellow powder, practically insol- 
uble in water or alcohol. Dose, as an emetic, gr. ij-v. 

Unofficial Organic Preparations. 

Mercurol, — is a compound of metallic mercury and yeast nuclein, containing 10 per 
cent, of mercury; a brown powder, soluble in water, insoluble in alcohol. It is used in a 1 per 
cent, solution as an injection in gonorrhea and cystitis. Dose, gr. ss-iij, thrice daily. 



302 HYDRARGYRUM. 

Sublamin, — is a combination of Mercuric Sulphate 3, and Ethylene-diamine 8, con- 
taining 43 per cent, of mercury, freely soluble in water, insoluble in alcohol. Used in 1 to 
500 or 1 to 1,000 solution for disinfecting hands and instruments. 

Triturations. 

These may be prepared according to the general formula under the title Trittjrationes 
in the Pharmacopoeia, 10 parts of the substance to 90 of Sugar of Milk. Mercury itself or 
any of its salts may be so treated with excellent results, the particles being much finer and 
therefore more easily absorbed than if rubbed up with another agent. In this form a larger 
proportion of the drug is utilized for specific purposes, while but a small amount remains 
to give rise to local irritation (Piffard). All trouble concerning incompatibility may be 
avoided by using triturations. 

Incompatibles. 

Incompatible with Mercuric Chloride {corrosive sublimate) are: Albumin, Alkalies, Alka- 
loids, Ammonia, Antimonous and Arsenous salts, Bromides, Borax, Carbonates, Copper and 
Ferrous salts, Formic Acid, Glucosides, Honey, Hypophosphites, Hypophosphorous Acid, 
Iodides; Infusions of Cinchona, Calumba, Oak-bark, Senna; Lead salts, Lime-water, Milk, 
Phosphates, Piperazin, Silver Nitrate, Soap, Sulphates of Potassium or Sodium, Sulphides, 
Syrup of Sarsaparilla Compound, Tannic Acid, Tartar Emetic, Vegetable astringents, Zinc 
salts. 

With Mercurous Chloride {calomel) are: Acacia, Acids mineral, Airol, Alkalies, Ammonia, 
Antimony Sulphide, Arsenites in alkaline mixtures, Bromides, Carbonates, Chlorides, 
Citric Acid, Cocaine, Copper salts, Cyanides, Hydrocyanic Acid, Hydrogen Peroxide, Hypo- 
phosphorous Acid, Iodides, Iodine, Iodoform, Lead salts, Lime-water, Mercuric Oxides, 
Pilocarpine, Sodium Bicarbonate; Sugar, both cane and milk; Silver salts, Soaps, Sulphides, 
Tragacanth. 

With Ammoniated Mercury are: Acids, Alkalies, Bromine, Chlorine, Iodine, Lime- 
water. With Mercuric Iodide, as with Mercuric Chloride. With Mercurous Iodide, as with 
Mercurous Chloride. With Mercuric Oxide are Acids (mineral), Chloral Hydrate, Mercuric 
Chloride. With Mercuric Subsulphate are Acids, Caustic Alkalies. 

Physiological Action. 
Mercury is tonic, purgative, alterative, antiphlogistic and sorbefacient, and 
indirectly cholagogue. Some of its salts are corrosive poisons, others are local 
caustics, all produce by long-continued administration the peculiar cachexia 
termed Hydrargyrism. The metal itself is inert, but by combination with the 
acids and fluids of the body it becomes active, and is readily absorbed in any 
form, passing into the blood from the skin, mucous membranes, lungs and 
stomach, in each case probably as an oxyalbuminate. Entering the stomach 
in any form it is first converted into a double chloride of sodium and mercury; 
it next unites with the albuminous juices to form a complex molecule of mer- 
cury, sodium, chlorine and albumin, which being soluble in an excess of so- 
dium chloride or albumin, exists in solution and is easily absorbed, then being 
decomposed in the blood and changed to the oxyalbuminate. Entering the 
intestines a purgative action is soon set up, of more or less severity according 
to the preparation used, a small portion only is absorbed, the rest being con- 
verted into a sulphide and excreted with the feces, unless combined with Opium, 
which delays its progress through the intestines and permits of its freer absorp- 
tion. On the blood its effects in small doses are tonic, but in quantity it indi- 
rectly produces impoverishment thereof, impairs the ozonizing function, di- 
minishes the red corpuscles, and consequently disorders nutrition and deranges 
digestion. From the blood it enters the tissues, where it remains for an indef- 



1IVDU VRGYRT M. 



.303 



inite period, exerting a peculiar influence, termed "alterative," on all processes 
characterized by growth of young cells, but not producing any definite ana 
tomicaJ changes either in the viscera or the nervous tissue, though in the latter 
a low form of inflammation arises, resulting in loss of coordination-power. It 
stimulates most of the glands to the production of pathological secretions, 

viallv the salivary glands and the pancreas, and is excreted with compara- 
tive slowness by all the excretory organs, being found in the saliva, sweat, milk, 
urine and bile. A single dose is entirely eliminated in 24 hours, but if repeated 
in less time it accumulates in the body, only gr. T \ T being eliminated daily by 
the kidneys, so that when its full desired effect is produced, the dosage should 
be decreased, and only enough should be given to maintain its action. It 
tends to accumulate in the liver, while stimulating its cells, and is not a direct 
cholagogue, though stimulating the flow of bile already secreted by reflex action 
on the bile-ducts due to its purgation of the duodenum. Its excretion is has- 
tened and completed by the use of Potassium Iodide. 

In small doses administered for a short time the mercurial preparations 
are blood-tonics, improving the general condition, increasing the number of 
red corpuscles and the body-weight. They soon begin to promote waste by 
stimulating the lymphatic system, and if the small doses are long continued 
or the quantity is increased, symptoms of mercurial poisoning begin to mani- 
fest themselves. 

The first symptoms of Hydrargyrism are fetid breath, swollen and spongy 
gums having a bluish line along their margins, stomatitis, sore and loosened 
teeth, inflamed and tender salivary glands pouring out a peculiar, thin saliva 
of foul odor in large quantity, and a metallic taste in the mouth. Anorexia, 
diarrhea and fever follow, also ulceration and in some cases even gangrene 
of the lips and tongue. If the use of the drug be continued nutrition will be 
greatly impaired through the extreme promotion of retrograde metamorphosis, 
and various nervous disturbances will follow, the effects being emaciation, 
pallor, edema, ulcerated skin, erythematous, vesicular or pustular eruptions, 
headache, insomnia, neuralgia, tremor through paresis of the muscles of the 
head and extremities, epilepsy, coma and convulsions. In pregnant women 
abortion will occur by reason of the impoverishment of the blood. As Dr. 
Ringer said in the earlier editions of his Handbook of Therapeutics, the phenom- 
ena produced by mercury are singularly similar to those which result from 
syphilis, and the serious symptoms known as secondary and tertiary syphilis 
can be produced both by syphilis and by mercury. The drug is a specific 
antagonist to the syphilitic virus, probably by reason of its affecting the same 
organs and tissues of the body on a similar line of action, both poisons mutu- 
ally destroying each other in the organism. It is certainly capable of bringing 
about a radical cure of syphilis, if introduced into the system in considerable 
quantity and its use protracted over a very long time, the action of the drug 
in all cases being kept short of ptyalism or any pronounced physiological effects. 



304 HYDRARGYRUM. 

The observations on the antiphlogistic and sorbefacient actions of Mercur 
are clinical rather than physiological, but it is generally agreed that exhibited 
in inflammation mercurials antagonize the increase of the hemic fibrin which 
is so constant an effect of the inflammatory process, and that in chronic diseases 
attended by the formation of semi-organized deposits, a mild mercurial course 
will almost insensibly remove the new-formed material. 

Salivation is most readily produced by blue mass, next by calomel, and 
less easily by gray powder. Individuals differ greatly in their susceptibility 
to the action of mercury, some persons having been affected after a single moder- 
ate dose. Children are not easily salivated. Inhalation of mercurial vapors 
is most apt to affect the nervous system; the internal administration and that 
by inunction are more likely to produce salivation. A not uncommon result 
of full doses of blue pill is an acute coryza of very severe character, which the 
writer has frequently observed to follow on neglect of the old-fashioned pre- 
caution to "work off" the mercurial by a saline cathartic. The symptoms 
produced are those of a severe attack of influenza, — epistaxis, conjunctivitis 
and obstinate muco-purulent discharge from the nasal passages being espe- 
cially marked. Similar effects have been observed during physiological ex- 
periments with mercury on animals by Overbeck and Bennett. 

All mercurials are antiseptic, germicidal, and antiparasitic, the Bichloride 
and Biniodide being the most powerful in these respects. Micrococci and bacilli 
in active growth without spores are killed by solutions of the Bichloride of i 
in 20,000, while solutions of 1 in 1,000 will rapidly destroy the spores of bacillus 
anthracis and bacillus subtilis. The chemical instability of this salt prevents 
its general use as a disinfectant, it being rapidly decomposed by ammonia and 
other substances usually present in excreta. The oleate, oxide, ammoniate, 
nitrate, and bichloride, are the preparations generally used to destroy the animal 
and vegetable parasites which infest the skin. The toxic action of mercury 
on protoplasm is due to its great affinity for nitrogenous molecules. The in- 
soluble preparations are less powerful as germicides than the soluble ones, 
owing to the difficulty of bringing them into intimate contact with the microbes; 
but the Subchloride (calomel) has considerable effect as an intestinal antiseptic. 

Notes on the Action of the Preparations. 

Metallic Mercury is not used internally except in the finely divided form 
obtained in blue pill and gray powder, which are capable of producing the 
effects previously described. Mercurial Ointment is the preparation generally 
used for inunction, a piece the size of a small nut being daily rubbed into the 
soft skin at the flexures of joints. The Oleate painted over the surface is a 
more cleanly method of making the same application. Both these preparations 
are efficient parasiticides. 

The Bichloride (corrosive sublimate) is the most actively toxic of the mer- 
curial salts. It is probably the most active germicide and parasiticide, a solu- 



BYDRARGYRUM, 305 

tion of 1 part in 2,000 being efficiently antiseptic for use as injections or dress 
ings, and a solution of 1 in 250 being the usual strength for use againsl epizoa 
and in parasitic skin affections. It is a very active gastro intestinal irritant, in 
toxic dose producing nausea, retching and vomiting, a metallic taste, constric 
tion of the fauces, burning pain in the stomach, suppression of urine, bloody 
diarrhea, collapse and death often preceded by convulsions. It affects specif- 
ically the lower bowel [Calomel preferring the upper intestine], and produces 
inflammation and ulceration of the rectum. It is, however, one of the most 
manageable and efficient of the mercurials when used in proper doses. 

The Subchloride (calomel) is very insoluble and unirritating, tasteless, 
laxative in grain doses, decomposed by the alkaline contents of the intestines, 
oxide of mercury being formed, and acts especially on the excrementitious glandu- 
lar appendages of the upper intestine, stimulating the liver by indirect reflex 
action as a duodenal purgative. In the presence of alkaline chlorides it is con- 
verted into the bichloride, but not in sufficient quantity to render it dangerous 
in the gastro-intestinal canal. Externally applied it is sedative to the mucous 
membranes and the skin. It is an efficient diuretic, in small doses frequently 
repeated. Ammoniated Mercury is an ammonio-chloride, and a useful stimu- 
lant and parasiticide when used locally in the form of ointment. 

The Iodides are actively poisonous, the red being much the most irritant, 
producing symptoms and results similar to those of the bichloride. The yellow 
Subsulphate is a prompt and usually harmless emetic, but has occasionally 
produced fatal results by its irritant action. The Oxides are irritant, the red 
being the most so, and are rarely used internally. The acid Nitrate is a good 
escharotic, the pain caused by it being transient though severe, and its caustic 
action being comparatively superficial. The Ointment of the Nitrate (citrine 
ointment) is more irritant than that of ammoniated mercury, and generally 
needs dilution. All these preparations may produce the constitutional effects 
of mercury, and the subjects of their administration should be carefully watched 
for the first symptoms of mercurialization. 

Therapeutics. 
Mercury is undoubtedly a specific in syphilis, but it is not always applicable 
to the tertiary form of the disease. As an accurate diagnosis of syphilis is essen- 
tial before administering mercury, it is now believed that it should be withheld 
until the secondary symptoms appear, for if there is no syphilitic virus to be 
antagonized the constitutional effects of mercurials will become manifest sooner 
and may do great harm in feeble subjects, besides the risk of mistaking them 
for the results of the disease supposed to be present. The yellow Iodide, in 
doses of gr. ^ to £ thrice daily with opium to prevent its running off by the 
bowels, is one of the best preparations for internal use. It should be carefully 
watched, and its administration stopped just short of ptyalism, but renewed 
again, and continued in this manner for several months. Fumigation by Calomel 



306 HYDRARGYRUM. 

volatilized by heat, or the inunction method with the Oleate or the Ointment, 
or the hypodermic method, may be used when the stomach will not bear anv 
mercurial. In tertiary syphilis the condition of the patient must be the chief 
guide to the use of mercury, which becomes necessary however when the local 
lesions threaten a fatal result or the production of organic changes in a vital 
organ. 

Tonsillitis, parotitis and other acute glandular inflammations of the throat 
and neck may often be rapidly cured by calomel gr. -^ or gray powder gr. \ 
every two hours. In irritable stomach with obstinate vomiting the same small 
doses of calomel every half hour are very efficient. The dysentery of adults 
with slimy and bloody stools is best treated by small doses (gr. T ^) of the bi- 
chloride, and in the diarrhea and dysentery (ileo-colitis) of infants gray powder 
gr. \ or calomel gr. ^V will be found effective. In gastric ulcer and in the first 
stage of hepatic cirrhosis, the bichloride in doses of gr. ■£$ to ^ thrice daily is 
a good remedy. Typhoid fever is treated in Germany by calomel, gr. x daily 
for three days, as an antipyretic. Diphtheria is by many practitioners con- 
sidered to be best antagonized by calomel in large doses, and in this affection 
the cyanide has had many advocates in doses of gr. -j-jnr~ oV every hour, a weak 
solution being used at the same time as a gargle. Asiatic cholera is frequently 
treated by small, repeated doses of calomel with opium from the start. Inflam- 
mations of sthenic character in the stage of exudation, especially when affect- 
ing serous membranes, are considered by many authorities to be best met by 
the free use of mercurials, but this treatment is fast going out of favor, except- 
ing in cases of iritis, which affection is very often of syphilitic causation, and in 
pneumonia, which is frequently treated, according to the best American au- 
thorities, with sedative doses (gr. xv-xx) of calomel. 

In the general condition known as "biliousness," manifested by whitish 
or clay-colored stools, constipation, nausea, anorexia, coated tongue, and slight 
jaundice, mercurial purgatives have long been a routine remedy, but mild 
saline purgatives are by many authorities considered equally efficient. As an 
antiseptic to the gastro-enteric tract in many forms of stomach and intestinal 
disorders (dyspepsia septica) the administration of minute doses of the yellow 
oxide will be found remarkably efficient. It is best used in trituration with 
sugar of milk, i to 1,000, and in doses of gr. -^VtV By the use of these small 
doses failing digestion and nutrition may often be improved. 

In laryngeal diphtheria (membranous croup) the subsulphate as an emetic 
is by many considered to have some specially beneficial influence. 

Locally, an ointment of calomel 3j to 5] of lard is an excellent antipruritic, 
and ointments of the chlorides and iodides are much used in skin diseases, par- 
ticularly psoriasis, herpes, acne and pityriasis. In parasitic affections a lotion 
of the bichloride, gr. ij to 3J of distilled water, or a 5 per cent, oleate with £th 
part of ether, is very efficient. The oleate is a serviceable application to syphilitic 
indurations, but is not deemed advisable when ulceration exists. In conjunc- 



n\ DB VRCV Rl M. 307 

tiviiis calomel may be used as a sedative application, or still better an ointment 
of the yellow oxide, gr. ij-x to ,sj of vaselin, triturated to the utmost fineness 
before mixing. Goitre and enlarged spleen are often speedily reduced by rub- 
bing into the skin covering them the ointment of the red iodide somewhat di- 
luted and applied before a hot fire or in the direct sunlight. The acid nitrate 
solution is one of the best caustics for destroying chancroid and syphilitic warts 
and vegetations. The black and yellow washes are used as applications to 
syphilitic erosions and ulcerated indurations. 

As an antiseptic injection or application to dressings a solution of the bi- 
chloride, gr. vijss in a quart of water, with gr. xl of citric or tartaric acid to 
prevent albuminate formation, is probably the most efficient, as it is the most 
generally used. This proportion makes a solution of 1 in 2,000, but weaker 
solutions, 1 in 5,000, are sufficiently antiseptic for many purposes. They should 
not be employed for the disinfection of surgical instruments, which are injured 
by this salt.' 

Sublamin is not irritant to the skin even in strong solution, and not form- 
ing an albuminate when applied to the tissues it has a more penetrating effect 
than the bichloride, and is said to be quite as efficient as that salt in germicidal 
power, while free from its disadvantages. This perparation is used in solu- 
tions of 1 in 500 or 1 in 1,000 for the sterilization of nickel-plated instruments, 
the operator's hands, and the site of operation. 

Mercurol does not coagulate albumin, and is used as an alterative, astrin- 
gent, and antiseptic application in many morbid conditions. As a gonococcide 
its use in ^ to 2 per cent, solutions is considered by many specialists to be a 
decided advance on the treatment of gonorrhea by astringent injections and 
balsamic remedies. In chronic cystitis a 1 per cent, solution as a wash for 
the bladder has given great satisfaction, and it is said to be the least irritant 
of effective antiseptics for the local treatment of the nose and ear. A 2 to 5 
per cent, ointment is used with benefit as a dressing for ulcers, and the pow- 
der itself may be dusted on wounds. Internally in doses of gr. j-jss twice daily 
it has given satisfaction in syphilis. 

The Hypodermic Injection of mercurials has many advantages in syphilis, being rapid 
and powerful in action, free from gastro-intestinal irritation, and cleanly, though somewhat 
painful. Many preparations have been thus used, but none has any distinct advantage over 
the Bichloride, which is less dangerous than many others, especially those containing calo- 
mel. Hebra's formula is a 1 per cent, solution in a 6 per cent, solution of sodium chloride, 
giving of the salt gr. J to J once daily, gr. J^ to J daily or every other day (Wood), injected deeply 
into the gluteal muscles or those of the back, the part being massaged to prevent local irrita- 
tion. The Sal Alembroth Solution is prepared by dissolving the bichloride gr. xvj, ammo- 
nium chloride gr. viij, in distilled water § j ; the dose of which is Ttjfx, containing gr. \ of mer- 
curic ammonium chloride. Gray Oil is prepared by emulsifying 5ij of lanolin with chloro- 
form, adding 3iv of metallic mercury, triturating, and adding \\h. part of olive oil; the dose 
being njjj-ij every 2 or 3 days: or mercury oj, lanolin 5ij, oil carbolized 2 per cent. 3j, 
made into a cream, of which njjx may be injected once a week. Other Preparations adapted 
to this method are: The Benzoate, in 1 per cent, aqueous solution, with J per cent, of sodium 
chloride (Gaucher); the Salicylate, gr. $— h in 20 minims of sterilized liquid petrolatum; the 
Subchloride {calomel) with sodium chloride" 5 parts of each in 50 of water. The latter causes 
much pain, frequently produces abscesss, and is liable to induce severe ptyalism. 



3o3 HYDRASTIS. 

HYDRASTIS, Hydrastis, — is the dried rhizome and roots of Hydrastis 
canadensis, Golden Seal, a small plant of the nat. ord. Ranunculaceae, grow- 
ing in most parts of the United States. It contains three alkaloids, Hydrastine 
C 21 H 21 H0 6 , white and crystalline, soluble in alcohol and in ether, insoluble 
in water; Berberine C 20 N 17 NO 4 , yellow and crystalline, soluble in hot water 
and in alcohol, insoluble in ether; and Canadine, C 21 H 21 N0 4 , white needles, 
present in very small quantity. From Hydrastine oxidation liberates Opianic 
Acid and the artificial alkaloid Hydrastinine C u H u N0 2 , the hydrochloride 
of which is official. Dose of Hydrastis, gr. x-xlv [av. gr. xxx.] 

Preparations. 
Fluidextractum Hydrastis, Fluidextract oj Hydrastis. Dose, gr. x-xlv [av. gr. xxx.] 
Tinctura Hydrastis, Tincture oj Hydrastis, — 20 per cent, strength. Dose, oss-jss 
[av. oj.] 

Glyceritum Hydrastis, Glycerite 0} Hydrastis, — has of Hydrastis 2, in Glycerin 1, pre- 
pared by percolation with water and alcohol. Dose, njx— xlv [av. ttjjxxx.] 

Hydrastina, Hydrastine, — the alkaloid (see above). Dose, gr. J— J [av. gr. -!.] 
Hydrastinina? Hydrochloridum, Hydrastinine Hydrochloride, — the hydrochloride 
of an artificial alkaloid derived from Hydrastine. Dose, gr. J— j [av. gr. ss ] in capsule 3 or 4 
times a day, or hypodermically in 10 per cent, solution. 

Hydrastin (Unofficial), — is an impure extract precipitated by hydrochloric acid from 
an alcoholic solution of hydrastis, and contains Berberine, Hydrastine, and resin. Dose, 
gr. ij-v. 

Incompatibles. 

Incompatible with preparations of Hydrastis are Alkalies, Hydrochloric Acid, Tannic 
Acid, and other alkaloidal precipitants, (see page 5). 

Physiological Action. 
Hydrastis is a simple bitter and a stomachic tonic. It promotes appetite 
and digestion and increases the secretions of the gastro-intestinal tract and 
the flow of bile, but if long used it will derange digestion and produce consti- 
pation. It is considered alterative to the mucous membranes, deobstruent to 
the glandular system, cholagogue, diuretic, antiseptic, and antiperiodic, in the 
latter respect ranking next to cinchona. Hydrastine stimulates the medullary 
centres and the intestinal, cardiac, and uterine muscles, raises arterial tension, 
slows and strengthens the heart beat, quickens respiration, promotes intestinal 
peristalsis and uterine contraction. In toxic dose it stimulates the spinal cord, 
causing tetanic convulsions, depresses the motor nerves and the muscles, and 
finally paralyzes the medullary and spinal centres and the heart, death occur- 
ring by respiratory paralysis. It is a poison to the muscular system, both striated 
and non-striated, throughout the body. Hvdrastinine is a powerful depres- 
sant to the entire motor tract, from the cerebral cortex to the muscular tissue. 
It has a stimulant effect upon the circulation, causes the heart to act more slowly 
and more powerfully, and contracts the blood vessels, producing a marked and 
prolonged rise of arterial tension throughout the body. It is believed to have 
a powerful antispasmodic action, and to decrease the general excitability of the 
cerebral cortex. Berberine causes toxic symptoms in small animals, but seems 



HYDROI 01 \ i E. 309 

to act only as a bitter tonic on man. Canadinc in small dose produces drowsi- 
ness and languor, in large dose it depresses the central nervous system after a 
short period of excitement, and causes weakness and arrhythmia of the heart, 
and its injection is followed by violent intestinal peristalsis and diarrhea. 

Therapeutics. 

Hydrastis is used as a stomachic tonic, an alterative application to mucous 
surfaces, and an antiperiodic. It is an excellent remedy locally and internally 
in all forms of catarrh, especially that of the stomach, duodenum, gall ducts, 
bladder, uterus and vagina. Internally it is efficient in many glandular swell- 
ings, in chronic constipation due to a sluggish state of the liver or deficiency 
of the other intestinal secretions, in chronic dyspepsia, and as a substitute for 
alcohol in dipsomaniacs when a catarrhal state of the stomach has been in- 
duced. In gonorrhea, gleet, and chronic nasal catarrh, it is employed locally 
with much benefit, also in syphilitic affections of the mouth, throat and nares. 
As an alterative and antiseptic application it is recommended for unhealthy 
ulcers and sores, cancerous ulcerations, mercurial and aphthous stomatitis, 
rectal fissure, fistula and prolapse, internal and external hemorrhoids, cracks, 
fissures and abrasions of the nipples, erosion and ulceration of the cervix uteri, 
and in conjunctivitis with muco-purulent discharge. In the second stage of 
gonorrhea, after the acute inflammation has subsided, injections of the com- 
mercial extract (hydrastin), or the fluidextract suspended in mucilage, are 
often very efficient in restoring the urethral mucous membrane to a healthy 
condition. Hydrastine and Hydrastin rank high in the treatment of intermit- 
tent fever and chronic malaria, though much inferior to quinine. 

Hydrastinine has long been known as a uterine vaso-constrictor, and as 
such has been successfully employed in metrorrhagia. It is considered preferable 
to hydrastine on account of its stimulant action on the cardiac muscle, and the 
persistent constriction which it produces in the walls of the vessels. The hydro- 
chloride is employed in a dose of one grain hypodermically, using a ten per 
cent, solution; the injections being best made, for menstrual irregularities, 
during a few days previous to the expected term. It has been used with great 
benefit in dysmenorrhea, metritis, endometritis, myomata and pyo-salpingitis. 
It has been employed successfully in the treatment of hydrophobia, strychnine- 
poisoning and epilepsy, in the latter disease having been given in doses of \ 
to \ grain, up to 2 grains daily, with marked benefit in many cases. It is an 
excellent subsidiary cardiac tonic, when a slow but permanent action on the 
circulation is required; and its mild and enduring effect as an arterial constrictor 
is useful in acute and chronic aortitis and arterio-sclerosis. 



HYDROCOTYLE, Pennywort (Unofficial), — is the leaf of Hydrocotyle asiatica, a small 
plant of the nat. ord. Umbelliferas, a native of southern Africa and India. It contains a pecu- 
liar, oleaginous substance, Vellarine, which has a bitter, persistent taste, and is thought to 
be the active principle. It has long been used in its native countries as an alterative to purify 



310 HYOSCYAMUS. 

the blood, and has been found of service in eczema, lupus, psoriasis, syphilitic and scrofulous 
sores, and in leprosy. An ounce of the dried plant or leaves is given daily in infusion. It 
causes great itching over the whole body, ovarian pain in females, and urinary irritation. In 
one case in which the drug was being given for lupus of the hand a severe orchitis was set up 
without any other apparent cause. It certainly exerts a markedly special influence on the 
genito-urinary tract. 



HYOSCYAMUS, Hyoscyamus, — is the dried leaves and flowering tops, 
collected from plants of the second year's growth, of Hyoscyamus niger, Hen- 
bane, nat. ord. Solanacese, growing in Europe and the northern United States. 
It should contain not less than 0.08 per cent, of mydriatic alkaloids, including 
Hyoscyamine C 17 H 23 N0 3 , isomeric with Atropine, Hyoscine C 17 H 21 N0 4 , closely 
allied to Atropine, and Atropine C 17 H 23 N0 3 (see under Belladonna), the lat- 
ter in very small quantity. Dose of Hyoscyamus, gr. j-vj [av. gr. iv.] 

Scopola, — is the dried rhizome of Scopola Camiolica, nat. ord. Solanacea?, 

yielding not less than 0.5 per cent, of its alkaloids. It contains the alkaloid 

Scopolamine, C 17 H 21 N0 4 , which is chemically identical with Hyoscine. The 

plant is a common one in the mountains of Bavaria and Hungary. Dose, gr. 

ss-j [av. gr. f .] 

Preparations of Hyoscyamus. 

Extractum Hyoscyami, Extract of Hyoscyamus, — obtained by evaporating the fluid- 
extract. Dose, gr. ss-jss [av. gr. j.] 

Fluidextractum Hyoscyami, Fluidextract oj Hyoscyamus, — Dose, ttjn-v [av. lrjmj.] 

Tinctura Hyoscyami, Tincture oj Hyoscyamus, — 10 per cent, strength. Dose, ngv-xxx 
[av. trjjxv.] 

Preparations of Hyoscyamus are very uncertain in strength and physiological activity. 

Hyoscinae Hydrobromidum, Hyoscine Hydrobromide, — colorless crystals, soluble in 2 
of water and in 16 of alcohol. Nearly all of this salt furnished by manufacturing chemists 
consists of Scopolamine Hydrobromide (Schmidt). Dose, gr. j^ ~ihs [ av - S r - T2«] f° r tnc 
sane; larger doses, up to gr. ^, are used for the insane. 

Hyoscyamina? Hydrobromidum, Hyoscyamine Hydrobromide, — white, prismatic 
crystals, or a yellowish, amorphous mass, of tobacco-like odor, and acrid, bitter, nauseous 
taste; very soluble in water, soluble in 2 of alcohol. Dose, gr. j^—tutt [ av - g 1 "- T2S-1 

Hyoscyamine Sulphas, Hyoscyamine Sulphate, — white crystals, or a white powder, 
odorless, of bitter, acrid taste; very soluble in water, soluble in 7 of alcohol. Dose, gr. ,',,,- 
iho [ av - S r - TITS'-]; but higher doses are used for the insane. 

Preparations of Scopola. 

Extractum Scopolae, Extract oj Scopola, — prepared by evaporating the fluidextract. 
Dose, gr. J-£[av. gr. >.] 

Fluidextractum Scopolas, Fluidextract oj Scopola,- — prepared by maceration and per- 
colation with Alcohol 8, Water 2. Dose, njss-ij [av. ttjvj.] 

Scopolamines Hydrobromidum, Scopolamine Hydrobromide, — chemically identical 
with Hyoscine Hydrobromide. Dose, gr. t^jj-j^o [ av - g r - t^s-1 

Incompatibles. 

Incompatible with Hyoscyamus are: Acids, Caustic Alkalies, Alkaloidal precipitant? 
(see page 5), Ferrous Sulphate, Lead Acetate, Silver Nitrate, Vegetable astringents. Liquor 
Potassii Hydroxidi, though incompatible, is frequently prescribed with the tincture of hyos- 
cyamus, the combination seeming to have therapeutical value. Physiological incompatibles 
are the same as for Belladonna (see page 172). 



E\ OSCYAMUS. 3] i 

Physiologicai Action. 

Hyoscyamus tas similar action to that of Belladonna, Duboisia and Stra- 
monium, except that it is the least powerful and irritant of the group, hut the 
most calmative and hypnotic. The delirium produced by it is never furious 
and is without hyperemia, but is frequently accompanied by insomnia. It is 
more stimulant to the vaso-motor system and to the cardiac accelerator appa 
ratus than Stramonium, but is less active on the pneumogastric. It has de- 
cided laxative and carminative effects on the intestines and a very marked seda- 
tive influence on the urinary passages. 

Hyoscyamine is considered identical with Atropine in its effects on the motor 
apparatus and the circulation, including the heart and the vaso-motor system, 
but having a less stimulant action on the central nervous system, producing 
symptoms of cerebral depression instead of garrulous delirium. It is less power- 
ful than atropine as a mydriatic, and in a few cases it has seemed to diminish 
the respiratory rate. It is believed to be a hypnotic, though some deny that 
it possesses any soporific influence. 

Hyoscine is a cerebral and spinal sedative, and a powerful hypnotic, di- 
rectly depressing the higher functions of the brain, and affecting the heart 
but feebly. It is probably the action of this agent which prevents Hyoscy- 
amus from causing the excitation and delirium of belladonna. After the hypo- 
dermic administration of a full dose (gr. ^), there is, in most subjects, a period 
of semi-maniacal delirium, with flushed face and dry mouth, lasting from one 
to two hours, and followed by the sedative action of the drug, during which 
the pulse-rate and frequency of respiration, at first quickened, are distinctly 
lowered. It especially affects the motor tract of the spinal cord and the cere- 
bral cortex, slightly depresses the heart, but paralyzes respiration. It is free 
from irritant qualities and may be used hypodermically. Its habitual use 
brings on muscular paralysis and delirium of violent character. It is frequently 
used as a hypnotic by alcoholics and nervous subjects, and will probably be 
responsible for many deaths. As a mydriatic its reputation is doubtful, some 
observers claiming greater power for it in this respect than that of Atropine, 
while others say that mydriasis may follow its use but is not always produced 
by even large doses. Severe toxic symptoms have followed the application 
of 4 drops of a 1 per cent, solution (equal to gr. -£%) to the ocular conjunctivae. 
In large doses Hyoscine is a dangerous depressant of the respiration, but it 
may be used without unpleasant effects in medicinal doses. Whenever full 
doses are employed the respiration should be watched for several hours. 

Dr. Balagopal, of India, has reported a case in which a man suffering from intermittent 
attacks of maniacal delirium was accidentally given gr. \ of the hydrobromide of hyoscine 
hypodermically. Severe toxic symptoms supervened, which were however antagonized 
by Sulphuric Ether administered subcutaneously. The patient recovered, and thereafter 
remained free from mental disorder. 



312 hyoscyamus. 

Therapeutics. 

Hyoscyamus is a valuable though feeble narcotic, and is chiefly used as a 
hypnotic and an anodyne when opium is contraindicated, and for children. 
It is by far the best agent to use in acute mania with great motor excitement, 
obstinate insomnia and varied hallucinations. Chronic mania has been more 
benefited by it than by any other drug, and it is very efficient in insanity char- 
acterized by frequent delusions. In delirium tremens and the delirium of fevers 
it is an excellent hypnotic, and the monomania of hypochondriacs is alleviated 
and often cured by it. Whooping-cough, nervous coughs, and especially a 
dry, tickling night-cough, are greatly alleviated by full doses of Hyoscyamus. 
It is efficient in colic of various forms, to palliate the trembling of paralysis 
agitans and mercurial tremor, and to relieve the pains and disordered coordi- 
nation of locomotor ataxia. In constipation it is a good remedy, the extract 
being much employed in combination with other purgatives to render them more 
efficient and less drastic, but the quantity generally used is too small to be of 
any particular benefit. The tincture is an efficient remedy in irritability of 
the bladder from any cause. 

Hyoscyamine may be used for the same purposes as Atropine, but being 
liable to considerable variation in purity and activity, it is not a popular agent 
with the profession. 

Hyoscine has been frequently used in neuralgia, whooping-cough, acute 
mania, insomnia from cerebral excitement, delirium tremens, asthma and en- 
teralgia, also in ophthalmic practice as a mydriatic. It is an excellent hypnotic 
and sedative, and has been used with satisfaction to control the motor restless- 
ness of fevers. It efficiently but temporarily controls the tremor of paralysis 
agitans, and is highly useful at times in the treatment of the morphine-habit, 
especially for the extreme restlessness and insomnia resulting from the final 
withdrawal of that drug. In such cases, however, it must be used only in em- 
ergencies and should not be given habitually, as it excites a high degree of de- 
lirium in most subjects at first, followed after about 2 hours by its secondary 
sedative influence. Excessively or carelessly employed, it is liable to seriously 
derange the mental faculties in the same manner as atropine, and is probably 
responsible for many of the impaired intellects which emerge from the so-called 
"bichloride of gold cures." Dr. Lionel Weatherly has found it particularly 
useful in that form of mental disturbance which renders the patient violent 
and abusive, restless and domineering — a nuisance to every one who has any- 
thing to do with him. Under the administration of repeated small doses of 
hyoscine such a patient becomes a changed man. Violence and abusiveness 
give place to an amiable politeness, and instead of indulging himself in the free 
exercise of an extensive, if somewhat shady vocabulary, the patient subsides 
into silence. 

Scopolamine-Morphine Anesthesia, produced by the hypodermic injection of Scopolamine 
(Hyoscine) Hydrobromide, gr. J 5 , and Morphine Sulphate, gr. jss, administered separately 1 \ 



[GN \l 1 \ II I HUM. ,}l 3 

hour before operation, induces deep narcosis and general anesthesia, in which surgi. aJ opera 
tions may be performed. Though used in mam < ases l>v Bios and others, this method is not 
generally approved, ;h it is sometimes ineffective, requires a previous test to determine the 

ptibility of the patient, and is dangerous to the respiration for some time after the 
coeis lias disappeared. 



IGNATIA, St. Ignatius' Bean (Unofficial),— is the seed of Strychnos 
Ignatii, a small tree of the nat. ord. Loganiaceae, native in the Philippine Islands, 
also called Ignatia Amara. It contains the alkaloids Strychnine and Brucine, 
about i per cent, of each, for a description of which see under the title Nux 
Vomica. 

Tinctura Ignatiae, Tincture oj Ignatia (Unofficial), — strength 10 per cent. Dose, 
irijij-x. [ncompatibles are the same as for Nux Vomica. 

Physiological Action and Therapeutics. 

Ignatia closely resembles Nux Vomica in action, a poisonous dose produc- 
ing the same exaltation of the spinal functions, with muscular twitching, tetanic 
spasms, and death by asphyxia through tetanic fixation of the respiratory mus- 
cles, but as it contains a greater quantity of Strychnine than the latter it is more 
powerful in the same dose. It exalts the susceptibility of the sensory nerves 
and the nerves of special sense for a time, but an opposite condition soon suc- 
ceeds, manifested by numbness and torpor with great mental depression. It 
causes a feeling of constriction about the throat and a sensation of anguish 
at the pit of the stomach. Its antagonists and incompatibles are the same 
as those for nux vomica. 

Ignatia is recommended in hysteria to control the general hyperesthesia, 
also for insomnia, clavus hystericus, mental excitement or depression, aphonia, 
perverted appetite, and convulsive crying or laughing. It will often remove 
the intercostal neuralgia of hysterical subjects, and the sensation as of a ball 
rising to the throat (globus hystericus). Cerebro-spinal irritability is di- 
minished by small doses though excited by large ones, Ignatia being probably 
the most efficient controller of functional phenomena of the cerebro-spinal 
axis. In the convulsions of children from intestinal irritation without cerebral 
congestion, and in insomnia from nervous erethism, small doses of Ignatia 
are used with the happiest results. It is by many practitioners preferred to 
nux vomica as a stomachic tonic, and is useful in the treatment of dyspepsia, 
hypochondriasis and various nervous affections. 



ILLICIUM, Star Anise, — is the fruit of Illicium verum, an Asiatic shrub of the nat. ord. 
Magnoliaceae. It contains a Volatile Oil which is chemically and practically identical with 
the Oil of Anise. Another species, Illicium anisatum {Illicium religiosum), is very poisonous, 
causing vomiting, epileptiform convulsions, dilated pupils and cyanosed countenance. Its 
carpels are more woody, shrivelled and wrinkled, and end in a curved beak. Illicium is recog- 
nized officially as a source of the Oil of Anise, and has actions and uses similar to those of 
Anisum. 



314 IODl'M. 

IODUM, Iodine, I, — is a non-metallic element, existing in sea-weed, sea- 
water, some fresh waters and fresh-water plants, also in sponge, oysters, eggs, 
cod-liver oil, rock salt and several ores. It occurs in bluish-black rhombic 
plates, of metallic lustre, peculiar odor, acrid taste and neutral reaction; spar- 
ingly soluble in water, readily so in ether, and in 10 of alcohol, also in an aqueous 
solution of potassium iodide or sodium chloride. It volatilizes slowly at ordi- 
nary temperatures, and produces a dark-blue color with gelatinized starch in 
a cold solution. Internally it is generally administered in the form of an iodide 
or as the compound solution of iodine. Dose, gr. j^-\ [av. gr. y 1 ^.] 

Preparations oj Iodine. 

Tinctura Iodi, Tincture oj Iodine, — strength 7 per cent. Dose, Trjjj — iij [av. trgjss]; but 
it is generally used as a local application, or for injection into cavities. 

Liquor Iodi Compositus, Compound Solution of Iodine, (LugoVs Solution) — has of 
Iodine 5, Potassium Iodide 10, in Distilled Water to 100. Dose, njlj-x, [av. Tijiij ], well diluted. 

Unguentum Iodi, Ointment oj Iodine, — has of Iodine 4, Potassium Iodide 4, Glycerin 12, 
Benzoinated Lard 80. 

Churchill's Tincture of Iodine (Unofficial), — contains Iodine gr. Lxxv, Potassium Iodide 
3jss, Alcohol 5j, and is used locally, chiefly in gynecology. 

Iodides and their Preparations. 

Ammonii Iodidum, Ammonium Iodide, NH 4 I, — a deliquescent, granular, white salt; 
soluble in 1 of water and in 9 of alcohol at 59 F. Dose, gr. ij-x [av. gr. iv.] 

Potassii Iodidum, Potassium Iodide, KI, — a colorless, deliquescent, crystalline salt, of 
saline and bitter taste; soluble in 0.8 of water and in 18 of alcohol. oj of this salt dissolved 
in oj of water makes nearly 5 jss of fluid, so that njivijss of the solution would be required to 
obtain gr. v, a fact to be remembered in prescribing. Dose, gr. v— xx [av. gr. vijss.] 

Unguentum Potassii Iodidi, Ointment oj Potassium Iodide, — has of the Iodide 10, 
Potassium Carbonate 0.6, Hot Water 10, Benzoinated Lard 80. 

Rubidii Iodidum, Rubidium Iodide, Rbl, (Unofficial), — occurs in white, non-efflorescent 
crystals, odorless, of milder taste and greater solubility in water than Potassium Iodide. 
Dose, gr. v— xx. 

Sodii Iodidum, Sodium Iodide, Nal, — minute, deliquescent crystals; soluble in 0.6 of 
water and in 1.8 of alcohol. Dose, gr. v— xx [av. gr. vijss.] 

Strontii Iodidum, Strontium Iodide, SrI,(H 2 0) 6 , — colorless, hexagonal plates, of bitter, 
saline taste; very soluble in water and in alcohol. Dose, gr. v— xx [av gr. vijss.] 

Iodoformum, lodojorm, Triiodomethane (Formyl Iodide), CHI 3 , — usually obtained by 
the action of iodine upon alcohol in the presence of an alkali, occurs in small, lemon-yellow 
crystals, of saffron-like and penetrating odor; very slightly soluble in water, soluble in about 
52 of alcohol, 12 of boiling alcohol, and in 5.2 of ether; very soluble in chloroform, benzin 
and fixed and volatile oils. Its solutions have neutral reaction. Dose, gr. j-vj [av. gr. iv.] 

To remove its odor without forming a compound the best agents are Thymol (gtt. ij ad 
oj of Iodoform), Oil of Mirbane (gtt. vj ad gr. xv), Oil of Bitter Almonds, or Oil of Rose 
(gtt. j ad oj). Oil of Turpentine is particularly serviceable in removing the odor from the 
hands, or from spatulas, mortars, etc. 

Unguentum Iodoformi, lodojorm Ointment, — Iodoform, finely pulverized, 10, Lard 90, 
thoroughly mixed bv trituration. 

Iodolum, Iodol, Tetraiodopyrrol, C 4 I 4 NH, — is a derivative of the base pyrrhol (a coal- 
tar ingredient), obtained by the action of iodine on the base in the presence of alcohol; a 
grayish-brown, crystalline powder, without odor or taste, soluble in 9 of alcohol, almost insol- 
uble in water. It dissolves readily in the gastric juice. Dose, gr. j-x [av. gr. iv.] 

Thymolis Iodidum, Thymol Iodide, Dithymol-diiodide, commonly known under the 
trade name Aristol, — contains 45 per cent, of Iodine, and occurs as a reddish-yellow, bulky 
powder, insoluble in water and in glvcerin, slightlv soluble in alcohol, readilv soluble in ether, 
chloroform, collodion, and in fixed and volatile oils. It should not be mixed with alklalies, 



tODl \i. 315 

metallic oxides, starch or water; and no heal should be used in dispensing it, as it readily parts 
with its iodine. It is used locally as a substitute for Iodoform. 

Other Iodides and preparations thereof arc Arseni [odidum, Liquor Axsenj el Hydrar- 

gvri Iodidum, Hvdrargyri Iodiilum Ruhnmi, Ilvdrargyri Iodidum Flavum, Syrupus Ferri 
lodidi, Pilulse Ferri lodidi, Plumbi Iodidum. Sulphuris Iodidum and Zinci Iodidum. As 
these preparations arc allied in action and uses less closely to Iodine than to the other elements 
in their composition, they are described under other titles. (See Arsenum, Hydrargyrum, 
etc.) Ethyl Iodide or Hydriodic Ether is described under /Ether. 

Hydriodic Acid Preparations. 

Acidum Hydriodicum Dilutum, Diluted Hydriodic Acid, — contains not less than 10 
per cent, by weight of Hydriodic Acid HI. Dose, njv-xv [av. njviij.] 

Syrupus Acidi Hydriodici, Syrup oj Hydriodic Acid, — contains about 1 per cent, of the 
absolute acid. Dose, o ss— i j [av. oj ], well diluted. 

Unofficial Iodine Compounds. 

Iodized Phenol, Carbolated Iodine, — is a mixture of Iodine and crystallized Phenol 
in varying proportions, generally 1 of the former to 4 of the latter: for local use, especially 
in gynecology. 

Iodipin, — is a compound of Iodine with the fatty acids of Sesame Oil, and occurs as a 
yellow or brown, oily fluid, which is marketed in two strengths, containing respectively 10 
and 25 per cent, of Iodine, the latter being intended for hypodermic use. Dose, of the 10 per 
cent, preparation oj-iv thrice daily, in emulsion or capsules; of the 25 per cent, preparation 
")ij- 5j*s daily. 

Iodomuth, — is a proprietary compound of Bismuth and Iodine, said to contain 25 per 
cent, of the latter. It occurs as a reddish-brown, impalpable powder, odorless and tasteless; 
and is used locally as an alterative and stimulant antiseptic for ulcers, sores and wounds, also 
internally for gastroenteritis, dysentery and cholera infantum. Dose, gr. j-viij. 

Europhen, I sobutyl-orthocrcsol Iodide, — is produced by the action of Iodine upon Iso- 
butyl-orthocresol in a solution of Potassium Iodide, and contains about 27 per cent, of Iodine, 
which it gives up to metallic oxides and mercury salts, and when brought into contact with 
aqueous liquids. It occurs as a very fine, amorphous, yellow powder, of faint, aromatic odor 
like that of saffron; insoluble in water and in glycerin, soluble in alcohol, ether, chloroform 
and fatty oils; readily decomposed by heat and by starch, slowly by light. It is five times 
lighter and more bulky than Iodoform, and is used as a substitute therefor in all local applica- 
tions where a dry antiseptic is required. It is incompatible with starch, metallic oxides, mer- 
curials, and other substances which readily unite with iodine. A 3 to 10 per cent, solution 
in olive oil is employed hypodermically. 

Nosophen, Iodophen, — is a patented preparation, chemically entitled Tetra-iodo-phenol- 
phlhalein, and obtained bv the action of Iodine on a solution of phenol-phthalein. It contains 
60 per cent, of Iodine and occurs as a yellow, insoluble powder, of feebly acid character, with 
alkalies forming soluble salts, the sodium salt being of blue color and named Antinosin. 
Nosophen is highhy germicidal and is used as an antiseptic dusting powder for wounds and 
ulcers, also internally for catarrhal inflammations of the gastro-intestinal tract. Dose, gr. v- 
viij. 

Bismuthi Subiodidum, Bismuth Subiodide, BiOI, — is described on page 177. It is odor- 
less, non-irritant, and highly antiseptic, and a powerful stimulant of granulation in wounds. 

Airol and Eudoxin are Iodine compounds, but are described under Bismuthum, on 
page 177. 

Potassium Sozo-iodolate, — contains 53 per cent, of Iodine, 20 of Phenol, and 7 of 
Sulphur. It is odorless, antiseptic, germicidal, non-toxic and non-irritant; and is used locally 
in eczema, scabies, and other skin affections. 

Incompatibles. 

Incompatible with Iodine are: Alkalies, Alkaline earths, Alkaloids, Chloral Hydrate, 
Ferrous salts, Hypophosphites, Hyposulphites, Mercurous salts, Metals, Oils, Turpentine, 
Starch, Tannic Acid. With Iodides are: Alkaloids, Arsenic salts in acid solution, Bromine, 
Chlorine, Hydrogen Peroxide in acid solution, Metallic salts (ic and ous), Nitrites in acid 
solution. With Iodoform are: Alkalies with heat, Balsam of Peru, Calomel, Mercuric Oxide, 
Oils in the light, Silver Nitrate, Tannic Acid. 



3 16 IODUM. 

Potassium Iodide decomposes nearly all the metallic salts and is incompatible with many 
other substances. Added to Potassium Chlorate in solution it forms a poisonous compound. 
It is best prescribed alone or in some simple vehicle, a favorite one being the Compound Syrup 
of Sarsaparilla. It may be prescribed with Tincture of Cinchona, an ounce of which dis- 
solves 30 grains, or in combination with Liquor Potassii Arsenitis, which prevents the iodic 
eruption to some extent. In the "mixed treatment" of syphilis it is combined with the 
Biniodide of Mercury. It is better borne when combined with Xux Vomica or Potassium 
Acetate, or given alternately with Iodide of Iron (Squire). Its efficacy is increased by uniting 
it with Ammonium Carbonate, 2 parts to 1 or ii of the Iodide (Gulll. 

Physiological Action. 

Iodine is irritant to the mucous membranes and to the skin. Applied to 
the latter it stains a deep yellowish-brown color and combines with the albumin 
of the tissue, causing considerable pain and subsequent exfoliation of the epi- 
dermis. Vesication may be quickly produced if the quantity used be large. 
Inhaled its vapor irritates the respiratory mucous membrane, producing sneez- 
ing, cough, dyspnea, also pain in the chest and in the frontal sinuses. In the 
gastro-intestinal canal it is equally irritant, but is gradually converted into the 
iodide or iodate of sodium, in which form or as an albuminate it is absorbed 
into the blood. Iodine decomposes organic molecules, and in the presence 
of phosphoretted or sulphuretted gases it acts like chlorine but more feebly, 
uniting with their hydrogen and thus breaking up those noxious compounds 
it is disinfectant and deodorant. 

Iodides are rapidly absorbed and less rapidly excreted, the potassium iodide 
appearing in the urine and saliva in about 15 minutes after its ingestion. About 
80 per cent, of it escapes within 24 hours, and the remainder is slowly eliminated 
during a period of about 5 days. At the points of elimination iodine and ozone 
are set free, hence they are remotely irritant to the mucous membranes, causing 
violent coryza, with soreness of the throat, acute conjunctivitis, profuse mucous 
discharges, headache and irritation of the kidneys and the skin. Intravenous 
injections of these salts produce at first a rapid elevation of arterial pressure 
with acceleration of the cardiac rate; followed by slowing of the heart, and 
later on lowered blood-pressure with increased heart-rate. If used for any 
length of time they induce great waste and rapid elimination of waste prod- 
ucts, causing anemia, emaciation and mental depression; but these effects 
are credited chiefly to the metallic constituent, being most severe from the potas- 
sium salt. They combine with certain poisons in the system, particularly lead, 
mercury and the products of the syphilitic disease, hastening their elimination. 
Iodism is the term applied to the general condition produced by these agents, 
and comprises the symptoms above noted together with frontal headache, ptyal- 
ism, a saline taste in the mouth, dysphagia, temporary impotence, and an acne- 
form eruption on the face and limbs. Sometimes the eruption is furuncular 
or even purpuric. It is less apt to result from the use of the Strontium Iodide 
than from that of the others. The copious dilution of these preparations with 
water promotes their excretion, and to a great extent prevents the development 
of unpleasant results. The ptyalism occasionally produced by iodides is not 



tODTTM. 317 

a direct result of their action, and occurs only In persons who have previously 
taken mercurials. In such cases the mercury, which had been deposited in 
the tissues as an albuminate, is set free by the iodide and coming again into 
the circulation it produces its constitutional effects. (Murrell.) 

Potassium Iodide occasionally gives rise to some peculiar symptoms in 
certain susceptible persons. Among these are diuresis, cerebral excitement as 
from alcohol, hemorrhages from the urethra and the vagina, glossitis (Gross), 
also laryngitis and sudden edema of the glottis. The latter may be of so in- 
tense a character as to require the instant performance of tracheotomy in order 
to avert death. On the circulation it produces marked and important effects 
in most cases. It causes acceleration of the pulse and vascular dilatation, 
leading to abundant secretion from several glands. It reduces the temperature 
a degree or more, and slows the rate of the respiration. 

Iodoform contains from 94 to 97 per cent, of Iodine and naturally resembles 
the latter in action. Locally its action is anesthetic and powerfully antiseptic. 
It is one of the best agents to prevent decomposition and to destroy the germs 
of putrefaction and of disease, but must be carefully employed, as when used 
in quantity on an extensive raw surface it has often produced fatal results with 
symptoms of narcotic poisoning. The first sign of its dangerous absorption 
is increase of temperature, which may reach 104 F. or more, then headache, 
quick and feeble pulse, marked anxiety and restlessness. Collapse and death 
may suddenly supervene. The quantities which have produced fatal results 
from local absorption vary from 525 to 4,500 grains. In small doses inter- 
nally it is considered to be a tonic and alterative, wasting does not occur, but 
the body-weight increases and the general condition improves. In these re- 
spects its action markedly differs from that of Iodine or the Iodides. In medic- 
inal doses internally administered for any length of time it may cause profuse 
salivation. 

Ethyl Iodide (see pages 87 and 90) is used by inhalation to bring the 
system rapidly under the influence of Iodine. It is a good antispasmodic and 
general stimulant and a very slow anesthetic. 

Therapeutics of Iodine. 
The tincture and the compound solution are much employed locally as 
counterirritants and by injection into cavities as alterative applications, in- 
stances of which are their use in glandular tumors, hypertrophied tonsils, cer- 
vical and ovarian cysts, empyema, and hydrocele. In various skin diseases, 
as chloasma, lentigo, lupus, the tincture or a glycerite is well applied, and in 
many splenic and hepatic disorders of chronic type the ointment or tincture 
is a favorite counterirritant application. In sores, ulcers, and fissures, a mix- 
ture of Iodoform and Tannin is strongly recommended, and the tincture is 
much used locally to promote absorption of the products of acute inflammations. 
In acute catarrh and hay-fever inhalations of Iodine-vapor or that from Iodized 



318 IODUM. 

Phenol are very serviceable, and in the vomiting of pregnancy i- to 5-drop 
doses of the tincture every hour are often efficient. The compound solution 
well diluted is given thrice daily in typhoid fever with good results in many 
cases, and in malarial fevers the same preparation combined with phenol has 
shown curative power. In strumous conditions Iodine internally is generally 
considered to be more efficient than any of the iodides. 

Therapeutics of the Iodides. 

Potassium Iodide is the most frequently used iodide, and is the form in 
which iodine is generally administered internally. It is best given in simple 
solution or in the compound infusion or syrup of Sarsaparilla. Though its 
mode of action has never been explained satisfactorily, it is known by clinical 
experience to counteract many pathological conditions, to promote the absorp- 
tion of morbid products, and the elimination of several metallic poisons. It 
is almost of specific rank in tertiary syphilis and its results, as neuralgias, paral- 
yses from gummata, ulcerations, syphiloma of the internal viscera, lupus, chronic 
rheumatism and sciatica, in all of which when of syphilitic origin this iodide 
in large doses (50 to 150 grains daily) to saturation of the system will speedily 
cause improvement. So also in mercurial poisoning and other chronic metallic 
toxemiae, the best treatment is by rapid saturation with Potassium Iodide. The 
products left behind by pneumonia, pleurisy and pericarditis often yield to 
moderate doses (5 grains), which if used for a prolonged period seem to retard 
the changes of chronic nephritis. It is the best remedy for the early stage of 
hepatic cirrhosis, and acts as a most efficient expectorant in chronic bronchitis. 
Aneurisms are often cured by large doses (20 to 30 grains), the sac becoming 
solid by fibrinous deposit. In acute catarrh and hay-fever, it is useful with 
Arsenic, the Iodized Phenol being at the same time used locally in weak solu- 
tion. In tonsillitis and simple sore throat a weak solution (gr. ij-v to the 5) 
is a good gargle, and in large doses it is often efficient in spasmodic asthma 
induced by bronchial catarrh. Sodium Iodide may be used instead of the 
potassium salt, in all affections in which the latter is indicated; but requires 
to be administered in somewhat larger doses, being less active and less toxic. 

Ammonium Iodide in grain dose repeated frequently is an excellent remedy 
in acute catarrh, hay-fever, duodenal catarrh and its accompanying jaundice, 
in chronic and capillary bronchitis, and in catarrhal pneumonia to prevent 
caseation of the products. In the first stage of hepatic cirrhosis and in chronic 
malarial poisoning it is equally efficient administered in conjunction with ar- 
senic. Being somewhat more irritating than the other iodides it is usually 
given in smaller quantity, but being less stable it is more energetic in action. 

Rubidium Iodide has generally the same physiological and therapeutical 
action as Potassium Iodide, but has a far less toxic action upon the cardiac 
muscle. It is well borne by the stomach, does not disturb the appetite or give 
rise to digestive derangements, and does not affect the circulation. It rarely 



[0D1 m. 319 

produces iodism, and even when the iododerma and catarrh were present as 
the result of the administration of potassium iodide, the change to the rubid 
ium salt has resulted in decrease of these symptoms. It has been employed 
in lieu of the potassium salt, with greater efficiency and less disturbance, in 
most of the affections for which the iodides are indicated. In eye affections 
requiring an absorptive treatment it is employed internally and externally as 
a 5 per cent, vaselin ointment or in the form of 5 per cent, drops (gj in sijss). 

Strontium Iodide is analogous in action to potassium iodide, its intravenous 
injection producing at first a rapid elevation of arterial pressure with accel- 
eration of the cardiac rate, followed by slowing of the heart, and later on by 
lowered blood-pressure with increased heart-rate. It has been used, with good 
results, in the treatment of scrofulous, rheumatoid and cardiac disorders, espe- 
cially scrofuloderma, scrofulous otorrhea, and enlarged lymphatic glands; also 
in lupus vulgaris and ozena. It is said to be less liable than the other iodides 
to produce cutaneous eruptions, and to be free from causing intestinal irrita- 
tion or depressed nutrition. 

Hydriodic Acid is used as a substitute for iodine and the iodides. As an 
alterative it is believed by some to possess all the powers of Iodine while it is 
much less offensive to the taste and the stomach. It has been used with benefit 
in asthma and bronchitis. 

Iodipin is carried to every tissue of the body, however administered, its 
iodine being converted into soluble iodides, and its fat being oxidized and act- 
ing as a nutrient (Winternitz). It may be given internally for a long time 
without disturbing the digestion or producing iodism. Administered by inunc- 
tion it is rapidly absorbed, and injected hypodermically it is painless, and causes 
neither abscess nor iodism. It is used with satisfaction in all affections in 
which the alkaline iodides are indicated, and is said to be even more efficient 
than the latter, by reason of its slower rate of elimination. It has been used 
efficiently and with satisfaction in syphilis and pulmonary tuberculosis. 

Iodoform is chiefly employed in local diseases as an antiseptic, anesthetic 
and alterative agent. It may be dusted in fine powder over a wound or sore, 
or used in ethereal solution to saturate gauze or absorbent cotton. It is a use- 
ful application to sloughing and phagedenic ulcers, gunshot wounds, chancroids, 
fistulae, sinuses and painful affections of the rectum or uterus. Internally it 
may be used as a general tonic and alterative in syphilis and other cachexia?, 
also for neuralgia, and is frequently prescribed with Iron. Triturated with 
tannin it forms a good application to the cervix uteri in erosions and ulcerations 
thereof, or an Iodo-tannin may be prepared by saturating the tincture of iodine 
with tannic acid, and applied on a cotton tent to the uterine mucous membrane 
in many chronic affections of that organ. Tuberculosis has been successfully 
treated by Iodoform, which is credited with some specific action in that dis- 
ease, though it has proved almost inert against the bacillus. It has rendered 
good service in diabetes mellitus and in syphilis. Its disagreeable odor is a 



320 IPECACUANHA. 

serious bar to its general use, and many other iodine compounds have been 
introduced as substitutes for it. 

Iodol is a close rival to Iodoform, and may be used whenever the latter is 
indicated, especially as a local application, on account of its freedom from un- 
pleasant odor. Internally it is highly esteemed as a remedy in chronic gastric 
catarrh, intestinal catarrh, and in ulceration of the gastro-intestinal mucous 
membrane. It has been found useful in bronchitis, bronchial catarrh, and in 
various respiratory neuroses; and has seemed to render good service in the 
treatment of tuberculosis and syphilis. In eczema of the external ear Iodol has 
proved very efficient. Under its use the inflammation disappears generally within 
two weeks, but irrigation should be kept up for a short time afterwards, in 
order to complete the treatment. (Chatellier.) 

Thymol Iodide (Aristol) is praised by those who have used it in the local 
treatment of ulcers, wounds, and other breaches of the tissues; in which it is 
considered nearly if not quite as efficient as Iodoform, with the great advantage 
of being odorless. Excellent results have been obtained with it in the treatment 
of indolent soft ulcers, lupus, psoriasis, syphilitic ulcerative processes, eczema, 
severe burns, affections of the ear, nose, and pharynx, as well as in the various 
cases in gynecological and dermatological practice in which Iodoform has hitherto 
stood supreme. Its prolonged use may give rise to chronic iodine poisoning. 
Aristol is best applied in powder or solutions in Oil or Ether (5 to 10 per cent.), 
or as ointments with a base of Lanolin or Vaselin (5 to 10 per cent.). A use- 
ful application is a liniment, prepared by dissolving 5 grains of Aristol in 31J 
of a mixture of equal parts of Ether and Alcohol, then incorporating §j of soft 
Soap. 

Europhen is said to be fully equal to Iodoform as a local antiseptic appli- 
cation, readily liberating free, nascent iodine when in contact with aqueous 
fluids. It may be dusted on a wound or ulcer, or applied as an ointment of 
10 per cent, strength with Lanolin as the base. A mixture of Europhen and 
Aristol, equal parts of each, is said to be remarkably adhesive, and is used 
with satisfaction as an antiseptic and healing application. 

IPECACUANHA, Ipecac, — is the dried root of Cepha'elis Ipecacuanha or 
C. acuminata, small plants of the nat. ord. Rubiaceae, growing in Brazil and 
Columbia. It contains Cepha'eline, C 14 H 19 N0 2 , a crystalline alkaloid; Emetine, 
C 14 H 18 (CH 3 )N0 2 , an amorphous alkaloid and a methyl compound of cephaeline; 
also a third alkaloid in very small quantity, a glucoside named Ipecacuanhic 
Acid, starch, gum, and a trace of a volatile oil. Dose of the powdered root, 
as an expectorant gr. ss-ij [av. gr. j]; as an emetic gr. x-xx [av. gr. x\\] 

Official Preparations. 

Fluidextractum Ipecacuanhas, Fluidextract of Ipecac, — Dose, as an expectorant 
Tijss-ij [av. Ttjjj]; as an emetic itjfx— xx [av. Ttjjxv.] 

Syrupus Ipecacuanhas, Syrup of Ipecac, — strength 7 per cent. Dose, as an expec- 
torant, njfx-xx [av. tqjxv]; as an emetic oij-vj [av. oiv.] 



EPECAC1 ami \. 321 

Vinum Ipecacuanhas, H'/nc <>/' //><■<:<, strength toper cent. Dose, njx-xx[av, new.] 

Pulvis Ipecacuanhas et Opii, Powder oj Ipecac and Opium, {Dover's Powder),- ha oi 
Ipecac 10, Powdered Opium 10, Sugar of Milk 80, triturated together to a fine powder. 1 ' 1 
gr. iij-xv [av. gr. vijss.] 

Tinctura Ipecacuanhas et Opii, Tincture oj Ipecac and ('/"'"'", — has of Tincture of 
Deodorized Opium 100 evaporated to 80, Fluidextracl of Ipecac 10, Diluted Alcohol to 100, 
and is a tluii! representative of Dover's Powder. Dose, liyiij-xv [av. njjviij.] 

Pilulae Laxatives Compositas, Compound Laxative Pills, — have in each pill gr. ,',., of 
[pecac (see under Ai.oes). Dose, j-iv, [av. ij.] 

Unofficial Preparations. 

Ipecacuanha De-emitinisata, De-emetinized I pecac, — is Ipecacuanha deprived of its 
alkaloids, for use in dysentery. Dose, gr. v-xx. 

Emetina, Emetine, — colorless, amorphous, soluble in alcohol, ether, chloroform and 
benzin, very sparingly in water, insoluble in caustic alkalies. Dose, as an expectorant, gr. 

■-.'.,. as an emetic, gr. $-f 

Emetinae Hydrobromidum, Emetine Hydrobromide, — crystalline in silky tufts of needles, 
readily soluble in water, contains 68 per cent, of the alkaloid. Dose, gr. ^ 5 _ zV- 

Cephaelinae Hydro chloridum, Cephaeline Hydrochloride, — is readily soluble in water. 
Cephaeline is more powerfully emetic than Emetine, but does not produce depressing effects 
in doses of gr. T 'j— J, and is slow of action. 

Incompatibles. 

Incompatible with Ipecacuanha preparations are: Acids (vegetable), Salts of Lead and 
Mercury, Vegetable astringent infusions. 

Physiological Action. 

Ipecac is nauseant, emetic, expectorant, cholagogue, diaphoretic, hemo- 
static, sternutatory, and irritant. Applied to the skin it produces redness, 
itching and occasionally a pustular eruption; injected subcutaneously it causes 
pain and inflammation often terminating in abscess. Used as snuff it excites 
violent sneezing and profuse mucous secretion; in some persons the inhala- 
tion of the smallest quantity induces an asthmatic paroxysm, with swelling 
and injection of the conjunctival and nasal mucous membranes, salivation, 
tears, sneezing, coughing and bronchial catarrh. Its action on the gastroin- 
testinal mucous membrane is also decidedly irritant. Internally, small doses 
(gr. £-£) act as a stomachic and hepatic tonic and increase the gastric secretions; 
larger doses (gr. v-xx) are nauseant and emetic in from 20 minutes to half an 
hour, but the emesis produced is not violent nor is it followed by much depres- 
sion. If these doses are repeated a tolerance of the stomach to the drug be- 
comes established and a cathartic action is produced, the stools having a bilious 
appearance. The circulation is only slightly affected by Ipecac, but it relaxes 
the skin and increases the broncho-pulmonary mucus. In large doses it is 
decidedly irritant to the intestinal canal, but here also it is capable of tolerance 
as in the stomach. In poisonous doses it has frequently produced hemoptysis 
and other hemorrhages. Rutherford found it to be a powerful hepatic stimu- 
lant. Woodhull believes that it is a direct nervous stimulant, acting chiefly, 
if not entirely, upon the sympathetic system. 

Emetine possesses strong constringent action on the blood-vessels and is 



322 IPECACUANHA. 

powerfully emetic and expectorant. It causes death in animals by cardiac 
paralysis, and the autopsies show evidence of gastro-intestinal irritation and 
hyperemic lungs with patches of hepatization. 

Therapeutics. 

Ipecac is much used as an emetic, being safe, efficient and non-depressant, 
though slow of action. It is the best agent of the kind to relieve the stomach 
in acute indigestion and bilious sick-headache, and an ipecac-vomit is consid- 
ered by many good practitioners to be very serviceable at the commencement 
of eruptive, continued and periodical fevers. The syrup is a favorite domestic 
emetic to cut short an attack of spasmodic croup, and may be used beneficially 
in laryngismus stridulus and in capillary bronchitis. In small doses Ipecac 
is an excellent stimulant of the gastric and hepatic functions, and an expectorant 
of great value. In atonic dyspepsia, catarrhal jaundice, intestinal colic, bron- 
chial asthma, hay fever, bronchial catarrh, acute laryngitis and pharyngitis, 
also in nervous and other coughs, it has rendered good service. In still smaller 
doses, wij of the wine frequently repeated, it is an efficient antiemetic in vomit- 
ing of nervous origin, and especially in the vomiting of pregnancy, also in that 
of gastric atony as seen in chronic alcoholism; its action in this affection being 
due perhaps to its possessing a sedative influence upon the pneumogastric in 
small doses. It is an excellent remedy in hemoptysis if given in small and 
frequently repeated doses until nausea occurs. As an antihemorrhagic it has 
been efficiently used in epistaxis, menorrhagia and post-partum hemorrhage, 
in the latter affection given with ergot. In doses of a grain several times a 
day it has given satisfaction in cases of idiopathic neuralgia, hyperidrosis, inter- 
mittent fever, erysipelas, acute and suppurative hepatitis and opium narcosis, 
also in many of the affections which frequently complicate the puerperal state. 

In acute intestinal affections Ipecac has achieved its greatest reputation 
as a remedy, one of its oldest titles being radix antidysenterica. Its power 
over acute dysentery was known to Piso and Helvetius in the 17th century, and 
was mentioned by Balmain (1797), Playfair (1813), Twining (1831) and Delioux 
(1851). The reports thereon by Docker (1858) attracted general attention, and 
since the latter date it has been universally recognized as a specific remedy for 
acute tropical dysentery and that of malarious districts. Under large doses, 
20 to 60 grains every four hours, the tormina and tenesmus disappear, the char- 
acter of the stools improves and the constitutional symptoms are relieved. Such 
doses are not necessarily emetic in all persons, especially if administered in the 
powder, with a very small quantity of water, preceded by a full dose of opium 
or a hypodermic injection of morphine and followed by a mustard plaster ap- 
plied to the epigastrium and perfect quiet in the recumbent posture. De-emetin- 
ized Ipecac is said to be as efficient as the unaltered drug in this disease, while 
nearly free from nauseant and emetic action. Chronic dysentery may be bene- 
fited by this treatment, though some physicians prefer to use smaller doses for 



IRIS I \l \1>\. 323 

a prolonged time in this form of the affection. Diarrheas of simple but painful 
form, especially the summer diarrhea of young children and that of teething 
infants, are often greatly relieved by Ipecac in doses of 1 to 5 grains, the bilious 
character being restored to the discharges and a healthy stimulation of the ali- 
mentary mucosae produced. Cholera morbus and cholera infantum have fre- 
quently been cured by this remedy, the action of which, in these affections and 
in dysentery, is most probably that of a sympathetic nerve stimulant, restoring 
the nervous tone of the intestinal mucous membrane (Woodhull). After 50 
years' experience in the use of Ipecac, Dr. Higginbottam (1868) stated that 
"its main efficacy is in stimulating and restoring the normal action of the capil- 
lary system." The non-emetic use of this drug, so ably advocated by Wood- 
hull, is not merely a method but a principle, and means the use of the remedy, 
regardless of dose,- so as to develop its stimulant rather than its emetic power. 

Ipecac is said to be destructive to the bacillus of anthrax though not to its 
spores. As the latter are not present in malignant pustule, this drug may prove 
efficient therein and success has followed its employment. It is used locally 
after excision of the pustule, also in moderate doses internally. 



IRIS, Blue Flag (Unofficial), — is the rhizome and roots of Iris versicolor, an indigenous 
plant of the nat. ord. Iridea?, growing in moist meadows and on the borders of swamps, hav- 
ing large blue flowers. It contains tannin, sugar, starch, gum, an acrid resin, fixed oils, and 
traces of an alkaloid. Dose of the powdered root, gr. v-xx; of the extract, gr. j-v; of the 
tluidcxtract njrv-xx. 

Iridin or Irisin (Unofficial), — is a so-called resinoid found in the shops, of undetermined 
composition, but probably an oleoresin precipitated by water from an alcoholic preparation. 
Dose, gr. j-v. 

Iris when fresh is actively purgative, emetic and diuretic, producing severe nausea and 
prostration. Iridin has been the subject of experimentation upon dogs, and is shown to be a 
powerful hepatic stimulant with considerable influence on the intestinal glands, being more 
purgative than euonymin and less irritant than podophyllin. In very small doses it causes 
obstinate constipation by producing rectal inactivity. 

Iris is very serviceable in duodenal catarrh with obstruction of the bile-ducts and conse- 
quent jaundice, also in malarial poisoning, bilious remittents, and jaundice of malarial origin. 
It is used in many hepatic and intestinal disorders as a cholagogue and purgative of mild but 
efficient action, also as a diuretic in dropsies. In small doses ( irjj of a tincture) it is strongly 
recommended in a peculiar blinding headache in the right supraorbital region with nausea 
or vomiting, supposed to be of hepatic origin. 

JALAPA, Jalap, — is the dried tuberous root of Exogonium Purga, a Mexican 
plant of the nat. ord. Convolvulacese. It should contain not less than 8 per 
cent, of total Resin, which is composed of two glucosides, Jalapin, soft, soluble 
in ether, and Convolvulin, which is hard, insoluble in ether, and the more active 
of the two. Dose, gr. v-xx [av. gr. xv.] 

Preparations. 
Resina Jalapse, Resin 0/ Jalap, — prepared from a tincture by precipitation by water. Is 
insoluble in water, soluble in alcohol. Dose, gr. j-v [av. gr. ij.] It is an ingredient of Pil. 
Cathartics Comp. and Pil. Cathartics Vegetabiles (see under Colocynthis). 

Pulvis Jalapae Compositus, Compound Powder oj Jalap, Pulvis Purgans, — has of Jalap 
35, Potassium Bitartrate 65, thoroughly mixed. Dose, gr. x-xlv [av. gr. xxw] 



324 jambul — juglans. 

Physiological Action and Therapeutics. 

Jalap is an active cathartic, producing copious and watery stools, with con- 
siderable tormina and tenesmus, also sometimes nausea. It does not produce 
hemorrhoids, but does increase the secretions of the intestinal canal and the 
flow of bile. Its action is not due to any one of the contained principles, but 
all the active constituents are found in the resin. Compared with other agents 
of the same class its action most nearly resembles that of scammony. It is more 
drastic than senna and less irritant than gamboge, but in overdoses may pro- 
duce dangerous hypercatharsis. 

Convolvulin in sufficient dose is an active irritant poison, producing gastro- 
enteritis and narcotism. Its action as a purgative seems to be wholly local, 
as from its intravenous injection no catharsis results, yet it exerts little if any 
irritant action on the conjunctiva, nasal mucous membrane or skin. It is not 
eliminated in the urine or the feces, and is therefore probably destroyed in the 
system by oxidation. 

In olden bowel-moving times Jalap and Calomel were used together in 
doses of gr. x each, "ten and ten," as a routine purgative prescription. Less 
ponderous doses are now considered equally efficient, and one grain of each 
agent with the same quantity of extract of hyoscyamus as a corrective may be 
used with advantage at the onset of fevers and inflammations. As the com- 
pound powder it is much employed to produce free watery evacuations in as- 
cites and anasarca. Being nearly tasteless it is a useful cathartic for children, 
and may be administered in syrup of rhubarb (gr. ij-v in gss). As a vermifuge 
it is efficient as an adjunct to more powerful agents, and is employed with cal- 
omel and santonin for the expulsion of lumbrici. Jalap is contraindicated in 
all inflammatory conditions of the intestinal mucous membrane, but in proper 
doses it is one of the most manageable and efficient cathartics. 

JAMBUL, Jamun (Unofficial), — the seeds and bark of Eugenia Jambolana, a native 
tree of India, has a very varied history of successes and failures in the treatment of diabetes. 
One writer contends that any efficient preparation should be made from the fresh seeds, dis- 
carding the pericarps, and avoiding the application of heat; also that a weak alcoholic men- 
struum exhausts the drug and gives a stable preparation. Dose of a fluidextract, njjv-xv. 

Reports, from observers abroad and in this eountry, show that favorable results have been 
obtained with Jambul in many cases of diabetes, even after the unsuccessful use of all the 
usual remedies. In two severe cases, in which 7 and 3 per cent, respectively of glucose was 
excreted, the urine was brought back to normal and kept there for two years, by the use of 
this remedy. It should be given with or after meals, in water or wine sweetened with a small 
quantity of saccharin, and accompanied by general treatment. 

JUGLANS, Butternut (Unofficial), — is the bark of the root, collected in autumn, of 
Juglans cinerea, the Butternut or White Walnut, an indigenous forest tree of the nat. ord. 
Juglandaceee. It contains an orange-yellow, crystalline and acrid substance named Juglandic 
Acid or Nucin, resembling Chrysophanic Acid, also some resin, volatile acid, etc., but neither 
tannin nor any alkaloid. Dose of the extract, gr. v-xx. 

Juglans is a mild cathartic operating without the production of pain or irritant symptoms. 
It is never used in substance, but the extract is a good laxative in doses of gr. v-x, and a pur- 
gative in larger doses. It has considerable reputation in dysentery and chronic constipation. 



JUNIPERUS — K\M\1\. 325 

JUNIPERUS, Juniper, — the source of the official Oleum Juniperi, is the 
fruit of Junipcris communis, an evergreen shrub of the nat. ord. Coniferae, 
growing in Europe and N. America. It contains a Volatile Oil, which con- 
sists of terpenes and camphors in complex combination, also a non-crystal- 
lizable principle named Jiiniperin, and grape sugar, resin, formic, acetic and 
malic acids, etc. The Oil, a Spirit, and a Compound Spirit are official. 

Preparations. 

Oleum Juniperi, Oil oj Juniper, — the volatile oil, a colorless or faintly greenish-yellow 
liquid, of terebinthinate and sweetish taste and the odor of juniper; soluble in 10 volumes of 
90 per cent, alcohol. Dose, trgj-v [av. njiij.] 

Spiritus Juniperi, Spirit of Juniper, — has of the Oil 5 in Alcohol 95. Dose, 5j-iv 
[av. ngxxx] or more, according to the quantity of alcohol desired. 

Spiritus Juniperi Compositus, Compound Spirit of Juniper, — has of the Oil 8, Oil of 
Caraway 1, Oil of Fennel 1, Alcohol 1400, Water to 2000. It approximates closely to a good 
grade of Gin. Dose, 5j-iv [av. 5ij ] or more, according to the quantity of alcohol desired. 

Oleum Cadinum, Oil of Cade, (Empyreumatic Oil of Juniper) — is a product of the dry 
distillation of the wood of Juniperus Oxycedrus. It is a tar-like substance, of uncertain com- 
position and purity; insoluble in water, partially soluble in alcohol, completely so in ether, 
chloroform or carbon disulphide. Used locally as a stimulant. 

Infusum Juniperi, Infusion of Juniper (Unofficial), — has of Juniper Berries Sj in Oj 
of boiling water. Dose ^ j— ij . 

Juniper is a stomachic tonic, diaphoretic, diuretic and aphrodisiac. The 
oil is the active principle, and is readily diffused, exciting increased cardiac 
action, stimulating the kidneys and the action of the skin, and causing a sub- 
jective sense of heat throughout the system. It is eliminated chiefly by the 
kidneys, and may set up renal irritation, in large doses producing strangury, 
priapism, hematuria, suppression of the urine and uremic convulsions. It 
imparts a violet odor to the urine, and will produce diuresis when inhaled. 

The Oil is used to flavor gin and to impart the diuretic power popularly 
ascribed to that liquor. The medicinal use of the juniper preparations (spirit 
and compound spirit) is restricted to their employment as vehicles for less ir- 
ritant diuretics. The oil acts therapeutically like the oil of turpentine, and 
may be used in chronic pyelitis and cystitis, prostatorrhea, and gleet, but is con- 
traindicated in all cases in which acute nephritis exists. 

Oil of Cade is used locally in chronic skin diseases as a stimulant applica- 
tion. It is too active for acute eruptions, but has been used with benefit in 
chronic eczema and psoriasis. The Oil of Tar (see under Pix) is equally effi- 
cient for all the purposes to which oil of cade has been applied. 

KAMALA, Rottlera (Unofficial), — the glands and hairs from the capsules of Mallotus 
philippinensis, or Rottlera tinctoria, a small tree of the nat. ord. Euphorbiace£e, growing in 
Abyssinia, Arabia, India, China, etc. It occurs as a granular, mobile, brick-red powder, 
inodorous and nearly tasteless, partly soluble in alcohol and in ether. It contains several 
resins, one of which is named Rottlerin, also tannin, starch, gum, and red coloring matter. 
Dose, oss-iij. 

Kamala is anthelmintic and purgative, sometimes causing nausea and colic, seldom vom- 
iting. It is used as a teniafuge and to expel the round and thread worms. One or two 
drachms are given suspended in water, mucilage or syrup, and repeated in 4 hours if necessary. 
A tincture ( gvj in §xvj of alcohol) may be used in doses of oj-oss. In India it is used 
locally in scabies and other skin affections and has been found of especial service in herpetic 



326 KAVA-KAVA — LACTUCARIUM. 

ringworm. As a remedy against tapeworm it is perhaps next after Male-fern in efficiency 
and requires no preparatory treatment. 

KAVA-KAVA, Ava-Kava (Unofficial), — the root of Piper methyslicum, a shrub of the 
nat. ord. Piperaceae, growing in South America and the South Sea Islands. It contains a 
crystalline principle, Kavahin or Methyslicin, which is analogous to Piperine, an acrid, 
greenish-yellow resin, Kawin, which is probably the active principle, also a Volatile Oil. 
Dose, 5ss-j macerated in water, or the same quantity of a fluidextract. 

Kava is intoxicant, diuretic and motor-depressant. A beverage is prepared in the Ha- 
waiian Islands by chewing the root and then infusing it in water or cocoanut milk, which 
produces a drowsy intoxication with pleasant dreams often of erotic character, and followed 
by severe headache. A moderate dose is tonic and stimulant, lessening the sense of fatigue 
and sharpening the mental faculties. It is highly recommended in gonorrhea and gout, also 
in chronic gleet and obstinate cystitis. 

KINO , Kino, — is the inspissated juice of Pterocarpus Marsupium, a tall tree of the nat. ord. 
LeguminosE, growing in India. It contains 75 per cent, of a variety of tannin named Kino- 
tannic Acid, which gives a greenish precipitate with persalts of iron; also a crystalline, 
neutral substance, Kinoin, and Kino-red, gum, pectin, etc. There are several other varieties 
of Kino in the market, brought from S. America, Africa, and Australia, which are 
products of other trees than the official one. Dose, gr. v-x [av. gr. vijss.] 

Tinctura Kino, Tincture of Kino, — has of Kino 5, in Alcohol 65, Water 14, and Glycerin 
15. Dose, 3 ss— ij [av. 3j-] 

PulvisKino Compositus, Compound Powder 0} Kino (Unofficial), — contains 5 per cent, 
of Opium, and has of Kino 15, Opium 1, Cinnamon 4. Dose, gr. v-xx. 

The action of Kino is the same as that of Tannic Acid, though less powerful, and it may 
be used for the same purposes, both internally and locally. It is chiefly employed as an as- 
tringent gargle and as a constituent of diarrhea-mixtures. The tincture, in drachm doses, 
is one of the most efficient means of combating the atonic diarrhea which results from the 
disuse of opium or morphine. Its incompatibles are the same as for Galls (see page 70). 

KRAMERIA, Krameria (Rhatany), — is the dried root of Krameria triandra, or two 
other species, nat. ord. Krameriaceas, shrubs which grow in Peru and Brazil. It contains 
20 to 45 per cent, of Rhatania-tannic Acid, also Rhatanine, an alkaloid, and wax, gum, etc. 
Dose, gr. x-xx [av. gr. xv.] 

Extractum Krameria?, Extract of Krameria, aqueous. Dose, gr. v-x [av. gr. vijss.] 
Fluidextractum Krameriae, Fluidextract 0} Krameria. — Dose, iijjv-xx [av. ttrxv.] 
Tinctura Krameria?, Tincture of Krameria, — 20 per cent. Dose, 5ss-ij [av. 3j-] 
Syrupus Krameriae, Syrup of Krameria, — has of the Fluidextract 45 parts, with Syrup 
55. Dose, 3ss-oss, [av. 3j-] 

Trochisci Krameria?, Troches of Krameria, — each troche contains nearly gr. j of the 
extract, with Tragacanth, Sugar and Orange-Flower Water. 

Krameria possesses the same astringent qualities as Tannic Acid and may be employed 
for the same purposes, except as an antidote to Antimony. It has long had a high reputa- 
tion as an injection for fissure of the anus, as a local application to spongy gums, as a tonic 
for debilitated subjects, in chronic diarrhea, also in passive hemorrhages and mucous dis- 
charges, as menorrhagia and leucorrhea. Its incompatibles are the same as for Galls (see 
page 70). 

LACTUCARIUM, Lettuce, — is the concrete milk-juice of Lactuca virosa, the Acrid 
Lettuce, a biennial European plant of the nat. ord. Compositae. It is partly soluble in alcohol 
and in ether, and yields a turbid mixture when triturated with water. Lactucarium is a 
mixture of several substances, the most important being Lactocin, which is thought to be the 
active principle. It occurs in white scales, is soluble in w^ater, and is used as a sedative and 
hypnotic in doses of gr. j-v. Lactucarium also contains three bitter principles, Lactucin. 
Lactopicrin and Lactucic Acid; also Lactucerin, an inert, waxy substance, constituting nearly 
one-half of the drug. A minute quantity of a mydriatic alkaloid, believed to be Hyoscyamine, 
has been found in the plant, but not in commercial lactucarium. Dose, gr. x-xx [av. gr. xv.] 



I \H\\ — l.F.l'TANDKA. 327 

Tinctura Lactucarii, Tincture 0} Lactucarium,—$o per cent. Dose, mi\ ,~>ij [av 
m\\\|, according to the activity of the < 1 rug. 

Syrupus Lactucarii, Syrup of Lactvcarium, has of the Tincture to per tent. Dose, 
5j-.-)j [av. 3ij.] 

Lactucarium is feebly hypnotic, somewhat sedative and diuretic. It is supposed to act 
similarly to Opium, but very feebly and without depressing after-symptoms. As much as 
half an ounce has been given to a dog without causing any special effect. Its preparations 
are very uncertain in activity, and are chiefly used as placebos, to allay cough and quiet ner- 
vous irritability. The syrup is a good vehicle for expectorants and antispasmodics. 

LAPPA, Lappa, (Burdock), — is the dried root of Arctium Lappa, and of 
other species of Arctium, the common burdock, a biennial weed of the nat. 
ord. Composite, found in waste places and along roadsides in Europe, Asia 
and N. America. Three varieties are recognized, formerly known as Lappa 
major, L. tomentosa, and L. minor, of which the first-named is most frequently 
met with in this country. It contains a bitter principle, traces of a volatile oil, 
also inulin, resin, tannin, mucilage, sugar, etc. Dose, gr. xx-xlv [av. gr. xxx], 

Fluidextractum Lappae, Fluidextract of Lappa, — made with diluted alcohol. Dose, 
ntjxx-xlv [av. njxxx.] Dr. Squibb recommended a tincture of the seed; lb. j of ground seed 
to gall, j of whisk)', allowed to stand for two weeks before decanting, and used in doses of 
oij-iij before meals. 

Lappa promotes all the secretions and is considered aperient, diuretic and 
diaphoretic, without irritating qualities. In decoction it has been a popular 
domestic remedy for many morbid conditions, especially rheumatism, gout, 
pulmonary catarrhs, and chronic cutaneous affections. By several practitioners 
it is praised as an alterative in constitutional diseases, as syphilis and scrofula, 
also as an external application to swellings, hemorrhoids and chronic sores. 
A tincture of the seed has proved remarkably efficient as a stomachic tonic and 
has cured several cases of psoriasis inveterata. 

LAVANDULA, Lavender, — the source of the official Oil of Lavender Flowers, is the 
fresh flowers of Lavandula officinalis, a small European shrub of the nat. ord. Labiatae, largely 
cultivated in England. They have a fragrant odor, and an aromatic, camphoraceous taste; 
and contain resin and tannin, also a Volatile Oil. 

Oleum Lavandulae Florum, Oil of Lavender Flowers, — is a volatile oil distilled from 
fresh Lavender, and having the fragrant odor of the flowers. It is soluble in alcohol in all 
proportions, in 3 times its volume of a mixture of alcohol 3 and water 1, and in glacial acetic 
acid. Dose, njj-v [av. itjiij.] 

Spiritus Lavandulae, Spirit of Lavender, — has of the Oil 5, in Alcohol 95. A perfume 
and flavoring agent. Dose, njjx-xlv [av. ttjjxxx.] 

Tinctura Lavandula? Composita, Compound Tincture of Lavender, — an aromatic 
stimulant, composed of the Oil 8, Oil of Rosemary 2, Saigon Cinnamon 20, Cloves 5, Nutmeg 
10, Red Saunders 10, Alcohol 750, Water to 1000. Is a constituent of Liquor Potassii Ar- 
senitis. Dose, tijx-xlv [av. ltgxxx.] 

Lavender is aromatic, stimulant and carminative, but is rarely used alone as a medicine. 
It is an agreeable flavoring and perfume, in the form of the official spirit, which is sold under 
the name of Lavender-water, after the addition of Oil of Bergamot and Essence of Ambergris. 
The compound tincture is a very agreeable combination of spices, and is much used as a rem- 
edy for gastralgia, nausea, and flatulence, and as an adjuvant or corrigent of other medicines. 

LEPTANDRA, Leptandra {Culver's Root), — is the rhizome and rootlets of Veronica 
virginica, an indigenous perennial plant of the nat. ord. Scrofulariaceae. It contains a gluco- 



328 LICOPERDON G1GANTETJM — LIMON. 

side named Leptandrin, which is probably the active principle, also Saponin, resin, tannin, 
etc. The Leptandrin of the shops is an impure alcoholic extract. Dose of Leptandra, gr. 
x-xx [av. gr. xv.] 

Extractum Leptandrae, Extract of Leptandra, — is a constituent of Pil. Catharticas Vege- 
tables. Dose, gr. j-vj [av. gr. iv.] 

Fluidextractum Leptandrae, Fluidextract of Leptandra. — Dose, njjx-xx [av. njfxv.] 
Leptandra is tonic, laxative, and like other resin-bearing purgatives decidedly cholagogue. 
The recent root is a violent cathartic, but in the dried state it is less active. It is indicated in 
duodenal indigestion and chronic constipation with insufficiency of the biliary and intestinal 
secretions. 



LICOPERDON GIGANTEUM, Puff-Bali (Unofficial),— is a common fungus of the 
nat. ord. Trichogastres, found in hilly and wooded districts. The dust, which consists of the 
capillitium and spores, is a valuable hemostatic, and dusted over bleeding surfaces acts 
promptly in arresting hemorrhage. It has been proposed as a surgical dressing, but while 
useful in emergencies where other agents are unattainable, the fetor which results from its 
application to wounds will prevent its use becoming general for this purpose. It may prove 
of value as an internal hemostatic in hematemesis and the hemorrhage of typhoid fever. 



LIMON, Lemon, — is the fruit of Citrus Limonum, a tree of the nat. ord. 
Rutaceae, native in Asia, but cultivated in Southern Europe and many other 
countries. It is official in the two forms described below. The Orange, Citrus 
vulgaris and C. Aurantium, the Citron, Citrus medica, and the Lime, Citrus 
acris, belong to the same genus. 

Limonis Cortex, Lemon Peel, — is the rind of the ripe fruit, and contains 
a Volatile Oil which is official, and a bitter crystalline glucoside, Hesperidin, 
chiefly contained in the white of the rind. 

Limonis Succus, Lemon Juice, — is the freshly expressed juice of the ripe 
fruit, each lemon yielding from § to i fluid ounce. It contains about 7 per 
cent, of free Citric Acid, besides phosphoric and malic acids, citrates of potas- 
sium and of other bases, etc. Dose, 5ss-iv [av. Sj.] 

Acidum Citricum, Citric Acid, H 3 C 6 H 5 7 +H 2 0, — is obtained from the 
juice of the Lemon or the Lime by adding chalk to form calcium citrate, which 
is then decomposed by dilute sulphuric acid. It occurs in colorless, rhombic 
crystals which are very soluble in water. A solution of gr. xvij in §ss of water 
corresponds to §ss of fresh lemon-juice, and this quantity of either will neu- 
tralize of Potassium Bicarbonate gr. xxv, of Sodium Bicarbonate gr. xx, and of 
Ammonium Carbonate gr. xivss. Dose, gr. v-xv [av. gr. vijss.] 

Citrates of Bismuth, Bismuth and Ammonium, Iron, Iron and Ammonium, Iron and 
Quinine, Iron and Strychnine, Lithium, Magnesium, Potassium and Sodium, ten in all, arc 
official. They are described under their respective bases, to which their medicinal qualities are 
due. 

Preparations. 

Oleum Limonis, Oil of Lemon, — is the volatile oil, extracted from fresh lemon peel by 
mechanical means. It is used for flavoring and is an ingredient of Spiritus Aurantii Compos- 
itus, and Spiritus Ammonia Aromaticus. Dose, ttjj-v [av. nj>iij.] 

Tinctura Limonis Corticis, Tincture of Lemon Peel, — a 50 per cent, tincture, made with 
alcohol. Dose, according to the amount of alcohol desired to be given, 5ss-iv. 



LINUM. 32c; 

Syrupus Acidi Citrici, Syrup of Citric Acid, — has of Citric Arid 1, Distilled Water 1, 
Tincture of Lemon Peel i, Syrup to 100. Used for flavoring. Dose, indefinite. 

Incompatible*. 

Incompatible with Citric Acid are: Acetates, Acids (mineral), Carbonates, Potassium 
rartrate, Sulphides. With Citrates axe: Alcohol, Lead Acetate, Potassium Permanganate in 
acid solution. Silver Nitrate. With Tincture oj Lemon Peel are: Acacia, Aqueous fluids, 
Gelatin. 

Physiological Action and Therapeutics. 

Lemon-peel is bitter and probably tonic to the stomach, but is used only 
lor flavoring purposes. Lemon-juice, on the other hand, is refrigerant and 
antiscorbutic, entering the blood as alkaline citrates, potassium salts and phos- 
phoric acid, the citrates being therein partly oxidized into C0 2 and H 2 0, while 
the potassium salts and phosphoric acid probably act upon the red corpuscles. 
Citric Acid has the same general action as Acetic and the other vegetable acids. 
It is wholly decomposed in the blood, and appears to be non-toxic in man, but 
used internally it may precipitate uric acid and thus promote the formation 
of calculi. Lemon-juice is employed largely in the treatment and prevention 
of scurvy, in which disease it possesses powers of specific rank, but whether 
its action therein is due to the citric acid, the phosphoric acid or the salts of 
potassium is not known. Lime-juice is equally efficient but citric acid itself 
is not so. 

As refrigerants and diuretic mixtures in fevers, Lemon-juice and Citric Acid 
are much used, entering into the composition of lemonades and effervescing 
draughts, to allay thirst and subdue restlessness, and to promote the action 
of the skin and the kidneys. For acidity of the stomach they are efficient if 
given in small doses before meals, but the mineral acids are usually preferred 
for this purpose. Long continued they will impair digestion and impoverish 
the blood. Atheromatous degeneration of the vessels is said to be retarded 
by the daily use of lemon-juice, which is supposed to dissolve the excess of in- 
organic matter and to aid its excretion. Obesity may be reduced by using the 
juice of limes or lemons in large quantity, but it will be done at the expense 
of the digestion. Lemon-juice has been found of service in acute rheumatism, 
probably through the alkalies which it conveys into the blood. As a local ap- 
plication it has been found efficient in pruritus scroti, sunburn, post-partum 
hemorrhage, and as -a gargle in diphtheritic sore throat. 

LINUM, Linseed, Flaxseed— is the seed of Linum ltsitatisshmum, flax, a 
cultivated annual plant of the nat. ord. Linaceae. It contains 15 per cent, of 
Mucilage in the epithelium, also 30 to 40 per cent, of Fixed Oil in the embryo. 
Ground linseed should yield not less than 30 per cent, of the fixed oil. 

Preparations. 

Oleum Lini, Linseed Oil, — the fixed oil expressed from Linseed without the use of heat. 
A yellow, oily liquid, of slight odor, bland taste, and neutral reaction, soluble in about 10 of 
absolute alcohol and in ij of ether. Consists chiefly of the Glyceride of Linoleic Acid, C lt - 



330 LITHIUM. 

H 2S <; which having a powerful affinity for oxygen becomes resinoid on exposure to the air, 
making it a "drying oil." Dose, 5 ss— ij [av. Bj] 

Infusum Lini, Linseed Tea (Unofficial), Linseed 5iij, Licorice-root oj, Boiling Water 
5x, infused for four hours and strained. Dose, indefinite. 

Linimentum Calcis, Lime Liniment, (Carron Oil), — consists of equal volumes of Lin- 
seed Oil and Lime-water, emulsified by agitation. A favorite application for burns. 

Physiological Action and Therapeutics. 
Linseed is demulcent, emollient, expectorant and diuretic. The oil is laxa- 
tive in a dose of sj, and in smaller doses is oxidized in the system and excreted 
as a resinoid body by the kidneys, which it stimulates slightly. The Infusion 
contains the mucilaginous principle and a small portion of the oil, and is ad- 
vantageously used in inflammations of the mucous membrane of the throat, 
the gastro-intestinal tract and the urinary passages. It is an excellent demul- 
cent in coughs of various kinds, and will be found very serviceable in cystitis, 
irritable bladder, renal colic and strangury. The Oil may be administered inter- 
nally as a laxative, and has considerable reputation as a remedy for hemorrhoids 
in doses of 31J twice daily. For laxative purposes, especially in children, it is 
usually administered as an enema. Externally it is a favorite application to 
burns, when made into an emulsion with lime-water, as in the official Linimen- 
tum Calcis. The ground seed, linseed or flaxseed meal, is commonly employed 
for making poultices, though objectionable from the aseptic point of view. [Com- 
pare the article on Poultices in Part III.] 

LITHIUM, Li, — is represented in the pharmacopoeia by five of its salts, 
of which the Carbonate is but slightly soluble, while the others are readily so. 
The low atomic weight of this metal (7) makes its saturating power greater 
than that of other alkaline metals, hence the value of its salts in medicine. 

Salts oj Lithium. 

Lithii Benzoas, Lithium Benzoate, LiC 7 H 5 2 ,— is classed with the Benzoates and de- 
scribed under Benzoinum. Dose, gr. v-xx [av. gr. xv.] 

Lithii Bromidum, Lithium Bromide, LiBr, — is classed with the Bromides and described 
under Bromum. Dose, gr. v-xx [av. gr. xv.] 

Lithii Carbonas, Lithium Carbonate, Li 2 C0 3 , — a light, white powder, permanent in the 
air, odorless, of alkaline taste and reaction, soluble in 80 of water; insoluble in alcohol. Dose, 
gr. ij-xv [av. gr. vijss.] 

Lithii Citras, Lithium Citrate, Li 3 C 6 H s 7 , — a white, deliquescent powder, odorless, of 
faintly alkaline taste and neutral reaction, soluble in 2 of water, almost insoluble in alcohol. 
Dose, gr. v-xx [av. gr. vijss.] 

Lithii Citras Effervescens, Effervescent Lithium Citrate, — prepared from the Citrate 5, 
with Sodium Bicarbonate 57, Tartaric Acid 30, Citric Acid 19$. Dose, 3j-hj [av. 3ij] i n 
water, as an effervescent drink. 

Lithii Salicylas, Lithium Salicylate, 2LiC 7 H 5 3 , — is classed with the Salicylates and 
described under Saucinum. Dose, gr. v-xx [av. gr. xv.] 

Unofficial Preparations. 
Alkalithia, — is the trade name of a granulated effervescent preparation, containing in 
each heaping teaspoonful 5 grains of Lithium Carbonate, 10 grains each of Sodium Bicar- 
bonate and Potassium Bicarbonate, and 1 grain of Caffeine. Dose, a heaping teaspoonful 
in a glass of warm water, 3 or 4 times daily. 



I (Mill I A. 331 

Thialion, -is a proprietary preparation, described in advertising chemical language as 
a sodio-trilithic-anhydro sulphate, but is probably nothing more than a mixture of Lithium 
Carbonate and Sodium Sulphate. It is laxative, and is given in doses of a heaping tcaspoonful 
in a glass of warm water, 3 or 4 times daily. 

Incompatibles. 

Incompatibles depend on the acid constituent of the Lithium salt (see under Carbonates, 
Citrates, etc.) 

Physiological Action and Therapeutics. 
The Lithium salts have strong alkaline qualities and act on the system 
in the same manner as other alkalies (see under Potassium). The high saturat- 
ing power of this metal makes its salts more alkaline than those of potassium, 
sodium, or calcium, hence more efficient in alkalinizing the urine. The Car- 
bonate and Citrate are the salts referred to in this connection, the others par- 
taking more of the qualities of their acid factors. Both these salts are antacid 
and strongly diuretic; the carbonate being but slightly soluble should be given 
in carbonic acid water, and the citrate in dilute solution. They are rapidly 
absorbed, and rapidly eliminated by the kidneys, giving an alkaline reaction 
to the urine. No case of poisoning by them is recorded, but large doses may 
cause gastro-enteritis, and if frequently repeated may produce depression of 
the circulation, malaise, and excessive muscular weakness. In the test-tube 
lithium and uric acid have a combining affinity for each other, forming lithium 
urate, which is the most soluble of the alkaline urates, but when taken internally 
the lithium salts have a greater affinity for the acid sodium phosphate in the 
blood than for uric acid. The Carbonate and Citrate are extensively used 
in gout and lithemia, in which affections they have an established reputation, 
though their value is a limited one, and their reputed solvent power on uric 
calculi is very doubtful. Their prolonged local application is said to relieve 
gouty joints, and gouty conjunctivitis is efficiently treated by washing the eye 
with a solution of the carbonate. They are useful in the indigestion and rheu- 
matic pains of obese subjects, also in irritable bladder from excessive acidity 
of the urine. Lithiated arsenical water, made by dissolving the carbonate 
gr. v-x, and sodium arsenate, gr. -fa, in half a pint of water for one dose, repeated 
thrice daily, has proved an efficient remedy in diabetes mellitus. Many mineral 
waters contain small quantities of the carbonate, varying from a mere trace to 
grain 0.01 in a pint, an amount so minute as to be practically inert in compari- 
son with the much greater quantities of potassium and sodium salts in the same 
waters. 



LOBELIA, Lobelia, (Indian Tobacco), — the dried leaves and tops of Lobelia 
inflata, nat. ord. Campanulaceae, collected after a portion of the capsules have 
become inflated. The plant is a common annual weed growing on roadsides 
throughout the United States, having pale-green alternate leaves, and small, 
pale-blue flowers. It contains gum, resin, fixed oil, wax, lignin, salts of cal- 



332 LYCOPODIUM. 

cium, potassium and iron, a liquid alkaloid Lobeline, C iC H 24 NO, also Lobelic 
Acid, and an acrid substance named Lobelacrin. Dose, gr. ij-xv [a v. gr. vijss.] 

Preparations. 
Fluidextractum Lobelise, Fluidextract oj Lobelia. Dose, njfj-xv [av. njjviij.] 
Tinctura Lobeliae, Tincture oj Lobelia, — 10 per cent. Dose, as expectorant itrv-xx 
[av. njjxv]; as emetic oss-ij [av. oj] 

Infusum Lobeliae, Infusion of Lobelia (Unofficial), — oj to a pint. Dose, oj- o j- 
Lobelinum, Lobelia (Unofficial), — an impure resinoid. Dose, gr. ss-j. 

Incompatibles. 
Incompatible with Lobelia preparations are: Caustic Alkalies, Alkaloidal precipitants 
(see page 5). 

Physiological Action and Therapeutics. 

Lobelia has an acrid, nauseous taste, and a heavy, unpleasant odor. It 
is expectorant, diaphoretic, emetic, purgative, antispasmodic, motor-depressant 
and narcotic. It excites an abundant flow of saliva, much gastric mucus, pro- 
fuse urination and sweating, with nausea, vomiting and great depression. The 
heart's action is enfeebled and the blood-pressure, at first increased, soon falls; 
muscular debility, reduced temperature and coma follow, and death occurs by 
paralysis of the respiratory apparatus. The drug produces paralysis of the 
motor nerve-trunks, the peripheral vagi, and probably the respiratory and 
vaso-motor centres. It strongly resembles tobacco in its action, and is highly 
dangerous in full medicinal doses, having caused many deaths when admin- 
istered therapeutically, the most important instance of its fatal results being 
the case of Ezra Lovett, Jr., who in 1809 was poisoned by Lobelia administered 
by the founder of the Thomsonian sect of medical practitioners. The responsi- 
ble party escaped conviction on the plea that he gave the drug in ignorance of 
its qualities. 

Lobelia was a favorite remedy with the Indians at the time of the first set- 
tlement of the United States, and was introduced into regular practice as an 
anti-asthmatic, after having served as the main stock-in-trade of irregular prac- 
titioners for many years. Its principal therapeutic action is that of an anti- 
spasmodic, and in cautious hands it is extremely useful in paroxysmal spas- 
modic asthma, also in dry cough with constant tickling in the throat. As an 
enema in cases of strangulated hernia the infusion is much safer than tobacco 
and fully as efficient, and may overcome the obstruction in intussusception, 
while the tincture in 2-drop doses every hour will often relieve a case of im- 
pacted cecum. In constipation from atony and deficient secretion a 10-minim 
dose of the tincture at bedtime acts excellently, and in poison-oak eczema the 
infusion is a good local application. The tincture with an equal quantity of 
glycerin is an efficient application for the pain of acute epididymitis. As an 
emetic it is dangerous and unreliable, and much too depressant for use in children. 

LYCOPODIUM, — is a very mobile, pale-yellow, fine powder, consisting of the spores 
of the Club-moss, Lyco podium clavatum, and other species of Lycopodiuni, nat. ord. Lyco- 



U u:\imi m. 333 

podiaces, a native of Europe and the United States. Lycopodium is odorless, tasteless, floats 
on water, which does not wet it, and burns quickly when thrown on a flame. It should be 
free from pine pollen, starch, sand anil other impurities, which are detected by means of the 
microscope, the lycopodium spores being about Sl ',, of an inch in diameter, four-sided and 
reticulated, with short projections on the edges. They contain about 47 per cent, of a bland, 
fixed oil. 

The plant' was formerly considered to be diuretic and antispasmodic, and was used in 
rheumatism and epilepsy, also in pulmonary anil renal disorders. The powder is employed 
quite extensively in pharmacy to facilitate the rolling of a pill-mass and to prevent adhesion 
of pills to each other. It makes an excellent absorbent and protective powder when dusted 
over an excoriated surface, as between the thighs of infants. 

By the homeopathic practitioners Lycopodium is elevated to the rank of an active drug 
when triturated with sugar of milk sufficiently long to break up the seeds and liberate their 
oily contents. In their first centesimal trituration ( ( ,!,,->) it is said to have produced symptoms 
of excitement of the circulation and irritation of the urinary organs, and they profess to use it 
with benefit in affections of the mucous tracts, dyspepsia, pyrosis, flatulence, constipation, 
ileo-colitis of infants, hepatic congestion, aneurism, chronic affections of the lungs and bronchi, 
diphtheria, lithiasis, intertrigo, porrigo capitis, plica polonica and pruritus ani, in all of which 
as an internal remedy and in high attenuation. 

MAGNESIUM, Mg. — This metal is represented by its Carbonate, Citrate, 
Oxide, and Sulphate, of which the last occurs native in sea-water, caves, etc., 
the others being prepared from it. Its salts are either white or colorless, and 
those which are official are as follows: — 

Official Salts 0} Magnesium. 

Magnesii Carbonas, Magnesium Carbonate (MgC0 3 ) 4 Mg(HO) 2 +5H 2 0, — light, friable 
masses, or powder, odorless and tasteless, insoluble in alcohol, almost insoluble in water. 
Dose, gr. x- 5j [av. gr. xlv.] 

Magnesii Oxidum, Magnesium Oxide, Magnesia, — is made by heating the light car- 
bonate in a crucible to expel nearly all the carbonic acid. A white, light and very fine powder, 
almost insoluble in water, insoluble in alcohol, and gelatinizes with 15 of water after standing 
] hour, having become hydrated. Is a constituent of Pulvis Rhei Compositus, and Ferri 
Hydroxidum cum Magnesii Oxido. Dose, gr. x-xlv [av. gr. xxx.] 

Magnesii Oxidum Ponderosum, Heavy Magnesium Oxide, Heavy Magnesia, — is a 
white, dense and very fine powder, corresponding in other properties and reactions to Mag- 
nesia, except that it does not gelatinize with water. It is made by calcining the heavier car- 
bonate, and is much slower in action than the light magnesia. Dose, gr. x-xlv [av. gr. xxx.] 

Magnesii Sulphas, Magnesium Sulphate, {Epsom Salt), MgS0 4 + 7H 2 0, — colorless 
prisms or acicular needles, slowly efflorescent, odorless, of cooling, saline taste, and neutral 
reaction, very soluble in water, insoluble in alcohol. Is a constituent of Infusum Sennae 
Compositum. Dose, 3j-oj[av. oiv.] in plenty of water. 

Preparations. 

Magnesii Sulphas Effervescens, Effervescent Magnesium Sulphate, — is prepared from 
the Sulphate 50, Sodium Bicarbonate 40.3, Tartaric Acid 21. 1, Citric Acid 13.6. A coarsely 
granular, white, deliquescent salt, of acid taste and reaction, soluble in water, insoluble in 
alcohol. Dose, 5j- oj [av. 5iv.] 

Liquor Magnesii Citratis, Solution of Magnesium Citrate, — prepared from the Car- 
bonate 15, Citric Acid ^3, Syrup of Citric Acid 60, Potassium Bicarbonate 2i, Water to 360. 
Dose, 5vj-xx [av. Bxij.], for catharsis. 

Mistura Magnesiae et Asafcetida, Magnesia and Asajetida Mixture, Dewees' Car- 
minative (Unofficial), — contains of the Carbonate 5, Tincture of Asafcetida 7, Tincture of 
Opium 1, Sugar 10, and Distilled Water to 100. Dose, oss-iv. Used for flatulent colic and 
diarrhea in infants. 

Incompatibles. 

Incompatible with Magnesium Oxide are: Acids, Copaiba (forms a solid mass), Water 
fin small quantity hydrates it). With Magnesium Salts are: Alkalies, Arsenates, Carbonates, 
Lead Acetate, Lime-water, Oxalates, Phosphates, Silver Nitrate, Sulphites, Tartrates. 



334 magnesium. 

Physiological Action. 

Magnesia and the Carbonate are mildly laxative and antacid, neutraliz- 
ing free acids in the stomach and forming therewith laxative salts. If used 
in large quantity for any length of time Magnesia may become hydrated and 
produce intestinal concretions. The freshly precipitated Hydroxide is an anti- 
dote to arsenic in solution, but less effective than the hydroxide of iron, with 
which it is combined in the official ferri hydroxidum cum magnesii oxido. Mag- 
nesia may also be used in poisoning by acids or phosphorus. 

The Citrate and Sulphate are saline cathartics, the latter being the more 
powerfully hydragogue, producing large watery discharges. It is the chief 
aperient constituent of many popular laxative waters, as Friedrichshall, Ptillna, 
and Hunyadi. If administered in plenty of water the sulphate usually pro- 
duces a prompt and free discharge from the intestines with little irritation or 
griping, but often accompanied by a sense of coldness and depression. The 
purgative action is chiefly due to its causing a greatly increased secretion of 
intestinal fluids, not by outward osmosis from the vessels as was formerly taught, 
but by stimulation of the intestinal glandular appendages. If the purgative 
action should not take place a diuretic one may result, but to secure the desired 
catharsis the drug should be administered in a considerable quantity of water. 
When injected into the circulation it is powerfully toxic, paralyzing first the 
respiration and then the heart. It abolishes sensation and paralyzes the sensori- 
motor reflex centres (Murrell). Large doses taken internally may cause serious 
results, §j in a boy of 15 years produced cyanosis, a roseolous rash, tetanic 
spasms, cold hands and feet, imperceptible pulse, weak and rapid heart, and an 
axillary temperature of 105 F. (Neale). A boy of 10 years was killed by 31J 
(Christison), and an adult was fatally poisoned by 5j (Luff). 

Therapeutics. 
Magnesia and the Carbonate are used as antacids and laxatives, in acidity, 
sick headache, and flatulent colic, also as antidotes in poisoning by acids, ar- 
senic, phosphorus, and mercuric and cupric salts. The Citrate is an agreeable 
laxative, cooling and acceptable to the stomach. The Sulphate is one of the 
most efficient of the saline cathartics and has a wide field of application. In 
acute inflammatory conditions, renal and cardiac dropsy, ascites from obstruc- 
tion of the portal circulation, increased blood-pressure within the cranium, 
intestinal obstruction without acute inflammation, the constipation of lead poison- 
ing, and habitual constipation from deficiency of the intestinal secretions, it 
is an excellent remedy. As it has but little influence on intestinal peristalsis 
it is usually combined with Senna, as in the Black Draught, which increases 
its purgative action. Acute dysentery is well treated by magnesium sulphate 
combined with diluted sulphuric acid, and followed by opium and starch en- 
emata. Bleeding from hemorrhoids and uterine hemorrhage are often relieved 
by the same combination when other agents fail. In acne vulgaris and other 



MANACA — MANCANUM. 335 

obstinate eruptions due to derangement of the stomach and intestinal canal, 
1 results are often obtained by a purgative dose of the sulphate daily before 
breakfast, or by doses of 5 grains in water three or four times a day, and finely 
triturated it makes an excellent dusting powder for acne rosacea. The ferro- 
•;aline mixture (see page 279) is a useful laxative in the constipation of anemic 
women. The bitter taste of this salt is best covered by coffee. Hypodermically, 
in doses of gr. jss-v, it is said to produce purgative effects without causing dan- 
gerous symptoms, but this method of administration is at best a doubtful one, 
and is open to many objections. 

MANACA (Unofficial), — is the root of Franciscea unifora, a shrub of the nat. ord. 
Scrophularinece, indigenous to Brazil, where it is known as Mercurio-vegetal, or vegetable 
mercury, a name applied by charlatans to a number of widely differing plants. Very little 
is known about Manaca, but it has been extensively advertised as an unfailing remedy 
for sub-acute and chronic rheumatism. It is also considered purgative, diuretic, emmena- 
gogue and antisyphilitic, being official in the Brazilian Dispensatories, and noticed as follows 
in the Diet, de Botan. Brazileira. 

"This whole plant, but especially the root, excites powerfully the lymphatic system, elim- 
inating morbid matter by the skin and kidneys. It is antisyphilitic; the interior bark is 
nauseating and stimulates the throat. In small doses it is resolvent; in larger purgative, 
diuretic and emmenagogue. In large doses it is an acrid poison. ' ' 

A fluidextract is on the market, the average dose of which is irjjx. 

MANGANUM, Manganese, Mn. — This metal is represented in the Phar- 
macopoeia by four salts, including the Hypophosphite, which is described under 
Phosphorus. The others are — 

Mangani Dioxidum Praecipitatum, Precipitated Manganese Dioxide, — is chiefly man- 
ganese dioxide, Mn0 2 , with small amounts of other oxides of manganese ; a heavy, fine 
black powder, odorless and tasteless, insoluble in water or alcohol, giving off oxygen gas at a 
red heat, and if heated with hydrochloric acid it causes the evolution of chlorine gas. Dose, 
gr. ij-x [av. gr. iv.] 

Mangani Sulphas, Manganese Sulphate, MnS0 4 +4H 2 0, — colorless prisms, of slightly 
bitter and astringent taste and faintly acid reaction, very soluble in water, insoluble in alcohol. 
Dose, gr. ij-vj [av. gr. iv.] 

Potassii Permanganas, Potassium Permanganate, KMnO,, — deep, purple-violet 
prisms, of sweet and astringent taste, neutral reaction, soluble in 16 of water with a scanty, 
brown residue, decomposed by alcohol and by heating to 464° F. It should be kept in well 
stoppered bottles, and should not be triturated or combined in solution with organic or 
readily oxidizable substances. Dose, gr. .ss^rpfav. gr. j] in pili. 

Unofficial Preparations. 

Syrupus Mangani Iodidi, Syrup of Manganese Iodide, — contains about 3j of the 
Iodide in each • Dose, ttjjx-xxx. For formula see U. S. Dispensatory. 

Syrupus Ferri et Mangani Iodidi, Syrup of Iron and Manganese Iodide, — each 5 
contains 50 grains of the mixed iodides in the proportion of 3 of the Iodide of Iron to 1 of that 
of Manganese. Dose, ttjx-xxx. For formula see TJ. S. Dispensatory. 

Pepto-mangan, Liquor Mangano-ferri Peptonatus, — a proprietary preparation, adver- 
tised to contain in each half -ounce "the equivalent of 3 grains of metallic Iron and 1 grain of 
metallic Manganese (as peptonates) in organo-chemical combination." It is claimed for 
this preparation that it does not have the astringent effect of the inorganic salts of these 
metals upon the glands of the stomach, and that it does not affect the alkalinity of the bowels. 
Dose, 5ss, three to four times a day, in white wine or milk, or alone. 

Condy's Red Fluid, — is a solution of Potassium Permanganate in Distilled Water, of 
about if per cent, strength, 81 grains to the ounce, or 176 grains in 20 ounces. It is used as a 



336 MANGANUM. 

disinfectant and deodorant for closets and bed-pans, also to wash the hands and utensils, 
but it cannot be employed to disinfect rooms. It is not irritant, and shows by its change of 
color when it has lost its efficacy. A one per cent, solution is official in the Br. Phar. the dose 
of which is given as oij-iv. 

Incompatibles. 

Incompatible with Manganese Salts are Alkalies, Carbonates; Bromine, Chlorine and 
Iodine in alkaline solutions; Cyanides, Phosphates. With Potassium Permanganate are 
Acids (mineral), Alcohol, Ammonia, Arsenites, Bromides, Chlorides, Charcoal, Fats, Ferrous 
salts, Glycerin, Gums, Hydrogen Dioxide, Hypophosphites, Hyposulphites, Mercurous 
salts, Oils, Organic substances, Oxalic Acid, Oxalates, Phenol, Picric Acid, Piperazin, 
Sulphites, Tannic Acid, Tartaric Acid. 

Physiological Action. 

Manganese salts are gastro-intestinal irritants, but in small doses they im- 
prove the appetite and the digestion and stimulate the action of the heart. Used 
in larger doses and for a considerable length of time they lower the heart's action, 
paralyze the muscular system especially the muscular coat of the arteries, and 
cause progressive wasting, paraplegia, and acute fatty degeneration of the liver. 
According to some observers they are motor-excitant in action, increase arterial 
tension, and act specifically on the uterus; but others deny that they are ab- 
sorbed in sufficient quantity to have any effect on the organism. The Sulphate 
is emeto-cathartic and decidedly cholagogue, and the Dioxide is considered em- 
menagogue. Traces of manganese are found in the blood and tissues, but the 
metal is apparently introduced accidentally with food, and is not considered 
to be an essential constituent of the organism. 

Potassium Permanganate is a powerful oxidizing agent, and hence is actively 
antiseptic, disinfectant, and deodorant; but its germicidal power is limited, 
the salt being quickly reduced by surrendering its oxygen to all organic material 
present. A solution of i in 833 destroys the pus micrococci in two hours (Stern- 
berg). Its oxygen constituent is largely given up to organic substances in the 
presence of water, it being thereby converted into manganese dioxide and potassa. 
Taken internally it is quickly decomposed by the albuminous contents of the 
stomach, at the same time oxidizing any oxidizable material present, and is not 
absorbed in its own form. Concentrated solutions are irritant and corrosive 
to the skin, and if swallowed in quantity may cause gastro-enteritis. It is con- 
sidered an efficient emmenagogue, and has been successfully employed to pro- 
duce abortion. 

Therapeutics. 

Manganese salts are administered by physicians who affect to see a man- 
ganese-anemia in cachectic subjects, but they are always prescribed in anemia 
with iron. The Sulphate is used in jaundice of malarial origin and in that 
due to catarrh of the biliary passages. The Dioxide is employed in gastro- 
dynia and pyrosis, amenorrhea and other derangements of the menstrual func- 
tion, also in menorrhagia and metrorrhagia. It is used as an ointment in many 
skin diseases. 

Potassium Permanganate has generally been the preparation given when 



MANGO — MANNA. 337 

the effects of Manganese were desired; but as it causes great gastric irritabil- 
ity, with abdominal pains and burning sensations, besides other decidedly un- 
pleasant symptoms, it is a difficult matter to get patients to take it for any length 
of time. It is an efficient remedy in amenorrhea, and is used with benefit in 
dyspepsia, flatulence, lithemia, obesity, and acute rheumatism. For internal 
administration it should be given in pill or capsule, the taste of a solution being 
very disagreeable. The injection of a strong solution in the immediate vicinity 
of the bites of venomous reptiles is reported to be a very efficient antidote to 
their poisons. Solutions of the strength gj to the pint are employed as anti- 
septic and germicidal washes for wounds, ulcers, abscesses, and caries, also to 
correct fetor in cancer, ozena, leucorrhea, and perspiring feet. It is used as a 
test and a corrigent for organic impurities in drinking water, also in strong 
solution (1 in 20), followed by a solution of oxalic acid to remove the stain, as 
a disinfectant for the hands of the surgeon. The stain left by it on fabrics may 
be removed by sulphurous acid, but as sulphuric acid is formed in the reaction 
the fabric should be immediately washed or rinsed in water. 

Potassium Permanganate is an efficient antidote for morphine in the stom- 
ach, and as the latter is constantly excreted into that viscus however admin- 
istered, the former may be used efficiently in any form of opium or morphine 
poisoning. If given soon after the ingestion of the poison, the dose should be 
double that of the morphine supposed to be present, and after washing out the 
stomach, small doses may be administered at intervals during the acute stage, 
to prevent reabsorption of the morphine excreted by the stomach. It has long 
been known that this agent deoxidizes morphine and renders it innocuous, but 
it was supposed that the presence of albumin in the stomach would prevent 
their reaction. It is now shown that the permanganate reduces morphine sul- 
phate more rapidly than it does albuminous matter, and in fact exhibits a marked 
selective affinity for morphine and also for physostigmine (eserine), but gives 
up its oxygen more quickly to albuminous substances than to strychnine, oxalic 
acid, colchicum or hydrocyanic acid. It exerts no oxidizing effect, in the pres- 
ence of albumin, on atropine, hyoscyamine, hyoscine, caffeine, cocaine, aconi- 
tine, veratrine, pilocarpine, muscarine or phosphorus. (Murrell.) Laboratory 
experiments have determined that it destroys many and probably all alkaloids, 
acting very rapidly on morphine and cocaine, but slowly on strychnine (Wood).. 

MANGO (Unofficial), — is the bark of Mangijera indica, an Indian tree of the nat. ord. 
Guttiferae. It is supposed to be an astringent with special tonic action upon mucous mem- 
branes. It is highly recommended by its vendors for nasal catarrh, hemorrhages and muco- 
purulent discharges from the intestines, uterus, vagina and bronchi. A fluidextract is sold, 
which may be used in doses of njjx- 5j- 

Mango-Fruit, or Mangostcen, is the fruit of Garcinia mangostana, nat. ord. Guttifera?, 
also from India. It is a powerful astringent, and is used for nasal catarrh, diarrheas, dysentery, 
and leucorrhea. 

MANNA, — is the concrete, saccharine exudation of Fraxinus Omiis, the flowering ash, a 
tree of the nat. ord. Oleaceas, growing in Southern Europe. Manna is produced also by 

23 



338 MARRUBIUM — MEL. 

several other trees, and substances resembling it are exuded by many plants. It contains 
from 40 to 90 per cent, of Mannil, C H M O 6 , or Manna-sugar, which does not undergo vinous 
fermentation, and is chemically allied to the alcohols and to glycerin. It also contains glucose, 
mucilage, some acrid resin, and a small quantity of the fluorescent glucoside Fraxin. There 
are no official preparations, but Manna itself may be given in doses of 3j- 5j [av. 5iv.] 

Manna is a mild laxative, with some tendency to produce flatulence and colic. It is 
usually combined with other purgatives, as Senna, Rhubarb, and Magnesia, to disguise the 
taste and increase the effect. It is a constituent of the official Infusum Sennae Compositum. 
Manna may be eaten by children if of good quality, or may be readily dissolved in milk and 
so administered. 

MARRUBIUM, — the leaves and tops of Marrubium vulgare, Horehound, a plant of 
the nat. ord. Labiatae, native in Europe, but naturalized in America. It contains a bitter 
principle named Marrubiin, also a volatile oil, resin, tannin, lignin, etc. There are no offi- 
cial preparations. Dose, gr. xx- 5j [av. gr. xxx.] 

Horehound in large doses is laxative, diuretic and diaphoretic, and in ordinary dosage a 
gentle tonic and stomachic. It is generally used in catarrhal states of the air-passages, over 
which it seems to have a soothing effect, and is much employed in confectionery as an ingre- 
dient of "cough drops.'" 

MASTICHE, Mastic, — is a concrete, resinous exudation from Pistacia Lentiscus, a tree 
of the nat. ord. Anacardiaceae, growing in the island of Scio. Alcohol dissolves about 90 per 
cent., including the resin Mastichic Acid, the remainder consisting of another resin, Maslichin, 
which is soluble in ether and resembles copal. There are no official preparations, but Mastic 
is an ingredient of the official Pil. Aloes et Mastiches. Dose, gr. xx-xlv [av. gr. xxx.] 

Mastic was formerly used for supposed properties analogous to those of other oleo-resins, 
but its application is now confined to dentistry, being employed as a temporary filling for 
carious teeth. A solution in ether is applied on cotton with moderate pressure, and remains 
as a firm plug after evaporation of the solvent. 

MATICO, — the leaves of Piper angustijolium, a Peruvian shrub of the nat. ord. Piperaceae. 
It contains a crystallizable acid Artanthic Acid, also resin, tannin, and a volatile oil. Its odor 
is aromatic, and its taste astringent, spicy and somewhat bitter. Dose, 3ss-jss [av. 5j.] 
Fluidextractum Matico, Fluidextract 0} Matico. Dose, 3ss-jss [av. 3j] 
Matico is an aromatic tonic and stimulant, also aphrodisiac, vulnerary and hemostatic. 
It acts like cubeb on the urinary passages, and is an excellent alterative stimulant to mucous 
membranes. It has been used with considerable success in mucous catarrhs, as gonorrhea, 
leucorrhea, and chronic cystitis, also in epistaxis, hemorrhoids, menorrhagia, hemoptysis, 
hematemesis and other hemorrhages. The under surface of the leaf is so formed as to pro- 
mote coagulation of blood if applied to a bleeding surface, and is a good local hemostatic for 
trivial cuts or wounds. 

MATRICARIA, — the dried flower-heads of Matricaria Chamomilla, German Chamo- 
mile, a European annual plant of the nat. ord. Compositae. They contain \ per cent, of a blue 
Volatile Oil, the color of which is due to Azulen, also a bitter extractive, tannin, etc. There 
are no official preparations, but the flowers may be eaten or a decoction used almost ad libitum 
[av. 3iv.] 

Matricaria is a mild tonic, in large doses emetic, anthelmintic and antispasmodic. It is 
much used in Germany, and in this country is a popular domestic remedy among German 
people, who use it in infusions as a diaphoretic. This plant is the Chamomilla of the homeo- 
paths, who find in it remarkable power over morbid impressionability of the sensory and 
excito-motor nerves, and administer it in pains aggravated at night and by heat, clonic spasms 
of pregnancy, irritability of teething children, and flatulent colic. 



MEL, Honey, — is a saccharine secretion deposited in the honeycomb by 
Apis melliftca, the honey-bee; occurring as a pale-yellowish, syrupy liquid, 
gradually becoming crystalline and opaque, of peculiar and heavy odor, and 



Ml-'.NTHA ril'IKH\. 339 

a very sweet, faintly acrid taste. It is a strong aqueous solution of several 
sugars (cane and grape sugar, levulose), with wax-pollen, coloring and odorous 
matters, etc. The sugars, which may be resolved into levulose and dextrose, 
amount to 70 or 80 per cent. Honey is frequently adulterated with starch and 
artificial glucose, which may be detected by the official tests (see U. S. Phar.). 
Dose, 3ss-ij [av. ,,j.] 

Preparations. 

Mel Depuratum, Clarified Honey, — is honey heated, skimmed and strained, with 
Glycerin added in the proportion of 5 per cent. It is an ingredient of Confectio Rosas, Mel 
Ross, and Massa Ferri Carbonatis. Dose, oss-ij [av. oj.] 

Mel Rosae, Honey oj Rose, — Fluidextract of Rose 12, Clarified Honey to 100. It is 
generally used as a local application to the throat for its astringency and flavor, in combina- 
tion with more active agents. Dose, oss-ij [a v. oj] 

Oxymel, O.xymel (B. P.), — has of Honey 8, Acetic Acid 1, Distilled Water 1. Dose, 
3 j-ij as a pleasant addition to gargles, or as a vehicle for expectorant medicines. 

Honey is emollient, nutritive and laxative, in some persons giving rise to 
pyrosis, flatulence and colic, and in others to an eruption of urticaria, but gen- 
erally constituting an agreeable article of diet. It is sometimes actually poison- 
ous from the presence of toxic agents extracted by the bee from certain plants, 
in this country generally the mountain laurel, Kalmia latijolia. Honey is chiefly 
used as an emollient in diseases of the throat, to relieve dryness, pain, cough 
and dysphagia. Honey of Rose is somewhat astringent, and is used in gargles 
or in washes, for the treatment of inflammation and ulceration of the mucous 
membrane of the nasal passages, the mouth and the throat. 



MENTHA PIPERITA, Peppermint, — the dried leaves and flowering tops 
of Mentha piperita, a perennial herbaceous plant of the nat. ord. Labiatse, a 
native of Britain, but largely cultivated elsewhere. They contain 1 to \\ per 
cent, of a Volatile Oil, which is official, and a little tannin. 

Menthol, C 10 H 19 OH, — is a secondary alcohol, obtained from the official 
oil of peppermint, or from other oils of peppermint, by deposit therefrom on 
exposure to cold. It occurs in colorless, acicular crystals, of peppermint odor, 
and a warm, aromatic taste, followed by a sensation of cold when air is drawn 
into the mouth. Soluble only slightly in water, freely in alcohol, ether, or chloro- 
form. Dose, gr. ss-iij [av. gr.j ], in pill or spirituous solution, several times a 
day. 

Preparations. 

Oleum Menthae Piperitae, Oil of Peppermint, — is the volatile oil distilled from the fresh 
herb; a colorless or pale yellow fluid, having the odor of peppermint, and a strongly aromatic 
taste followed by a cold sensation when air is drawn into the mouth. It consists of a liquid 
terpene and Menthol (see above). Dose, iuj-v [av. lrjiij.] 

Aqua Menthae Piperitas, Peppermint Water, — has of the Oil 2 parts in 1000 of distilled 
water. Dose, 5ij-vj [av. oiv.] 

Spiritus Mentha? Piperitae, Spirit of Peppermint, {Essence of Peppermint), — is an alco- 
holic solution containing 10 per cent, of the Oil and 1 per cent, of the bruised herb. Is an 
ingredient of Mistura Rhci et Soda. Dose, njfx-xlv [av. ttjjxxx.] 



340 MENTHA VIRIDIS — METHYLTHIOXIN/E HYDROCHLORIDE. 

Incompatibles. 
Incompatible with Menthol are: Borneol, Bromal Hydrate, Butyl-chloral Hydrate, 
Chloral Hydrate, Camphor, Chromic Acid, Euphorin, Exalgin, Naphtol, Phenol, Potassium 
Permanganate, Pyrocatechin, Pyrogallol, Resorcin, Thymol, Urethane. With Spirit of Pep- 
permint are: Acacia, Aqueous fluids, Gelatin. 

Physiological Action and Therapeutics. 

Peppermint is an aromatic stimulant, also carminative and antispasmodic. 
The oil possesses these qualities in greater degree and is also a local anodyne 
and anesthetic when applied locally, especially if its evaporation be prevented. 
The Chinese oil contains a large quantity of Menthol and is particularly anodyne. 
Menthol is antiseptic and locally anesthetic, but not corrosive, and acts also 
as a vascular stimulant when applied to the surface. 

Peppermint is used internally for the relief of nausea and colic, and to expel 
flatus by its local stimulant and after sedative action on the bowels. It is an 
agreeable corrigent for combination with purgatives to prevent griping, and 
efficiently covers the taste of many nauseous substances. The spirit is the best 
form for internal use. The oil is used locally to relieve the pain of superficial 
neuralgia, a cloth being wet with it, laid along the course of the affected nerve 
and covered with oiled silk to restrain evaporation. It is efficient in rheuma- 
tism as an anodyne and counterirritant application. 

Menthol is highly praised as an external application in various neuralgia, 
sciatica, pleurodynia, and toothache. For neuralgia it is used in saturated 
alcoholic solution painted over the affected nerve. For toothache a crystal 
introduced into the carious cavity is promptly anodyne. In spray containing 
5 to 20 per cent, it is highly efficient in epidemic influenza and in tuberculous 
laryngitis. It is a good application in parasitic skin diseases, and has marked 
value as an antipruritic. Its vapor by inhalation is efficient against cough, and 
it has considerable power as an anti-emetic, having stopped nausea and vomit- 
ing after the usual remedies had failed. For this purpose ten drops of a 20 
per cent, solution in olive oil are given on sugar. 

MENTHA VTRIDIS, Spearmint, — the dried leaves and flowering tops of Mentha 
spicata, the "mint" of the kitchen garden, a plant of the nat. ord. Labiatae, indigenous to 
England, but naturalized in many countries. Its constituents and properties are identical with 
those of peppermint, but its odor and taste differ therefrom. 

Oleum Menthae Viridis, Oil of Spearmint, — is the Volatile Oil distilled from the plant. 
Dose, trjjij— v [av. Trgiij.] 

Aqua Menthae Viridis, Spearmint Water, — has 2 parts of the Oil in 1000 of Distilled 
Water. Dose, 5ij-vj [av. 5iv.] 

Spiritus Menthae Viridis, Spirit of Spearmint, (Essence of Spearmint), — is an alcoholic 
solution containing 10 per cent, of the Oil and 1 per cent, of the bruised herb. Dose, njx-xlv 
[av. njjxxx.] 

Spearmint corresponds in action to Peppermint, but is less powerful. It is employed to 
correct flatulence and to relieve colic, and makes an agreeable flavoring for mixtures. 

METHYLTHIONDLE HYDROCHLORIDUM, Methylthionine Hydro- 
chloride, Methylene Blue, — a derivative of Aniline, occurs as a dark green 



MEZEREUM -MOKK1HM'. OLEUM. 341 

crystalline powder, or as prismatic crystals of bronze like lustre; readily soluble 
in water, less so in alcohol, the solutions having a deep blue color. Dose, gr. 
j-vj [av. gr. iv], up to gr. xx daily, with gr. ij of powdered nutmeg given with 
each dose to prevent strangury. Incompatible are Caustic Potassa, Potassium 
Dichromate, Potassium Iodide, Sulphuric Acid and other reducing agents. 

Methylene Blue should not be confounded with Methyl Blue, the dye, which 
is highly poisonous. It manifests a strong affinity for nerve tissue, and is the 
best staining agent for the malaria plasmodium. It destroys the plasma of 
this organism, and is curative in the forms of malaria showing the crescents 
and full-grown parasites, while quinine is more efficient when the nuclei are 
more developed than the plasma (Ehrlich). Its best action in malarial affec- 
tions has been obtained in children, and being tasteless it may be administered 
to them more easily than quinine, besides being free from the vomiting and 
headache which so frequently result from the latter drug. It has very consider- 
able anodyne power over neuralgic and rheumatic affections, and has been 
employed as an antipyretic and internal antiseptic in rheumatism of the joints and 
muscles, also in acute nephritis and cancer with varying results. In diphtheria 
and simple ulceration of the throat a 10 per cent, solution is used locally with bene- 
fit. It has been employed successfully in chonic cystitis and diabetes mellitus, and 
has given satisfaction in several very obstinate cases of arthritis deformans. 
It has been used hypodermically for conditions of excitement in a number of cases 
of different forms of insanity, with very satisfactory results. In the early stage 
of gonorrhea its internal administration will shorten the duration of the disease. 
It is rapidly eliminated by the kidneys, and imparts a blue color to the urine. 

MEZEREUM, Mezsreum (Mezereon), — is the bark of Daphne Mezereum and of other 
species of Daphne, plants of the nat. ord. Thymeleaceae, growing in mountainous districts of 
Europe and Asia and cultivated as a garden shrub in Britain. It contains an inert, fixed oil, 
an inactive glucoside, Daphnin, and an acrid Resin, which is the anhydride of a resinous acid 
named Mezereinic Acid. Mezereum is an ingredient of the compound fluid extract of Sarsa- 
parilla. Dose, gr. j-x [av. gr. vijss.] 

Fluidextractum Mezerei, Fluidextract of Mezereum, — is too acrid for internal use. 

Mezereum is a sialogogue, and an intensely acrid, irritant poison, producing violent 
vomiting, purging, nephritis and gastro-enteritis. In small doses it is laxative and diuretic, 
and has had considerable reputation as an alterative. Externally the recent bark is a powerful 
local irritant, speedily producing vesication. 

Mezereum is rarely used internally by itself, but is employed in mixtures with Sarsa- 
parilla, etc., as an alterative in syphilis, rheumatism and some skin diseases of chronic type, 
but with doubtful efficacy. It has been used with good effect in toothache and as a masti- 
catory in paralysis of the tongue. Its principal use is as a local irritant to keep up the dis- 
charge from issues or blisters, and to stimulate indolent ulcers. 

MORRHIL-E OLEUM, Cod Liver Oil, {Oleum Jecoris Aselli)— is a fixed 
oil obtained from the fresh livers of Gadus Morrhua, the cod-fish, also from 
other species of Gadus. It is a colorless or pale yellow, thin, oily liquid, of 
slightly fishy odor and taste, and faintly acid reaction, soluble in ether. It 
contains the fixed bases Aselline and Morrhuine, volatile bases, acids, etc. (see 
below) ; also traces of iodine and bromine, the ordinary inorganic salts of animal 



342 MORRHUAE OLEUM. 

tissue and products, and perhaps bile constituents. When saponified it does 
not yield glycerin, but oxide of propyl. Three kinds or varieties are found in 
the market, the pale, the light-brown and the dark. The pale is the official 
oil and the purest. Dose, -jj-vj [av. 3iv], beginning with a small dose, and in- 
creasing as assimilated. 

Preparations. 

Emulsum Olei Morrhuae, Emulsion of Cod Liver Oil, — has of the Oil 50, Acacia 12J, 
Syrup 10, Oil of Gaultheria 0.4, and Water to 100. Dose, 3j-vj [av. 3 ij -] 

Emulsum Olei Morrhuae cum Hypophosphitibus, Emulsion oj Cod Liver Oil with 
Hypophosphites, — has of the Oil 50, Acacia 12J, Calcium Hypophosphite 1, Potassium 
Hypophosphite 0.5, Sodium Hypophosphite 0.5, Syrup 10, Oil of Gaultheria 0.4, and Water 
to 100. Dose, 3j-vj [av. oij] 

Morrhuol (Unofficial), — is obtained from cod liver oil by treating it with sodium bicar- 
bonate to remove the acids, then agitating with alcohol and evaporating the latter. Dose, 
gr. iij in capsule. 

Physiological Action. 

The action of Cod Liver Oil is that of any other fat, except that it is more 
easily assimilated than any other member of the class. Fats in small quantity 
are necessary for the digestion of nitrogenous food and form the molecular basis 
of the chyle, being prepared for absorption by the pancreatic juice and the 
bile, especially the latter. Fat is an essential constituent of the products of 
tissue formation, whether physiological or pathological, and is the principal 
material concerned in the production of force. After oxidation it is excreted 
as carbon dioxide water. Locally applied fats reduce the body-temperature. 

Cod Liver Oil is the most easily digestible of fats, penetrating animal mem- 
branes with comparative ease after being emulsified by the pancreatic and 
biliary secretions, hence entering the lacteal vessels readily and appearing to 
carry with it the oily and nitrogenous elements of the food. The result is facili- 
tation of the digestive process, increase of the red blood-corpuscles and of the 
body-weight, and stimulation of healthy cell-formation throughout the tissues. 

Gautier and Mourgues of Paris have made an exhaustive series of analytical researches 
upon Cod Liver Oil, and find that it contains — (1) Fixed Bases, Aselline and Morrhuine, 
the latter constituting about J of the total alkaloids, and being probably one of the most effi- 
cient principles in the oil. (2) Volatile Bases, Butylamine, \ of the total bases; Amylamine, 
\ of the whole; Dihydrotoluidine, ^ of the total alkaloids; Hexylamine, a small amount. (3) 
Acids, Morrhuic Acid 1 J per cent., also a mixture of Formic and Butyric Acids; and a small 
proportion of Phosphoric Acid, derived from the phosphates, phospho-glycerates and lecithins 
of the extracts. As to the properties of these constituents they state that Butylamine, Hexyla- 
mine, and particularly Amylamine increase the urinary secretions. Dihydrotoluidine is a con- 
vulsivant toxic base. Aselline in sufficient doses produces dyspnea, stupor, convulsive dis- 
turbances, and if continued death. Morrhuine, the most important of the extractive prin- 
ciples, is a powerful stimulant of the functions of nutrition and assimilation, promoting meta- 
bolic changes; it produces a rapid circulation of the extractive residues of cell life towards the 
excretory organs, where they are eliminated, provoking in their way indirectly a powerful 
movement of assimilation correlative of the losses consequent upon the inverse movement of 
de-assimilation. This is considered to be proved by the super-excitation of appetite in ani- 
mals brought under its influence. The physiological experiments with these substances dem- 
onstrate that cod fiver oil is a reconstituent of the tissues through its richness in phosphates, 
phospho-glyceric acid, and organically combined phosphorus. Bromine and iodine, which are 
present in small quantities, also contribute to the reparative action, but chiefly to the active 
principles butylamine, amylamine, and especially morrhuine and morrhuic acid, does the oil 
owe its true medicinal value. 



Mosciii's. 343 



Therapeutics. 



The value of Cod Liver Oil is wholly that of a nutrient, its action being 
most marked in wasting diseases. In high febrile states or catarrhal condi- 
tions of the gastro-intestinal tract its use is contraindicated, but in phthisis a. 
slight degree of fever will not interfere with its beneficial employment. It is 
found to be of most value in the chronic forms of phthisis, in chronic bronchitis 
ami emphysema, chronic rheumatic disorders, atheroma of the arteries, stru- 
mous skin diseases and diarrhea, syphilodermata, neuralgia, chorea and epilepsy. 
In many disorders referable to exhaustion or debility of the nervous centres it 
is of great value as a nerve tonic, and in convalescence from acute diseases it 
is of marked benefit. It should always be considered as a supplementary food, 
and if its use endangers the appetite for other food it should be abandoned. 

The administration of this valuable agent is a serious matter, as many pa- 
tients cannot overcome their repugnance to its taste and smell. Various emul- 
sions are on the market, but they are objectionable because in no case do they 
conceal the taste, and the efficacy of the oil is seriously impaired by the proc- 
esses used in their preparation. Moreover, the temptation is very great to 
employ an inferior grade of the oil or to adulterate it with other fish oils in the 
manufacture of these preparations, and when the commercial spirit of gain is 
remembered one can never be sure of the quality of the oil so prepared. The 
oil itself is the best form for use, in small doses, say a teaspoonful thrice daily 
for an adult, after meals, in black coffee, beer or lemon-juice. The essential 
oil of eucalyptus in the proportion of i part to ioo of cod liver oil will effectu- 
ally extinguish the odor and taste to many persons. Alkaline stomachics given 
before meals, the oil after, and a teaspoonful of Liquor Pancreaticus given half 
an hour afterwards, would be a good routine in most cases, the latter agent 
preventing the fishy eructations which often give so much trouble. Extem- 
poraneous emulsions may be prepared with glyconin, white of egg, mucilage 
of tragacanth, extract of malt, or any syrup, and flavored with lemon, cinnamon 
or bitter almond. The addition of "Kiv of Ether to each 5 of the oil promotes 
its digestion by stimulating the pancreatic secretion, and enables a patient to 
take it with whom it had previously disagreed. 

Inunction by Cod Liver Oil is a method of value in the wasting diseases of 
children. A tablespoonful may be rubbed into the skin of the abdomen twice 
a day, and covered with a flannel binder having oiled silk or mackintosh- cloth 
outside. It readily passes through the skin and is absorbed, producing valuable 
and lasting results. 



MOSCHUS, Musk, — is the dried secretion from the preputial follicles of Moschus mos- 
chijerus, the Musk-deer, an animal inhabiting the mountainous region of Central Asia. It 
occurs in irregular, unctuous grains, of a reddish-brown color, peculiar and penetrating odor 
and bitterish taste, contained in oval sacs about 2 inches in diameter, membranous on one 
side, hairy on the other. It is soluble in 10 of alcohol, and in 2 of water. Chinese Musk in 
the pods or sacs is the most valuable, but all varieties are adulterated, the price of the drug 



344 MYRCLE OLEUM — MYRISTICA. 

being high. The odor is destroyed by drying, but returns again on the addition of moisture. 
Trituration with Camphor or Hydrocyanic Acid destroys it. The odorous principle has not 
been isolated, but is probably a product of decomposition which is constantly being formed. 
The constituents of Musk are a bitter resinous substance, ammonia, fat, cholesterin, etc. 
Dose, gr. ij-vj [av. gr. iv.] 

Tinctura Moschi, Tincture of Musk, — 5 per cent. Dose, itjxx- ojss [av. 3j-] 
Musk is a very diffusible stimulant, acting directly on the nervous and circulatory sys- 
tems, but without much energy. It is also an antispasmodic, and is employed with benefit in 
general prostration of the system with nervous agitation or irregular muscular action. It has 
been used with advantage in laryngismus stridulus, insomnia, the collapse of typhoid and 
typhus fevers, spasmodic affections of the stomach, obstinate hiccough and convulsions of 
children due to intestinal spasms. The pure Musk is very difficult to obtain, and its high 
price makes it an extremely expensive medicine, so that it is seldom used except as a perfume. 

MYRCIA OLEUM, Oil of Myrcia, Oil of Bay (Unofficial),— is a volatile oil distilled 
from the leaves of Myrcia acris, the Bayberry, a tree of the nat. ord. Myrtaceae, native of the 
West Indian Islands. It contains a hydrocarbon and Eugenic Acid. Used only as a perfume. 

Spiritus Myrciae, Spirit of Myrcia, Bay Rum (Unofficial), — contains Oil of Myrcia 16, 
Oil of Orange-peel 1, Oil of Pimenta 1, Alcohol 1220, Water to 2000. 

The Oil of Bay is an agreeable perfume chiefly used in cosmetic preparations. The spirit, 
known as Bay-rum, is used principally as a refreshing perfume, and is thought to relieve head- 
ache and faintness, by applications to the forehead or to the nostrils. 



MYRISTICA, Myristica (Nutmeg), — is the kernel of the ripe seed of 
Myristica fragrans, nat. ord. Myristicaceae, a native of the Banda Islands. Its 
odor is strongly aromatic; its taste is agreeably aromatic, warm, and slightly 
bitter. Dose, gr. v-xv [av. gr. vijss.] 

Macis, Mace (Unofficial), — is the arillode (fleshy covering) of the seed of 
Myristica fragrans, the Nutmeg-tree. It occurs in narrow bands about an 
inch long, branched and lobed, of brownish-orange color, fragrant odor, warm 
and aromatic taste. It yields a fixed oil by pressure and a volatile oil by dis- 
tillation, the latter being probably identical with Oil of Nutmeg. Dose, gr. 

v-xx. 

Preparations. 

Oleum Myristicae, Oil of Nutmeg, — is the volatile oil, and consists chiefly of a terpene 
and an oxygenated oil, Myristicol. It is colorless or pale-yellow, of hot, spicy taste and neutral 
reaction, and is soluble in alcohol. Dose, njy'-v [av. njiij.] 

Nutmeg is an ingredient of Acetum Opii, Pulvis Aromaticus, Tinctura Lavandula? Co., 
and Trochisci Sodii Bicarbonatis. 

Incompatibles are Mineral Acids, Cinchona infusion, Ferrous Sulphate, Mercuric Chloride, 
Silver Nitrate. 

Physiological Action and Therapeutics. 
Nutmeg is an aromatic stomachic of agreeable flavor. In small doses it 
stimulates the production of gastric juice, promotes digestion, increases appetite, 
and relieves intestinal spasm and flatulence. In large doses it is powerfully 
narcotic, acting directly on the cerebrum, and producing stupor and delirium. 
It is used chiefly for flavoring purposes, and generally in substance grated as 
required, but has been employed as a carminative, anodyne and astringent 
in diarrheas and dysentery, also to relieve nausea and vomiting. Strangury 
is efficiently treated by small doses of powdered nutmeg given several times a 



ms rich \ sis un 01 i.i'M. 345 

day; and the same remedy is often used in the south of Germany to relieve 
the uncomfortable feeling experienced after drinking an excessive quantity of 
new beer. Grated nutmeg is used by women in England and Australia as an 
abortifacient, often with toxic results. The Volatile Oil is decidedly rubefacient 
svhen used externally, and has narcotic powers if used internally in sufficient 
quantity. It is occasionally employed as an external stimulant in paralysis 
and chronic rheumatism. Mace is stimulant, carminative and aromatic. It 
is used solely as a spice or condiment. 



MYRRHA, Myrrh, — is a gum-resin obtained from Commiphora Myrrha, 
an Arabian tree of the nat. ord. Burseraceas. It occurs in roundish tears, hav- 
ing a waxy fracture, a balsamic odor and a bitter taste. When triturated with 
water it forms a brownish-yellow emulsion; treated with alcohol it yields a 
brownish-yellow tincture which turns purple on the addition of nitric acid. 
It contains Gum, 60 per cent.; Myrrhin, a resin, 35 per cent.; also Myrrhol, 
C 10 H u O, an oxygenated ethereal oil, 2 per cent. Dose, gr. v-xv [av. gr. vijss.] 

Tinctura Myrrhae, Tincture 0} Myrrh,— 20 per cent. Dose, njjx— xxx [av. itrxv.] 
Myrrh is contained in Mistura Ferri Co., Pil. Aloes et Myrrhae, Pit. Rhei Co., and Tinctura 
Aloes et Myrrhae. 

Locally applied Myrrh is stimulant and disinfectant to mucous membranes 
and ulcerated surfaces. Administered in small doses internally it acts as a 
gastric stimulant, but in large doses it irritates the gastro-intestinal mucous 
membrane, causing vomiting and purging. It quickens the action of the heart, 
diminishes bronchial secretion, and is a uterine stimulant and an emmenagogue. 
Myrrh is used in combination with other drugs, as noted above, for anemia, 
amenorrhea and bronchial catarrh. It is believed to diminish excessive secre- 
tion from the mucous surfaces of the uterus, vagina, bladder and bronchi, also 
to have an especially beneficial influence on chronic pharyngitis. Locally used 
the tincture has a good tonic action on diseased mucous surfaces and is applied 
svith benefit to spongy gums, relaxed throat, aphthous patches and unhealthy 
ulcers, and diluted with water it makes an excellent gargle for ulcerated sore 
throat. Myrrh has long been employed as an ingredient of dentifrices. 

Binz observed that the internal administration of Myrrh produced a leucocytosis in which 
the white blood-cells were increased to four times their original number. This fact has been 
made the basis of treatment in severe cases of diphtheria by Stroll, who reports 80 cases so 
treated with only one death, and has collected nearly 300 cases in which the same treatment 
was employed with strikingly good results. His prescription has of the tincture 4, glycerin 8, 
and distilled water to 200 parts, of which 5j under 2 years of age, 3ij up to 15 years, and 
r>iij-iv for adults, every half hour or hour until the symptoms moderate, then every two 
hours, continued for 48 hours after the membrane disappears. 

MYRTI OLEUM, Oil of Myrtle, Myrtol, (Unofficial) ,— is a volatile oil 
distilled from the leaves of Myrtus communis, the myrtle, nat. ord. Myrtaceae, 
and consists of a mixture of Pinene, another hydrocarbon, and Cineol; the latter 



346 NAPHTHALENUM. 

being identical with eucalyptol, and probably the active medicinal ingredient. 
Dose, nij-iij; m capsules. 

Myrtol is a very active antiseptic and parasiticide. Applied to a raw surface 
it is sufficiently irritant to excite inflammation, but it does not so affect the un- 
broken skin. Internally, in small doses, it excites a sense of warmth in the 
mouth, increases the saliva, and acts as a tonic to the stomach. Full doses are 
sedative to the nervous system, but large ones act as an irritant. It is eliminated 
by the lungs and kidneys, acting as an expectorant, an antiseptic and a stimulant 
to the mucous membranes at the points of elimination. It imparts an odor 
like that of violets to the urine of the person taking it. 

Administered in small doses, Myrtol aids digestion, and is an efficient dis- 
infectant and alterative in bronchorrhea, fetid bronchitis and gangrene of the 
lung; and in cystitis and urethritis it acts similarly through the urine on the 
local mucous membrane. It may be expected to give good results in chronic 
and capillary bronchitis, whooping-cough and humid asthma. It has rendered 
good service in hematuria not due to acute congestion, and in passive hemor- 
rhages generally. Locally it has proved curative in favus, herpes, pityriasis 
and parasitic skin diseases; also in otorrhea, ozena and other foul discharges 
from ulceration of the mucous membranes. It has been employed success- 
fully against both the round and the thread worm. 

Chekan (Unofficial), — the leaves and shoots of Myrtus Chekan, nat. ord. Myrtaceae, a 
native of Chili. They contain a Volatile Oil resembling that of eucalyptus, also Chekanine, a 
volatile alkaloid, and tannin. Chekan is antiseptic, tonic, expectorant and diuretic; and is 
chiefly used in catarrh of the mucous membranes, especially those of the bronchi and the blad- 
der. It has been employed with benefit in cases of phthisis, and in bronchitis with thick, 
purulent expectoration. The expressed juice diluted with water makes a good lotion for 
conjunctivitis, and a decoction of the bark is valued as an astringent in dysentery. A fluid 
extract is marketed, the dose of which is 3j-iij- 

NAPHTHALENUM, Naphthalene, (Naphtalin), C 10 H 8 — is a hydrocarbon 
obtained from coal-tar, and is formed during the manufacture of ordinary 
coal gas. Chemically, it is one of the benzene derivatives, being formed by 
the union of two benzene groups in an overlapping ring (see page 232). When 
redistilled, it crystallizes in colorless, rhomboid plates, of slightly tarry but 
strong odor, and burning, aromatic taste; insoluble in water, soluble in 15 of 
alcohol, very soluble in boiling alcohol, ether, chloroform, carbon disulphide, 
and fixed or volatile oils. It is seen frequently in the form of moulded blocks, 
under such names as Alabastrine and Camphylene, for preserving furs and flan- 
nels from moths, and for disinfecting urinals. Dose, gr. j-iij [av. gr. ij], in emul- 
sion, or as a powder with sugar in wafers or capsules. 

Derivative. 

Beta-Naphthol, Beta-naphthol (Naphtol), C 10 H 7 OH, — a phenol occurring in coal-tar, 
but usually prepared from Naphthalene. It is one of several naphthols, and occurs in colorless, 
shining, crystalline laminae, or a whitish, crystalline powder, of faint, phenol-like odor, and 
sharp taste. Soluble in f of alcohol, in about 1000 of water, and in 75 of boiling water; very 
soluble in boiling alcohol, ether, chloroform, olive oil and petrolatum. Used as ointment, 



\ aimi in \i i \i \i. 347 

i to 5 for adults, but for children it should be not over a per cent, strength. Dose, gr. iij-vj 
[av. gr. iv ], in cachet or pill. 

Unofficial Preparations and Derivatives, 

Hydronaphthol, — is said to be an impure beta-naphthol. It occurs in glistening, mica- 
ceous scales, freely soluble in alcohol, glycerin, and fixed oils, in 2,000 of cold water, in 100 of 
hot water, precipitating as the water cools but leaving a saturated solution of 1 in 1,000. A 
powerful and non-irritating antiseptic and germicide. Dose, gr. j-iij or more, in pills coated 
with keratin or salol. 

Naphthol Camphoratum, Camphorated Naphthol, Naphthol Camphor, — is prepared 
by heating carefully one part of beta-naphthol with two of camphor; the product being a homo- 
geneous, oily fluid, which is insoluble in water, and decomposes readily on exposure to light and 
air Used as a parenchymatous injection, the undiluted fluid being well borne, or in Olive oil, 
in doses of itRij-v. 

Asaprol,— is calcium beta-naphthol alpha-monosulphonate, and occurs as a white powder 
soluble in water. It is used as an antipyretic and analgesic in sciatica and rheumatism, also 
in chronic nephritis. Dose, gr. v-xv. 

Betol, — is the salicylate of beta-naphthol ester, occurs in small, white, tasteless crystals, 
soluble in alcohol and fixed oils, insoluble in water. It is used in rheumatism, cystitis, and 
intestinal catarrh, also in pencils for gonorrhea. Dose, gr. ij-viij, as powder, or in pills with 
glucose. 

Benzonaphthol, — is prepared from beta-naphthol by the action of benzoyl chloride, and 
occurs as a white, tasteless powder, almost insoluble in water. It is used as an intestinal anti- 
septic and disinfectant in typhoid fever and tropical dysentery. Dose, gr. v-xv. 

Epicarin, — a combination of beta-naphthol and creosotic acid, is a non-poisonous para- 
siticide, which has been used as a 5 to 10 per cent, ointment with Lanolin as a base, for scabies 
and prurigo with most satisfactory results. 

Incompatibles. 

Incompatible with Naphthalene are: Chromic Trioxide, Phenol, Pyrocatechin, Salol. 
With Beta-naphthol are Antipyrine, Borneol, Camphor, Chorinated Lime, Exalgin, Ferric 
Chloride, Menthol, Phenol, Potassium Permanganate, Pyrocatechin, Urethane. With Asa- 
prol are Antipyrine, Bicarbonates, Iodides, Quinine, Sulphates. 

Physiological Action and Therapeutics. 

Naphthalene is destructive to all forms of low life, and hence is antiseptic 
in a high degree, but must be intimately mixed with the substances upon which 
it is to act. Internally it is a stimulant expectorant of decided power, and 
disinfects the contents of the intestinal canal. Being sparingly soluble but 
little of it is absorbed, and hence it does no injury to the organism. What is 
taken up by the blood is excreted by the urine, partly unchanged, partly as 
naphthol and perhaps some as phenol. Beta-naphthol is more easily absorbed 
and may induce vomiting, hematuria, convulsions and unconsciousness. An 
ointment containing 2 per cent, applied with friction for scabies to two brothers, 
aged 6 and 8 years respectively, caused nephritis in both and death in one, the 
diagnosis of nephritis being verified at the autopsy. 

Naphthalene is employed as an antiseptic for the intestinal canal in typhoid 
fever, diarrhea, both acute and chronic, tuberculous diarrhea, and dysentery. 
It renders the urine aseptic and may 'be employed in vesical catarrh. It is used 
internally for humoral asthma, verminous affections, the chronic pulmonary 
catarrh of the aged, and chronic bronchitis with copious secretion. It is said 
to be effective as a teniacide, also as a vermifuge for seat-worms given bv in- 



348 NITROUS OXIDE. 

jection, gr. xv-5ss in Siij of olive oil. Burned in the patient's room it has given 
excellent results in pertussis, giving force to the belief that the well-known 
benefit resulting from taking children to gas-works for whooping-cough is due 
to the naphthalene fumes rather than to those of the gas-tar. Locally, Naph- 
thalene has high value as an antiseptic for indolent ulcers, sloughing wounds, 
open cancers, and pus cavities. Painted over organic remains it effectually 
prevents the ravages of insects, and has largely supplanted camphor for protect- 
ing woolen clothing from moths. 

Beta-naphthol is used in the form of a 2 per cent, soap in prurigo, herpes, 
ichthyosis and favus, also in a £ to 5 per cent, alcoholic solution, or as a 10 
per cent, ointment, for hyperidrosis, scabies, and eczema, but it is a dangerous 
and irritant application. Internally it has been employed in typhoid fever, 
dilatation of the stomach, intestinal dyspepsia, diarrhea and dysentery. Its 
germicidal rank is probably second to many other agents, but it has value as 
an internal antiseptic, being nearly free from toxic action on the higher ani- 
mals in medicinal doses. 

Asaprol is a safe internal antiseptic, antipyretic and analgesic. It has been 
used with benefit in epidemic influenza, rheumatism, sciatica and chronic 
nephritis, but its most brilliant results have been obtained in atonic dyspepsia, 
when fermentation alternates with acid eructations. It is not irritant to the 
intestinal canal, and may be used internally instead of naphthol. 

Camphorated Naphthol has been employed for the irrigation of joints, 
bony cavities, tendinous sheaths, cold abscesses, in the pleural and uterine 
cavities, and in tuberculosis of the bladder, all these localities seeming to tolerate 
the undiluted fluid well. In tuberculous adenitis and tuberculosis of the tes- 
tis, it was used hypodermically in several cases with gratifying results (Reboul). 

NITROUS OXIDE, Nitrogen Monoxide, Laughing Gas, N 2 0, (Unoffi- 
cial), — is a colorless and odorless gas of slightly sweetish taste, produced by 
the distillation of Ammonium Nitrate, and supplied by the manufacturers in 
condensed form. Inhaled it causes mental excitation, followed by brief gen- 
eral anesthesia, during which the blood pressure is raised, and the face is bloated 
and cyanozed by venous stasis as in other forms of asphyxia. The anesthetic 
effect is partly due to its depriving the subject of oxygen, partly to its own in- 
herent cerebral action. It stimulates the vaso-motor centre, has no definite 
action on the heart, does not affect the motor nerves, and has only a feeble in- 
fluence on the spinal cord. The after-effects are slight, and usually consist of 
dizziness and light-headed sensations lasting a few hours. Death occurs by 
asphyxia from paralysis of respiration. 

Nitrous Oxide is the safest of all anesthetics, only nine deaths being recorded 
as caused by it, though it is administered to more than 750,000 persons yearly. 
It is applicable to minor operations only, its anesthesia being of brief duration 
with a rapid return to consciousness. Some operators administer it mixed 



\t \ VOMICA. 



;io 



with oxygon, in order to lessen the asphyxia] symptoms, but this method h.a 
been generally abandoned for the pure gas alone, giving oxygen when indicated 
by the facial expression of the subject. It is eontraindieated when there is any 
impediment to free breathing, also when atheroma or other arterial disease 
exists on account of the high blood pressure which it produces. It gives rise 
to erotic sensations which may result in false accusations, hence it should not 
be administered to women without the presence of a witness. It may be used 
as a preliminary inhalation before the use of ether, but chloroform should not 
be inhaled immediately after the gas without giving time for the cyanosis to 
clear up. 

NUX VOMICA, Nux Vomica, (Poison Nut, Quaker Button)— -is the dried, 
ripe seed of Strychnos Nux-vomica, a tree of the nat. ord. Loganiaceae, grow- 
ing in India, Cochin-China and the neighboring countries, all parts of which 
are bitter and poisonous. The seeds are flattened and nearly circular, about 
one inch in diameter, ashy-gray in color, covered with short, satiny hairs, in- 
ternally translucent, tough and horny, with a large cavity; inodorous, but of 
intensely bitter taste. They contain the alkaloids Strychnine and Brucine (see 
below), in combination with Igasuric (Strychnic) Acid, also the glucoside Loganin, 
a yellow coloring matter, a concrete oil, gum, starch, wax, and earthy phosphates. 
Dose, gr. ss-jss [av. gr. j.] 

Preparations of Nux Vomica. 

Extractum Nucis Vomicae, Extract oj Nux Vomica, — should contain 5 per cent, of 
strychnine. Dose, gr. J-J [av. gr. |] up to a maximum in 24 hours of gr. ij. 

Fluidextractum Nucis Vomicae, Fluidexlract 0} Nux Vomica, — should contain 1 per 
cent, of Strychnine. Dose, iijss-jss [av. itjrj.] 

Tinctura Nucis Vomicae, Tincture oj Nux Vomica, — should contain J$ per cent, of 
strychnine. Dose, itjjv-xv [av. ttjjx.] 

Alkaloids and their Salts. 

Strychnina, Strychnine, C 2 iH 22 N 2 02, — is an alkaloid obtained from Nux Vomica, Ig- 
natia, and other plants of the order Loganiaceae; crystalline, intensely bitter even in 1 to 700,- 
000 solution, of alkaline reaction, soluble in 7 of chloroform, no of alcohol, 6700 of water. 
It is a constituent of Ferri et Strychninae Citras, Pil. Laxativae Comp., and Syrupus Ferri 
Quininas et Strychninae Phosphatum. Dose, gr. tttt - jV [ av - S r - ■??•] 

Strychninae Sulphas, Strychnine Sulphate, — crystalline, efflorescent, odorless, of in- 
tensely bitter taste, even in 1 to 700,000 solution, neutral reaction, soluble in 50 of water, in 
iog of alcohol, and in 2 of boiling water, insoluble in ether. It contains 75 per cent, of Strych- 
nine. Dose, gr. yJo - ^ [ av - g r - sVl t> ut after tolerance is attained much larger doses may be 
safely used. 

Strychninae Nitras, Strychnine Nitrate, — forms colorless needles of a silky lustre and 
very bitter taste, soluble in 90 parts of cold water, 3 of boiling water, in 70 of alcohol, and in 26 
of glycerin, insoluble in ether. It contains 84 per cent, of Strychnine, and is preferred to the 
sulphate for hypodermic use, being less irritant. Dose, -n?o~ztf [ av - g 1 "- t?VJ> or more after tol- 
ance is attained. The Phar. Ger. gives the maximum single dose as gr. \, the daily maximum 
as gr. \. 

Strychninae Arsenis, Strychnine Arscnite (Unofficial), — is soluble in 35 parts of cold 
water, in 10 of boiling water, also in alcohol, less so in ether. Dose, gr. xwnV As 't is 
highly toxic, the initial dose should never exceed the minimum given. 

Brucina, Brucine, C^HjuNjG^ (Unofficial), — occurs in colorless prisms, pearly flakes 
or masses, bitter, soluble in 850 parts of water and in ii of alcohol. It is separated with 



350 NUX VOMICA. 

difficulty from Strychnine, in many samples of which it occurs as an impurity. It is seldom 
used. Dose, gr. T V— J. 

Incompatibles. 

Incompatible with Nux Vomica and Strychnine are Alkalies and their Carbonates, Bro- 
mides, Iodides, Chlorides, and all other alkaloidal precipitants (see page 5). Oils and fats 
retard the absorption of strychnine salts. Physiologically incompatible are Aconite, Alcohol, 
Amyl Nitrite, Atropine, Chloral Hydrate, Chloroform, Curarine, Digitalis, Hydrocyanic 
Acid, Morphine, Nicotine, Paraldehyde, Physostigmine, Potassium Bromide, Urethane. 

Tests jor Strychnine and Brucine. 

Strychnine and its salts dissolve without color in concentrated Sulphuric Acid, but, on 
adding to the solution some deoxidizing substance, a play of colors results, Lead Peroxide pro- 
ducing a beautiful blue, passing into violet, then red, and finally yellow (Marchand). A 
minute quantity of Potassium Bichromate produces similar results (Otto), while Ceroso-ceric 
Oxide causes a blue, changing to violet and then to a permanent cherry-red. If these tests arc 
carefully applied, as minute a quantity as 1 part in 900,000 of the solution may be detected 
(Wenzell). A similar blue-violet reaction is produced when a mixture of Hydrastine 1 and 
Morphine 9 is acted on by Sulphuric Acid and Potassium Bichromate, or by Sulphuric Acid 
alone (Lloyd) ; but the occurrence of the reaction with the acid alone serves to distinguish the 
mixed alkaloids from Strychnine, which dissolves in sulphuric acid without producing any color. 
[Brucine is detected by the red color which it yields with Nitric Acid. Neither Nitric nor 
Sulphuric Acid colors Strychnine unless Brucine is present as an impurity, a test which dis- 
tinguishes this alkaloid from several others. Brucine does not decompose Iodic Acid, and is 
thereby distinguished from Morphine. 

Physiological Action. 

The action of Nux Vomica is that of its principal alkaloid Strychnine. Ex- 
ternally, the latter is a very powerful antiseptic, but is too poisonous for safe 
use, and in concentrated solution hypodermically it has a decided irritant action 
on the tissues. Internally in small doses its bitter quality makes it a good stom- 
achic tonic. Increasing the vascularity of the gastric mucous membrane and 
promoting the secretion of gastric juice, also the pancreatic and biliary secre- 
tions, it aids digestion and sharpens the appetite, but like all other bitter tonics 
it deranges digestion when used excessively or for a long time. It stimulates 
the muscular coat of the intestines increasing peristalsis and thus acts as a pur- 
gative, but it restrains the fecal discharges when their frequency is due to atony 
of the bowel. It stimulates the motor nerve-cells of the spinal cord, the car- 
diac motor ganglia, the respiratory and vaso-motor centres in the medulla, 
contracting the arterioles all over the body (though by full doses they are re- 
laxed), also the excitability of the sensory nerves and their terminal elements. 
The result is that respiration is deepened and quickened, the action of the heart 
is increased and the blood-pressure raised, the field of vision is enlarged, the 
sight and hearing are sharpened, and the sense of touch is rendered more acute, 
but the cerebral convolutions are not affected. Excreted chiefly by the kidneys, 
it causes increased frequency of urination, and when taken in excess produces 
spasm of the neck of the bladder. It probably excites some degree of uterine 
contraction, but undoubtedly promotes menstruation, disposes to sexuality, and 
provokes erections of the penis. 

The most marked feature of the action of Strychnine is the great increase 
which it causes in the reflex excitability of the spinal cord and other reflex cen- 



NUX VOMIC \. 351 

tres, such as the vaso-motor and respiratory centres in the medulla. When 
the dose is large this increase is so great as to induce convulsions and cause 
death by asphyxia. After a large dose (gr. ,'._,) the pupils dilate, the Limbs 
take on jerking movements, respiration becomes spasmodic and the lower jaw 
stiff, a sensation of cerebral tension may be felt, and sudden shuddering and 
anxiety follow, the face taking on an unmeaning smile, the risus sardoniciis. 
A toxic dose (gr. £ to gr. ij) produces powerful and characteristic convulsions 
of a tetanic character. Within an hour after its administration, sometimes after 
only a few minutes, the patient feels a sudden sense of suffocation and dyspnea, 
the muscles begin to shudder and jerk, the limbs are suddenly stretched out 
rigidly, with hands clenched and feet arched, then the head is bent backward 
and the whole body becomes stiffly arched resting on the head and the heels, 
the belly tense, the chest muscles fixed and the breathing all but arrested. In 
the height of the paroxysm the face is dusky and congested and the eyeballs 
project. Nearly all the muscles of the body are affected, but those of the jaw 
are not seriously implicated until near the end, and never so powerfully as in 
tetanus. The pulse is very rapid and the body-temperature is above normal, 
but the intellect remains unclouded and the patient often expresses a sense of 
impending dissolution. After the paroxysm has lasted a minute or two it usu- 
ally relaxes for a time. In the interval the patient suffers from soreness of the 
muscles, feels exhausted and sweats profusely, but soon becomes aware that 
the spasm is returning and may cry out for some one to hold him or to rub his 
limbs. The convulsions rapidly increase in severity, a breath of wind, the 
slightest noise, even a bright light, being sufficient to bring them on, and in 
one the patient may jerk himself out of the bed. At last the respiration stops 
in the middle of a fit and the heart soon ceases to beat. Death occurs, after 
two or three hours at most, by asphyxia from tetanic fixation of the muscles 
of respiration, with possible factors in spasm or exhaustion of the heart, con- 
sciousness being preserved until carbon dioxide narcosis sets in. 

Strychnine exalts all the functions of the spinal cord, reflex, motor, vaso- 
motor, and sensory, the latter being the least affected. It has selective action 
on the large multipolar ganglia in the anterior columns, which it first stimu- 
lates and finally paralyzes by over-stimulation, in this respect illustrating the 
rule that small and large doses of an active agent act antagonistically to each 
other. A massive dose seems to destroy the spinal and medullary functions 
as by a single blow. The spasms of Strychnine may be distinguished from those 
of tetanus by their intermittency (the latter being constant), by the meaning- 
less smile, the less marked trismus, the absence of a wound, and the rapid course 
of the symptoms. Thebaine, the tetanizing alkaloid of opium, is also a spinal 
exaltant,"and acts much the same as strychnine. 

Strychnine does not directly affect the muscular tissue, the motor nerve- 
trunks or nerve-endings, or the cerebral convolutions. Occasionally, how- 
ever, large medicinal doses cause a greatly heightened sensibility of the optic 



352 - NUX VOMICA. 

and auditory nerves, so that brilliant lights and loud sounds produce painful 
impressions; and in a few cases there occurs a true cerebral intoxication re- 
sembling a slight degree of drunkenness. It probably affects all the nervous 
centres in some degree, the sensory, however, much less than the motor and 
vaso-motor ones. It is to some extent oxidized and destroyed in the body, 
the remainder being eliminated by the urinary, salivary and cutaneous chan- 
nels. As it contracts the renal arteries, it hinders its own excretion by the kid- 
neys, and being rapidly absorbed it may accumulate in the system if even a 
small dose is frequently and continuously administered. It is much more poison- 
ous when injected into the rectum than when swallowed. 

The fatal dose of Strychnine is placed by Taylor at gr. \ to gr. ij for an 
adult, but recovery has taken place after larger doses, even 7 and 8 grains, cases 
probably of imperfect absorption, due perhaps to the presence of fat or tannin 
in the contents of the stomach. A child, aged 2^ years, died in four hours from 
a dose of gr. T ^. After death from this poison cadaveric rigidity is marked, with 
opisthotonos, clenched hands, and arms flexed across the chest. The mus- 
cular rigidity may persist for several months after death. The face is usually 
pale, but sometimes livid, the internal organs are gorged with dark blood, and 
the bladder is generally contracted. 

On other animals Strychnine acts as it does upon man, but in different de- 
grees. Birds, guinea-pigs and perhaps monkeys, are comparatively insuscep- 
tible to it, while ruminants are less easily affected than other quadrupeds, and 
cats resist it singularly. Very minute portions in the soil will destroy the life 
of growing plants. 

Therapeutics. 
Nux Vomica and its chief alkaloid, Strychnine, are exceedingly useful rem- 
edies, having a wide range of therapeutic efficacy. They are chiefly employed 
as stomachic tonics, and as stimulants to the heart, the respiratory apparatus, 
and the muscular and nervous systems. As the quantity of strychnine in nux 
vomica varies greatly, it is best to use the alkaloid when its physiological action 
is desired, more definite dosage being thus obtained. The tincture in 5-drop 
doses is excellent in atonic dyspepsia and gastric catarrh, especially in drunk- 
ards, and in constipation from atony of the bowels it may be given in 10-drop 
doses with good results, not as a purgative but to increase peristalsis. The 
extract is much used in laxative pills for habitual constipation. In the vomit- 
ing of pregnancy the tincture is frequently an efficient remedy, and in the 
vomiting of phthisis Strychnine is one of the very best agents. In the con- 
dition clinically known as that of torpid liver, where the stools are of pale 
color and very offensive odor, showing absence of bile therein, the tongue 
coated with a thick, perhaps yellowish fur, and the patient complaining of 
headache, lassitude, anorexia, and a bad taste in the mouth, small doses of 
Strychnine (gr. ■£$) twice or thrice daily will frequently act as well as a mer- 
curial, restoring the bile to the stools, and correcting the other symptoms. 



m\ VOMICA. 353 

Epidemic diarrhea and dysentery are often controlled by Strychnine, and 
in anemia and chlorosis it is an invaluable remedy, especially when com- 
bined with iron and quinine. In intermittents, as an adjunct to quinine 
it is always useful, and in neuralgia, especially of the viscera, and infraorbital 
and other forms accompanying anemia and general debility, it is highly effi- 
cient, but in these affections very small doses (gr. T ^ 7 ) should be employed. 

Headaches are often controlled by Nux Vomica, especially the sick head- 
ache of gastric origin, in which minim-doses of the tincture every ten or fif- 
teen minutes frequently give marked relief, and a dose of n^x before each 
meal will prevent frontal headache in many persons liable thereto. A sense 
of heat and weight on top of the head, accompanied or not by flatulence, 
and usually occurring in women at the climacteric, will often yield to the 
tincture in doses of n\,v before each meal. Its undoubted influence on the 
pneumogastric makes it a valuable remedy for many kinds of cough, even 
those of phthisis, bronchitis, pneumonia and emphysema, but it is particularly 
efficient in coughs of neurotic origin, such as periodical cough, night cough, 
and the paroxysmal laryngeal cough without lung or bronchial symptoms, 
but characterized by a persistent tickling sensation in the throat. In all 
these drop-doses of the tincture frequently repeated are more serviceable 
than larger doses at longer intervals. In bronchial asthma and asthma of 
neurotic origin, in the dyspnea of pulmonary affections and that with cardiac 
palpitation in hysterical subjects, in irregular action and over-action of the 
heart, in functional anesthesia, hypochondriasis, abdominal cramps, nervous 
movements accompanying pregnancy, cold hands and feet due to languid 
capillary circulation, prolapsus ani and urinary incontinence in children, 
and paralysis of the bladder in old people, small doses of Strychnine frequently 
repeated are remarkably beneficial. In many of these affections the ther- 
apeutic action of the drug is unmistakably that of an antispasmodic, illustrat- 
ing the opposite effects of large and small doses of an active agent, a thor- 
oughly established fact in many cases, though not a universal rule. 

Nux Vomica is a most efficient remedy in impending cardiac failure from 
almost any cause. Even with the pulse imperceptible, the extremities cold, 
and death apparently imminent, the administration of a drop of the tincture 
every five minutes has frequently given renewed strength to the cardiac con- 
tractions after five or six doses, and initiated an improvement which resulted 
in eventual recovery. Local paralyses of various forms are well treated by 
the hypodermic injection of Strychnine into the substance of the affected 
muscles, and diphtheritic paralyses are almost invariably cured by its internal 
administration. It may prove useful in hemiplegia when degeneration has 
not set in, and when the paralyzed muscles are completely relaxed; but it 
is of no avail in recent cases or when electrical contractility is lost. If used 
early in cerebral paralyses, especially when due to hemorrhage, it may do 
serious harm; and in the early stage of organic spinal lesions it may be de- 
24 



354 NUX VOMICA. 

cidedly injurious, particularly if given in large doses. It should never be 
used in spinal paralysis when there are symptoms of congestion or inflam- 
mation of either the cord or its membranes. In hysterical paralysis and that 
caused by lead it is decidedly beneficial, also in the form which is limited 
to one or two groups of muscles, especially infantile paralysis of long stand- 
ing, even when the atrophic process has gone so far as to greatly impair the 
electrical sensibility. In multiple peripheral neuritis the hypodermic injec- 
tion of strychnine has proved eminently serviceable. 

Strychnine is very useful in cases of nervous impairment of the sight, 
especially in amblyopia from lead, tobacco or alcohol, from atrophy of the 
optic nerve, and from functional • disorders of the retina without apparent 
lesion, also in muscular asthenopia. In these affections it may be used in- 
ternally, but it is usually administered by injection into the tissues around the 
temple, beginning with gr. -£$, and gradually increasing the dose up to gr. | 
or $. Improvement may not be apparent until the larger doses are reached. 

In acute and chronic alcoholism, Strychnine is undoubtedly of great 
service. In small doses it is an effective remedy for the morning vomiting 
and dyspepsia of drunkards, for the tremor of chronic dipsomaniacs, in the 
forming stage of delirium tremens, and for the depression due to enforced 
abstinence from alcohol. The nitrate, in doses of gr. ^ to y\, hypodermi- 
cally three or four times daily for a week, and less frequently for two weeks 
longer, removes the craving for stimulants, counteracts the vaso-motor pa- 
ralysis to which most of the injurious effects of alcohol are due, and is prob- 
ably in other respects a true antagonist to the action of that narcotic poison 
on the human organism. The published reports of its efficacy in dipso- 
mania, by Luton, Dujardin-Beaumetz, Portugaloff and others, have been 
fully confirmed by other observers, so that Strychnine is now the acknowl- 
edged remedy for inebriety, and the efficient constituent of the numerous 
"cures" therefor so widely advertised in the religious and secular press. 

Strychnine is a physiological antagonist to chloral, physostigmine and 
morphine, and may be used as a respiratory stimulant in poisoning by these 
drugs, also in narcotic poisoning by any agent when the respiration is fail- 
ing. It has been employed in Australia as an antagonist to serpent venom 
with great success in the hands of Mueller and others, and with doubtful 
efficacy in the experience of many observers. From the results of experi- 
ments made by Dr. Elliot, of the Indian army, it would seem that its use in 
poisoning by cobra venom is of no service whatever and may actually hasten 
death. 

Strychnine Arsenite possesses strong antiperiodic power, and may prove 
an efficient remedy for any intermittent disease which proves rebellious to 
the influence of quinine. As it is a highly toxic agent, the minimum dose 
(gr. j-jj-g) should not be exceeded at its first administration, and its effects 
should be watched after repetition of the dose. 



01 1\ i 0] i'i \i. 355 

Brucine acts precisely as strychnine, excepl that it is absorbed more slowly, 
is much less powerful as a convulsant, and is more poisonous to the sensory 

nerves (Reichert). If pure it is a powerful local anesthetic in 5 to 10 per 
cent, solutions on mucous membranes, and in a 20 per cent, solution on the 
skin. In the latter strength its solutions have been employed with satisfac- 
tion for chronic pruritus, and in a weaker solution (5 per cent.) for the local 
pruritus of inflammation about the external ear, in which Dr. Burnett claims 
for it more satisfactory results than are obtained with cocaine. 

OLIViE OLEUM, Olive Oil, (Siveet Oil, Salad Oil),— is a fixed oil 
expressed from the ripe fruit of Oka europaa, the olive tree, nat. ord. Oleaceae, 
which is cultivated in southern Europe, California and Australia. It is a 
pale-yellow or greenish-yellow oily liquid, of nutty, oleaginous taste and 
neutral reaction, sparingly soluble in alcohol but readily soluble in ether. 
Dose, 5ss-jss [a v. §j.] 

Olive Oil consists in the main of the combined glycerides of oleic, palmitic and arachic acids. 
It is frequently adulterated \vith cheaper fixed oils, especially poppy oil, lard oil, and cotton-seed 
oil, quantities of the latter being exported every year to Italy, whence it is returned to us as 
Olive Oil under a French label. (See Gossypium.) It is an ingredient of Unguentum Di- 
achylon, and is the source of the official Soap. 

Physiological Action and Therapeutics. 

Externally used Olive Oil is a good protective from the air, and renders 
the skin soft and flexible. If rubbed into the integument it is absorbed by 
the lymphatics and is directly nutritive in effect. Internally it is nutritious 
and mildly laxative, and in quantity acts as a protective to the mucous mem- 
brane against acrid or poisonous substances. Like other oils it is partly 
emulsified, partly saponified in the intestines, its glycerin being set free and 
its fatty acids combining with the free alkalies to form soap, which with 
the emulsion forms the molecular basis of the chyle, entering the blood 
through the lacteals and being finally oxidized into carbon dioxide and water, 
though an excess will appear unchanged in the urine. Oils are therefore 
a food within certain limits, increase the fat of the tissues, furnish heat and 
force, and lessen the waste of nitrogenous tissue, but are unable of them- 
selves to support life. 

Olive Oil possesses some very marked therapeutic powers over any other 
bland oil or fat. It is a good laxative for infants administered internally, 
and may be used as an enema followed by warm water. There is much 
clinical evidence to prove that administered internally it is a very efficient 
remedy in both nephritic and biliary colic, due to its setting free glycerin, 
which being absorbed reaches the liver and stimulates the production of a 
watery bile, which is solvent to the cholesterin of gall-stones. In large doses 
it has proved very efficient in the treatment of severe dysentery. It is much 
employed locally. Applied to burns and other acute inflammatory affections 
of the skin it is an excellent protective, coating the surface and excluding 



356 opium. 

the air; and as an ingredient of liniments it acts as a diluent for more active 
agents. It is used to facilitate friction over enlarged or stiff joints, and in 
the desquamative stage of scarlet fever is a very useful and grateful appli- 
cation. As an antidote in corrosive poisoning it acts mechanically by pro- 
tecting the mucous membrane of the stomach and preventing absorption. 
In pharmacy its bland, unirritating qualities have procured its common em- 
ployment as an ingredient of liniments, plasters, ointments and cerates, but 
the foreign article is so frequently adulterated with inferior oils that Cotton- 
seed Oil is now directed in its place in many official preparations. 

OPIUM, — is the concrete, milky exudation, obtained by incising the 
unripe capsules of the White Poppy, Papaver somniferum, an annual herb 
of the nat. ord. Papaveraceae, indigenous to Western Asia, but cultivated 
extensively elsewhere. Its capsules are globular, two or three inches in 
diameter, and are crowned by a sessile, stellate stigma, which distinguishes 
them from Colocynth and Bael fruits. Opium occurs in irregular lumps 
or cakes, of dark-brown color, sharp, narcotic odor, and bitter taste; and 
in its normal, moist condition should yield not less than 9 per cent, of Mor- 
phine when assayed by the official process. Dose, gr. ss-iij [av. gr. jss.] 

Opium contains 20 alkaloids in combination with meconic, lactic and sulphuric acids; the 
neutral principles Meconin and Meconoiasin; also glucose, mucilage, resin, pectin, caoutchouc, 
fats, essential oil, odorous substances, salts of ammonium, magnesium and calcium, and 
water. Its principal alkaloids are the following six, viz. — 

Morphine, C 17 H 19 N0 3 , 2 \ to 20 per cent., — the principal alkaloid, occurring in the drug 
in the form of the tribasic meconate. Its properties are anodyne, hypnotic and narcotic. 
From it by a process of dehydration by heat and hydrochloric acid is prepared the artificial 
alkaloid Apomorphine, a powerful emetic and expectorant. 

Codeine, C ls H 2 iN0 3 , 0.3 to 0.5 per cent., — is calmative and when pure a not very active 
alkaloid, but is frequently contaminated with other alkaloids. Apomorphine may be pre- 
pared from it. 

Narceine, C 22 H 29 N0 9 , 0.2 to 0.7 per cent., — was said by Bernard to be a powerful nar- 
cotic, but the preparation used by him was probably impure, and it is now believed to 
have little or no action. 

Narcotine, C 22 H 23 NO r , 2 to 10 per cent., — is antiperiodic and a tetanizer, but wholly 
devoid of narcotic properties. 

Thebaine, or Paramorphine, C 19 H 21 N0 3 , 0.2 to 1 per cent., — is a powerful spinal exaltant 
and tetanizer, resembling Strychnine in its action. 

Papaverine, C 20 H 21 NO 4 , 1 per cent., — stands midway between morphine and codeine in 
its action on the central nervous system, but is a comparatively weak poison. 

Other Alkaloids are — Codamine, Cryptomine, Gnoscopine, Hydrocotarnine, Lantho- 
pine, Laudanine, Laudanosine, Meconidine, Oxynarcotine, Papaveramine, Protopine, 
Pseudomorphine, Rhceadine, and Tritopine. Many of them occur only in traces, and some 
are regarded as probable derivatives of morphine. Porphyroxin is said to be a complex com- 
bination of several of the alkaloids, and not a proximate principle. 

Official Preparations o} Opium. 

Opii Pulvis, Powdered Opium, — is Opium dried at a temperature not exceeding 185 F., 
and reduced to a very fine powder. It should contain not less than 12 nor more than i2§ 
per cent, of crystallized Morphine, when assayed by the official process. Dose, gr. ss-iij 
[av. gr. j.] 

Opium Granulatum, Granulated Opium, — is Opium dried and reduced to a coarse 
powder. It should yield from 12 to 12 J per cent, of Morphine. Dose, gr. ss-iij [a v. gr. j.] 



OPIUM. 357 

Opium Deodoratum, Deodorised Opium, (Denarcotieed Opium) — is powdered Opium 
freed from the constituents which are soluble in Petroleum Benzin, namely, Narcotine and the 
odorous principles, which are supposed, to cause the unpleasant after-effects of the drug. It 
should yield i -• to \:\ per rent, of Morphine, and is a good preparation, being a purified 
opium with a fixed morphine standard. The proprietary article named Svapnia is a similar 
preparation. Dose, gr. ss-iij [av. gr. j.] 

Extractum Opii, Extract of Opium, — an aqueous extract containing 20 per cent, of 
Morphine, and freed from principles insoluble in water. Dose, gr. J— ij [av. gr. ss.] 

Pilulae Opii, Pills of Opium, — each pill contains about gr. j of powdered Opium incor- 
porated with Soap. Dose, j-iij pills [av. j.] 

Tinctura Opii, Tincture of Opium, Laudanum, — Opium-strength 10 per cent, or 48 
grains to the flo- Morphine-strength about 6 grains (equal to 7^ grains of morphine sulphate) 
to the flo- Ten minims equal 1 grain of Opium or J- grain of Morphne. Sixty minims 
equal on the average about 120 drops. Dose, njv-xxx [av. njrviij], according to the effect 
d.esired. 

Tinctura Opii Deodorati, Tincture of Deodorized Opium, — an aqueous extract is pre- 
pared and shaken with Benzin, which being separated the residue is dissolved in water, and 
enough alcohol is added to preserve it. An excellent liquid preparation, being freed from all 
the noxious and useless ingredients soluble in alcohol and ether. Opium-strength 10 per 
cent., average Morphine-strength gr. vj to the flo. Dose, as of Tinctura Opii. Drops of 
this preparation nearly equal minims. McMunn's Elixir is a similar preparation, so also is 
another proprietary nostrum named Papine. 

Vinum Opii, Wine of Opium, {Sydenham' s Laudanum), — Opium-strength 10 per cent., 
with the aromatics Cinnamon and Cloves of each 1 per cent., in Alcohol and White Wine. A 
vinous tincture decreased somewhat in strength from the wine of 1870. Dose, as of Tinctura 
Opii. Drops of this preparation are larger than those of the tincture. 

Acetum Opii, Vinegar of Opium, {Black Drop) — Opium-strength 10 per cent., with 
Xutmeg and Sugar in Dilute Acetic Acid. Is now \ weaker than formerly, having the same 
strength and dose as Tinctura Opii. 

Tinctura Opii Camphorata, Camphorated Tincture of Opium, Paregoric, — has of 
Powdered Opium 4, Benzoic Acid 4, Camphor 4, Oil of Anise 4, Glycerin 40, Diluted Alcohol 
to 1000. oss contains nearly one grain of powdered Opium. It is about ^ of the strength of 
Laudanum. Dose, for an infant gtt. v-xx, for an adult oj-iv [av. 5ij-] Is an ingredient 
of Mistura Glycyrrhizas Composita. 

Emplastrum Opii, Opium Plaster, — contains of Extract of Opium 6 parts, Adhesive 
Plaster to 100. 

Pulvis Ipecacuanhae et Opii, Powder of Ipecac and Opium, {Dover's Powder) — has of 
Ipecac io, Powdered Opium 10, Sugar of Milk 80, rubbed together into a very fine powder. 
Dose, gr. v-xv [av. gr. vijss]. 

Tinctura Ipecacuanhae et Opii, Tincture of Ipecac and Opium, — has of Tincture of 
Deodorized Opium 100 evaporated to 80, Fluidextract of Ipecac 10, Diluted Alcohol to 
100. Is intended to represent Dover's Powder in liquid form. Dose, njy-xv [av. Tnjviij.] 

Trochisci Glycyrrhizse et Opii, Troches of Glycyrrhiza and Opium — each troche con- 
tains of powdered Opium gr. T V, with Extract of Glycyrrhiza, Acacia, Sugar and Oil of Anise. 
Dose, j-iv troches. 

Official Preparations of Morphine. 

Morphina, Morphine, C I7 H 19 N0 3 +H 2 0, — white, prismatic crystals, or fine needles, or a 
crystalline powder, odorless, of bitter taste and alkaline reaction, almost insoluble in water. 
Its comparative insolubility makes the salts preferable for use, and as a very small propor- 
tion of acid neutralizes it, the dosage is about the same for the alkaloid and its salts, viz., gr. 
H [av. gr. I.] 

Morphinae Acetas, Morphine Acetate, — a white, crystalline or amorphous powder of 
faintly acetous odor, bitter taste, neutral or faintly alkaline reaction, soluble when fresh in 2 J 
of water at 59° F. Dose, gr. \-\ [av. gr. -}.] 

Morphinae Hydrochloridum, Morphine Hydrochloride, — white, feathery crystals of 
silky lustre, of bitter taste and neutral reaction, soluble in 24 of water and in 62 of alcohol at 
S9°'F. Dose, gr. \-\ [av. gr. }]. 

Morphinae Sulphas, Morphine Sulphate, — white, feathery, acicular crystals of silky 
lustre, of bitter taste and neutral reaction, soluble in 21 of water and in 702 of alcohol at 
59 F., and in 0.75 of boiling water. Contains about 80 per cent, of morphine. Dose, gr. 



358 OPIUM. 

l~h t av - g r - l]i g r - i is a small dose for an adult, gr. J a moderate one, gr. J a full dose, and 
gr. h a large dose, admissible only under exceptional circumstances. 

Pulvis Morphinae Compositus, Compound Powder oj Morphine, {Tally's Powder) 
■ — has of Morphine Sulphate ii part to Camphor 32, Licorice 33 and Calcium Carbonate 33$. 
A similar preparation to Dover's powder minus the Ipecac. Dose, gr. v-xv [av. gr. vijss] ten 
grains containing gr. J of Morphine Sulphate. 

Injectio Morphinae Hypodermica, Hypodermic Injection oj Morphine (B. P.), — is a 
solution of the Tartrate, containing gr. j in njxxij. Dose, by hypodermic injection, njij-v. 

Tinctura Chloroformi et Morphinae Composita, Compound Tincture oj Chloroform 
and Morphine (B. P.), — a substitute for Chlorodyne (see page 220). Dose, nj}v-xx. 

Unofficial Preparations oj Opium and Morphine. 

Tinctura Opii Composita, Compound Tincture oj Opium, Squibb's Diarrhea Mixture, — 
has of Tinct. Opii, Spt. Camphoras and Tinct. Capsici oj of each, Purified Chloroform 3iij, 
Stronger Alcohol q. s. ad §v. Each fl5 or teaspoonful contains about 100 drops or njixij 
of each of the first three ingredients and TTjjivss or 18 drops of Chloroform. Dose, for in- 
fants gtt. j-x, for children gtt. x-xxx, for adults 3ss-j. 

Liquor Morphinae Sulphatis, Solution oj Morphine Sulphate, Magendie's Solution, — 
has gr. xvj of Morphine Sulphate in each fio, or gr. j in njxxx, or gr. \ in njjvijss. If con- 
taining Benzoic Acid, the solution will not spoil, and is not irritant hypodermically. The 
same result is attained by adding Phenol, ltjiij to the §. 

Oleatum Morphinae, Oleate oj Morphine, — Morphine-strength 10 per cent, with Oleic 
Acid 90. For local use. 

Liquor Opii Sedativus, Sedative Solution oj Opium, Battley's Sedative, — is about 50 
per cent, stronger than Tinct. Opii. It was formerly a favorite preparation. 

Dalby's Carminative, — contains Opium, about gr. £ to the ounce, also Oil of Pepper- 
mint, Nutmeg, Anise, and Magnesium Carbonate. 

Godfrey's Cordial, — contains Laudanum, Sassafras and Treacle, its opium strength 
being gr. J to the ounce. 

Nepenthe, — is a purified alcoholic solution of Morphine Meconate in sherry wine. 

Chlorodyne, — (see page 220). contains Morphine in varying proportions, that of 
J. Collis Browne having gr. vj to the ounce. 

Mrs. Winslow's Soothing Syrup, — contains Morphine, with Essence of Anise and 
Syrup of Tolu. After years of persistent denial, its proprietors have admitted that it contains 
J grain of Morphine in each fiuidounce (Squibb). 

Derivatives oj Morphine. 

Apomorphinae Hydrochloridum, Apomorphine Hydrochloride, C 17 H 17 N0 2 HC1, — is the 
hydrochloride of the artificial alkaloid Apomorphine, which is prepared from morphine 
or codeine by the action of strong acids or zinc chloride, the morphine losing in the process 
a molecule of water. The salt occurs in minute, colorless crystals, odorless, of bitter taste, and 
neutral or faintly acid reaction; soluble in about 45 of water and in the same quantity of 
alcohol at 50° F., almost insoluble in ether or chloroform; decomposed by boiling water or 
boiling alcohol. Dose, as an expectorant gr. - £ 6 £ 6 [av. gr. ^]; as an emetic gr. jy-$ [av. 
gr. yV] For young children, gr. ^5 should not be exceeded. Solutions should be fresh 
when used, and as they alter rapidly by keeping should have a few drops of hydrochloric acid 
added to them, to prevent dcomposition. 

Injectio Apomorphinae Hypodermica, Hypodermic Injection oj Apomorphine (B. P.)> 
— has of Apomorphine Hydrochloride gr. j, Diluted Hydrochloric Acid iijrj, Distilled Water 
to Tt£cx; and is a 1 per cent, solution. Dose, hypodermically, tijv-x. Should be recently pre- 
pared. 

Cotarnine, C 11 H 12 N0 3 (O.CH 3 ), — is a base produced from Narcotine by oxidation. The 
Hydrochloride (unofficial) has the trade name Styplicin, and occurs as a yellow powder, sol- 
uble in water and in alcohol. Dose, gr. j-v by the mouth or hypodermically, 4 or 5 times 
daily, as a uterine hemostatic and sedative. 

Dionin (Unofficial), — the hydrochloride of the mono-ethyl ester oj morphine, occurs as a 
white powder, soluble in 7 of water and in 2 of alcohol. It possesses the analgesic and nar- 
cotic properties of morphine but without its intensity, is probably the most innocuous of the 
morphine derivatives, and may be used in children. It does not seem to give rise to any 
habit when its administration is prolonged, and hence has been recommended in morphinism. 



OPIUM. 359 

It is used by ophthalmologists as .1 local analgesic in .) to 7 per cent, solution, and ba 1 been 
employed with satisfaction in whooping-cough and other coughs, dysmenorrhea, and cardiac 
affections. Dose, gr. J-i; for children gr. , | ,, to gr. ,'., according to age. 

Heroin, (Unofficial),— is diacetyt-morphine, and occurs as a fine, white powder, insol- 
uble in water, but soluble in dilute acids. It is one of the most toxic agents of the morphine 
group, and is considered even more poisonous than morphine itself, having a bad influence 
on the respiratory apparatus. Doses of gr. ,'.. have caused suppression of urine and threaten- 
ing coma (Cohen). It has been extensively vised in cough and dyspnea, asthma, neuralgic 
affections, pertussis, and morphinism, and is an ingredient of many trade preparations widely 
advertised as cough syrups and remedies for asthma. Dose, gr. 2 ' T -J in pill or powder, or in 
aqueous solution with a few drops of diluted acetic acid. 

Peronin, Benzyl-morphine, (Unofficial), — is the hydrochloride of the benzyl ether of 
morphine, and occurs as a white powder, soluble in water, insoluble in alcohol, chloroform 
or ether. It produces sound sleep without previous excitement, and has been useful in allay- 
ing cough, also in relieving rheumatic and neuralgic pains. It is almost free from the by- 
effects of morphine. Dose, gr. J— j in pill or in aqueous solution. 

Other Alkaloids and their Preparations. 

Codeina, Codeine, C ls H ;i N0 3 -fH 2 0, — white or yellowish-white, rhombic prisms, efflo- 
rescent in warm air, of bitter taste and alkaline reaction, soluble in 80 of water and in 17 of 
boiling water, very soluble in alcohol, chloroform and ether. Dose, gr. J— j [av. gr. ss.] but gr. 
£ has caused alarming symptoms in children. Much of the so-called codeine in the market 
consists largely of morphine. 

Codeinae Phosphas, Codeine Phosphate, — white crystals of slightly bitter taste, soluble 
in 2} of water and in 261 of alcohol. Is the most soluble salt of codeine and comparatively 
unirritant, hence it is well suited for hypodermic use in solution of 1 part in 20 of water. Dose, 
gr. }-j [av. gr. ss.] 

Codeinae Sulphas, Codeine Sulphate, — a crystalline powder, soluble in about 30 of 
water, and in 6} of hot water. Dose, gr. J— j [av. gr. ss.] 

Syrupus Codeinae, Syrup 0/ Codeine, (Unofficial), — has of Codeine Phosphate gr. xxxij, 
dissolved in Distilled Water 3ijss, adding Syrup to §xvj. Of this oj contains gr. \ of Co- 
deine Phosphate. Dose, oj-iv. 

Narcotinae Hydrochloras, Narcotine Hydrochlorate, (Unofficial), — Dose, gr. ij-x, as an 
antiperiodic. 

Incompatibles. 

Incompatible with Opium preparations are Alkalies, Alkaloidal precipitants (see page 
500), Carbonates, Catechu, Cinchona, Copper salts, Galls, Iron salts, Kino, Lead Acetate and 
Subacetate, Lime-water, Mercuric Choride, Silver Nitrate, Zinc Sulphate. With Morphine 
Salts are Alkaloidal precipitants (see page 500), Borax, Chlorates, Ferric Chloride, Iodates, 
Iodides, Iodine, Lead Acetate and Subacetate, Magnesia, Spirit of Nitrous Ether, Silver 
Nitrate. With Apomorphine Hydrochloride are Alkali Hydrates and Carbonates, and other 
alkaloidal precipitants (see page 500), Ferric Chloride, Iodides, Lime-water, Permanganates, 
Picric Acid, Tannic Acid, Silver Nitrate. With Codeine are Alkalies and other alkaloidal 
reagents (see page 600), Ichthyol, Salts of Copper, Iron and Lead. Physiological Incompat- 
ibles are Atropine, Caffeine, Chloral Hydrate (with apomorphine and codeine), Chloroform, 
Cocaine, Gelsemium, Hyoscyamine, Nicotine, Paraldehyde, Physostigmine, Picrotoxin, 
Strychnine (with apomorphine), Veratrum Viride. 

Tests for Morphine. 
1 

Nitric Acid produces an orange-red color, turning yellow, then disappearing. Test- 
solution of Ferric Chloride gives a blue color changing to green with excess of the reagent, 
and destroyed by free acids or alcohol, but not by alkalies. Iodic A cid liberates Iodine which 
may be tested by starch. Vaughn has shown that certain intestinal ptomaines will give the 
same reactions with these reagents. 

Physiological Action. 
Opium is analgesic, hypnotic, antispasmodic, diaphoretic and narcotic. 
It first stimulates and afterwards depresses the cerebrum, heart and respir- 



360 OPIUM. 

atorv apparatus, and is classed among the cerebral depressants, though it 
kills by paralyzing the respiratory centres in the medulla. 

In medium dose (gr. j) it diminishes all the secretions except the milk 
and the sweat, the latter being increased; producing dryness of the 'mouth 
and throat, retarded digestion from decrease of the gastric juice, and decided 
loss of appetite. The action of the heart is increased, arterial tension is 
raised and the pupils are slightly contracted. The cerebral faculties are 
stimulated to a pleasant activity by increased blood-supply, ideas follow 
each other rapidly through the mind, and an exhilaration bordering on mild 
intoxication is experienced, succeeded by a calm of variable length. Sleep 
generally follows, disturbed by dreams, and after waking, headache, malaise, 
constipation, digestive disturbance and some depression result. The con- 
ductivity of the nerves is not affected. Frequently the stage of mental activ- 
ity is absent, but in persons habituated to the use of opium it is usually well 
marked. In some subjects a lengthened period of calm repose takes the 
place of sleep, in others neither calm nor sleep occurs, but the stimulant ac- 
tion of the drug prevails, the spinal functions as well as the cerebral are ex- 
alted, and great restlessness results. 

In full dose (gr. iij) the same symptoms are produced but in greater in- 
tensity; the stage of stimulation is much shorter, digestion is arrested, nausea 
and vomiting produced, also profuse diaphoresis. The conductivity of the 
nerves is more or less impaired, the respiration, heart and circulation are 
depressed, oxidation being interfered with and the body-temperature low- 
ered. The pupils are contracted by stimulation of the motor oculi through 
the basal ganglia, intense pruritus is produced, especially at the nose, and 
often spasmodic retention of the urine. Profound sopor soon comes on, 
with irregular and slow respiration, but in some subjects this is replaced by 
coma-vigil and delirium. After-effects are nausea, depression, constipation, 
racking headache, vertigo, anorexia, nasal pruritus, and fetid pathological 
secretions. 

A toxic dose produces cold and clammy sweat, very slow pulse, slow and 
stertorous respiration gradually becoming feeble and irregular, cyanosed 
face, abolished reflexes, coma gradually deepening, the pupils minutely con- 
tracted but dilating as the end approaches, and finally death by paralysis 
of the respiratory centre. Postmortem examination shows only a wet brain, 
congested lungs, and engorgement of the venous trunks and of the right 
heart. 

The coma produced by opium-narcosis, when deep and when a history of the case cannot 
be obtained, is almost impossible of differential diagnosis from that due to alcohol, apo- 
plexy, uremia, epilepsy, etc. [See under Alcohol, page no.] The odor of the breath may 
point to laudanum or some other preparation of opium. The pupils are very much con- 
tracted in opium poisoning (also from physostigma and chloroform), but they may dilate 
just before death (as with chloroform), due to the irritation of the centres by the excessive 
venous condition of the blood. In alcoholic coma they may be either contracted or dilated; 
and in apoplexy they are generally contracted unequally, though in apoplexy of the pons varolii 
they may be equally and minutely contracted. The rectal temperature may be an important 



OPIUM. 361 

sign, for in most cases of apoplexy there is an initial fall of temperature with a subsequent rise. 
A previous history of convulsions points to epilepsy, and the presence of albumin in the urine, 
with sometimes edema of the legs, indicates uremia as the cause of the coma. 

The principal action of Opium is exerted upon the nervous system, first 
affecting the cerebral convolutions, which are briefly stimulated and soon 
depressed. Next the perceptive and sensory centres in the higher brain are 
blunted, and the conductivity of the afferent nerves is impaired. Soon the 
ganglia at the base of the brain are involved, evinced by the contraction of 
the pupils, vomiting, and slowing of respiration; the cardiac, vascular and 
other centres are depressed, but to a less degree than the respiratory and 
perceptive. The gray matter of the cord, at first stimulated, as shown by 
the increase of reflex excitability, is also depressed, and locomotion becomes 
difficult, the motor nerves being paralyzed from the centre outward, but 
muscular irritability is never lost. Death occurs generally by paralysis of 
respiration, rarely by cardiac failure. 

Metabolism is greatly reduced in activity by Opium, the quantity of urea 
excreted being markedly lessened, and the biliary and glycogenic functions 
of the liver being affected, resulting in whitish stools, perhaps jaundice, and 
certainly decided decrease of the sugar excreted by diabetics when the drug 
is given to them by the stomach. 

The vaso-motor centre is slightly if at all affected by small doses of Opium, 
but large doses depress it. On the vessels of the skin the first effect of the 
drug is to cause their dilatation, shown by turgescence of the vessels of the 
external ear and a sense of heat therein, and often giving rise to a roseolous 
cutaneous eruption accompanied by itching. The continued use of opium 
causes marked contraction of the capillaries and arterioles throughout the 
body, the skin is excessively pale and the subject always feels cold at the 
ordinary temperature of the atmosphere. In those accustomed to its use 
it acts as a vaso-motor and cardiac stimulant, raising the blood pressure 
and increasing the force of the heart. The symptoms of its withdrawal are 
chiefly due to the fall in blood pressure which occurs when the habitual stimu- 
lus is removed. 

On the uterine and generative functions Opium exerts a marked influ- 
ence, stopping menstruation if its use be continued, and in men causing im- 
potence. Both male and female functions, however, return as soon as the 
drug is discontinued, but the female organs of generation suffer atrophy from 
its long-continued use. In one case, intra-uterine measurements, taken dur- 
ing a period of two years, showed a diminution in the size of the cavity from 
5.1 to 1.9 inches. 

The hypnotic action of Opium is produced by a double influence: on the 
vascular system, causing anemia of the brain; and on the cerebral cells, 
diminishing their activity and lessening their demand for blood. Its con- 
stipating action is shown experimentally to be produced by stimulation of 
the inhibitory nerves of the intestines through the splanchnics. 



362 OPIUM. 

Morphine was discovered by Serttirner in 1817. Its action is generally 
similar to that of Opium, it being the principal alkaloid therein, but when 
used by itself its influence is not complicated with the effects of the convul- 
sive alkaloids (thebaine, codeine and narcotine) which must influence the 
action of opium to a considerable degree. As compared with the latter, 
Morphine acts more quickly, and for a shorter time, has less influence on 
the intestines and skin, is less constipating, less stimulating, less convulsant 
and less diaphoretic, but more sedative, more anodyne and hypnotic and 
produces more intense pruritus. Its elimination commences quickly but 
may not be completed for as much as 48 hours, and is effected by the intes- 
tines, the urine, and the salivary glands. It is also eliminated by the gas- 
tric mucous membrane, is reabsorbed by the intestinal vessels, and constantly 
reappears in the stomach until finally excreted. When injected hypodermi- 
cally more than one-half the amount administered may be recovered by repeat- 
edly washing out the stomach. It is probably retained in the organism to 
a great extent when the action of the kidneys is defective, and when given 
continuously in renal disease may accumulate with fatal result. 

Apomorphine in dose of gr. y\ given hypodermically is a systemic emetic, 
acting directly on the vomiting centre, and is the quickest, most certain and 
least irritating of all emetics, acting in about ten minutes with but moderate 
nausea. Small doses (gr. ^) given by the mouth are expectorant, and the 
same quantity, administered hypodermically, is said to have a hypnotic effect 
lasting from one to two hours. Large doses depress the heart and respi- 
ration, cause delirium and convulsions, and finally paralyze the motor and 
sensory nerves and the voluntary muscles. In a weak adult gr. yy caused 
death by cardiac failure. Morphine kept for a long time in solution may 
become changed into apomorphine. 

Codeine differs chemically from morphine in having the radicle methyl 
(CH 3 ) replacing an atom of hydrogen, and may be considered a methyl- 
morphine. Like all methyl compounds it possesses motor-paralyzant power, 
like that of curare. On man it has some hypnotic action, but far less than 
that of morphine. It exalts the spinal cord more than morphine does, pro- 
ducing muscular tremor in excess of its sedative action. It has a special 
sedative influence on the pneumogastric nerve, contracts the pupils, and is 
remarkably analgesic to the nerves of the abdominal and pelvic viscera. 
When administered for several consecutive days it lessens the irritability of 
the digestive tract to such an extent that arsenic produces neither vomiting 
nor purging (Murrell). It markedly reduces the amount of sugar excreted 
by diabetics, but has no advantage over morphine in that respect. 

Narcotine should be named Anarcotine, as it has little or no narcotic 
power. It is a convulsant in the lower animals and an antiperiodic in man. 

Narceine is said by some observers to be remarkably hypnotic, and free 
from convulsant action; by others equally deserving of credit it is considered 



Ol'll \l. 

almost inert. This alkaloid is difficult to obtain pure, hence the samples 
heretofore used have probably been contaminated with other alkaloids. It 
is said to possess laxative properties. 

Thebaine is a powerful convulsant, exalting the spinal cord almost like 
strychnine and brucine. It is not used medicinally. 

Cotarnine is closely related to Hydrastinine, both chemically and physi- 
ologically, being powerfully styptic and hemostatic by producing contrac- 
tion of the arterioles. 

Protopine and Crvptopine produce in frogs a condition of the voluntary 
muscles in which a series of electric shocks causes rapid clonic spasms in- 
stead of tetanic contractions. They also slow and weaken the heart, but 
accelerate the respiration. 

The opium alkaloids, with the exception of protopine and cryptopine, 
in their action on the central nervous system form a series, in which Mor- 
phine stands at one end and Thebaine at the other. In this series the nar- 
cotic action is gradually replaced by reflex stimulation, the latter being most 
marked in the action of thebaine, which closely resembles that of strychnine. 
The most important members of the series may be arranged in the follow- 
ing order — morphine, papaverine, codeine, narcotine, thebaine, — the most 
narcotic being placed first and the most stimulant standing last. 

Fatal Doses. 

In a child one day old lrjvj of Laudanum caused death. A medicinal dose given to a 
nursing mother proved fatal to the infant. A few drops of Paregoric have killed a child of 
nine months. In the adult gr. £ of Morphine in one case, and gr. iv of crude Opium in another, 
have proved fatal. 

Therapeutics. 
The chief indications for the use of Opium or Morphine are: to relieve 
pain from any cause except acute inflammation of the brain; to produce 
sleep, particularly in the insomnia of low fevers with delirium, in which a 
mixture of morphine and chloral is very efficient; to allay irritation in the 
various forms of acute nervous erethism; to check excessive secretion, as in 
diarrheas, dysentery, diabetes, and ptyalism; to support the system in low 
fevers and other adynamic conditions, when sufficient food cannot be retained; 
and as a sudorific, to produce sweating in coryza and other affections. It 
is a valuable remedy in irritative conditions of the stomach, bladder, or bronchi, 
also in severe vomiting, both forms of diabetes, gastralgia, colic and mus- 
cular spasm. In diabetes mellitus Morphine by the mouth reduces the sugar 
promptly, but when used hypodermically it has little or no effect thereon, 
even in the same case. In peritonitis and inflammation of other serous mem- 
branes, used freely even to narcotism it has often saved life. In cerebro- 
spinal meningitis it is the chief remedy if given early, before exudation has 
set in. Cholera morbus and dysentery are often treated efficiently by a full 
dose of Opium, after emptying the bowel by castor oil or a saline cathartic. 



364 OPIUM. 

In muscular rheumatism and acute colds Dover's powder as a diaphoretic, 
conjoined with hot drinks and foot-baths, his old but excellent treatment. 
In chronic mania and melancholia, nervous prostration and the delirium of 
fevers, Opium is one of the best hypnotics. In acute mania it does not act 
so well as Hyoscine, and in delirium tremens it should be used only in cases 
which show great prostration, and then for temporary effects alone, as a stimu- 
lant. In chronic melancholia small doses of Opium three times a day give 
better results than any other treatment. Severe pain from any cause (except 
cerebritis) is relieved by Opium with an efficiency possessed by no other drug, 
as the pain of sciatica, neuralgia, lumbago, cancer, renal and hepatic colic. 
Cough of harassing and frequent character with but little secretion is 
best treated by Opium, but when there is profuse expectoration it should not 
be used, as the lowering of excitability of the respiratory centre which it pro- 
duces would be dangerous in such a case. In nearly all acute inflammations 
it is valuable, especially when it becomes advisable to lock up the bowels. 
Its tranquilizing power over the circulation makes it invaluable in the various 
forms of hemorrhage, while in that from uterine fibroids and cancer the im- 
planting of the opium-habit is deserving of consideration as a beneficial 
measure, as it checks and even stops the bleeding, as soon as established. 
Dyspnea from any cause is relieved by Morphine, especially that of cardiac 
disease; "it gives the power to breathe" (Huchard). In cardiac disease, 
especially aortic stenosis or insufficiency, with dyspnea, paroxysms of angina 
pectoris, or signs of cerebral anemia, Morphine hypodermically affords great 
temporary relief. Loomis used and recommended Morphine in full dose 
hypodermically for the uremic convulsions of acute parenchymatous nephritis, 
and this use of the drug has been endorsed by many clinicians and condemned 
by others of equal ability and experience. It is employed in puerperal con- 
vulsions with comparative safety when the nephritis is parenchymatous, but 
is highly dangerous in cases due to interstitial nephritis (Tyson). It is gen- 
erally considered to be a dangerous agent in uremia, especially when due to 
chronic renal disease, either parenchymatous or interstitial. 

Apomorphine as an emetic is of much service in poisoning, especially 
when swallowing is difficult, and it may be used with advantage in narcotic 
poisoning before narcosis has blunted the vagus centre. It is a valuable 
emetic in any case of poisoning where time is of great importance. As an 
expectorant it is one of the most efficient and useful agents at our command. 
In catarrh of the bronchi gr. -3^ by the mouth every three or four hours is very 
beneficial, but the drug must be used in all cases with caution, especially 
in young children, who bear it very badly. In hacking coughs without ex- 
pectoration it will prove serviceable, if given in very minute doses, not ex- 
ceeding gr. yg- in the entire 24 hours. In phthisis it may be given in com- 
' bination with morphine with advantage, especially in cases where there are 
dyspnea, continual and harassing cough, and thick, tenacious expectoration. 



Ol'lt \1. 365 

The two agents do not destroy each other's action, 1ml from the Combination 
we get increased secretion from the mucous membrane, with diminished ir- 
ritability of the respiratory centre and consequently lessened cough (Hrun- 
ton). In all conditions in which morphine is used to secure rest and sleep, 
better results will he obtained from gr. T V with gr. ^ of apomorphine, than 
from larger doses of morphine given alone. In doses of gr. .,',1 hypodermically 
Apomorphine has proved efficient as a sedative in epilepsy, hystero-epilepsy, 
hiccough, spasmodic contractions and angina pectoris, and as a hypnotic 
in acute alcoholism; also in somewhat larger dose as a sedative and soporific 
in mental disease characterized by excitement with restlessness and a dis- 
position to violence or suicide. It has been used successfully, by hypodermic 
injection, as an antidote to strychnine in dogs; and in one case, in which 
it was given in mistake for morphine, it entirely dissipated an acute and 
severe attack of sciatica. In small doses, gr. ■£$ hypodermically, it has been 
used as a hypnotic, and is said to produce a sleep lasting from one to two 
hours (Douglas). 

Codeine is much employed as a palliative for cough, especially the ir- 
ritable, hacking cough of phthisis unaccompanied by much expectoration. 
It seems to have a special influence on the nerves of the larynx, and will re- 
lieve a tickling night-cough better than any other opiate, if given in one dose 
of gr. £ an hour before bed-time. In vomiting from almost any cause, doses 
of gr. \, repeated two or three times at hourly intervals, are usually very effi- 
cient. In the milder forms of diarrhea, gr. \ to gr. j will generally check 
the disorder without inducing any unpleasant after-effects. In diabetes 
Codeine lessens the amount of sugar in the urine and often removes it entirely, 
but it must be given in large doses, beginning with gr. ij-iv, and rapidly in- 
creasing to gr. xv or xx. It is highly efficient in abdominal and pelvic pain, 
especially when ovarian in origin. 

Cotarnine Hydrochloride is used internally as a hemostatic in hematemesis, 
pulmonary hemoptysis, and every form of uterine hemorrhage not due to 
fungus, neoplasms, or retained fragments of placenta; also locally in nasal 
and dental hemorrhage. Its sedative action is utilized in dysmenorrhea, and 
its contractile power on the uterine vessels is beneficial in subinvolution of 
the uterus. As it is not ecbolic it is available in the hemorrhage of threat- 
ened abortion. 

Applications of the Various Preparations. 
Superficial pain is often alleviated by the plaster or by extemporaneous 
liniments containing laudanum or some other fluid preparation. It is, how- 
ever, very doubtful whether such applications are of direct value, as mor- 
phine is not absorbed by the unbroken integument; but the oleate is said to 
be very penetrating. Intense pain, as from the passage of calculi, is best 
met by the hypodermic injection of morphine sulphate in full doses (gr. \- 
i) with atropine sulphate (gr. y^-jj). Either the solution of morphine or the 



366 OPIUM. 

liquid preparations of opium may be given by the mouth in corresponding 
doses for the same purpose. Severe pain enables the system to resist the 
action of opium, which in such cases should be repeated at short intervals 
for effect, regardless of dosage. 

Sedative action is obtained by different preparations for various organs. 
The stomach is best affected by the solution of morphine in effervescing 
mixtures, the extract in a small pill, or morphine given hypodermically over 
the epigastrium. The intestines may be influenced by laudanum in an enema 
of starch, or internally by Dover's powder, pulvis opii, or pil. opii, especially 
the latter with or without calomel, as an astringent when the bowel must be 
quieted, as in peritonitis, hernia, and intussusception. The rectum and 
other pelvic organs are promptly affected by a suppository of the extract 
of opium, gr. \, with gr. y 1 ^ of the extract of belladonna. The ovaries and 
the abdominal and pelvic organs generally are markedly susceptible to the 
analgesic action of codeine in doses of gr. j to gr. ij for an adult in severe pain. 

To produce sleep the most efficient preparations are the tinctures, the 
solution of morphine, pil. opii and Dover's powder, in doses corresponding 
to the degree of insomnia and restlessness present. 

Cough is relieved by the tinctures, and the solution of morphine in small 
doses with syrup of wild cherry or syrup of tolu; also by codeine in the last- 
named syrup. Diaphoresis is obtained by the use of Dover's powder in 
either of its forms. 

A dministration. 

Probably no drug in the materia medica is so useful as Opium or has 
so wide a range of application. At the same time no other drug requires 
such careful handling, by reason of the many influences which modify its 
action and uses. Many persons are found with idiosyncrasies in respect to 
opium, some being easily narcotized, others being remarkably insusceptible 
to its action, and many suffer from a decided shock after its hypodermic ad- 
ministration, which may even produce alarming symptoms of collapse. In 
subjects of kidney disease it may accumulate and act more powerfully than 
expected, and generally it may be said to be contraindicated or to be used 
with great care in alcoholism, congestion of the brain, and advanced disease 
of the respiratory organs, heart and kidneys. Children bear Opium badly, 
and for them its proportionate dosage should be much below that for other 
agents. Morphine should not be given to children below 10 years of age, 
and never hypodermically to those beneath the age of 15. Opium given to 
a nursing mother will affect the child, being partly excreted in the milk. 

The conjoint administration with opiates, of the spiritus aetheris, spiritus 
astheris compositus, or spiritus setheris nitrosi, an equal part with tinctura 
opii deodorati, will prevent the nausea often excited by the latter, and cor- 
rect the drying-up effects of opium, due to its checking secretion. Some of 
its cerebral effects, as vertigo and mental confusion, are removed by a full 



OXYGENIUM. 367 

dose of potassium bromide, others are antagonized by quinine, and the 
eral intra-eranial effects of the drug are to some extent opposed by digitalis 
and by tartar emetic. 

Morphine and Atropine are sufficiently antagonistic to each other to make 
their combination extremely valuable as a therapeutic measure, and their 
use as mutual antidotes in poisoning by either a most efficient procedure if 
employed with due precautions, and intelligent consideration of their limi- 
tations (see the article on Poisoning in Part III). When Morphine is given 
as a hypnotic or anodyne, Atropine should generally be administered at the 
same time in the proportion of gr. T i ff of the latter to gr. £ of the former. By 
this means the anodyne and hypnotic qualities of morphine are increased, 
while the nausea and depression with the subsequent dyspepsia and con- 
stipation due to it are avoided. Moreover, in the doses above mentioned 
atropine is a cardiac and respiratory stimulant, and will counteract the de- 
pressing tendency of morphine on the heart and respiration in subjects who 
are unduly susceptible to its action. 

OXYGENIUM, Oxygen, O. This element is not official though it is 
extensively used in medicine. Its two combinations with Hydrogen, Water 
H,0, and Hydrogen Dioxide H 2 2 , are official, also eleven other Oxides, 
namely — those of Arsenum, Calcium, Chromium, Ethyl, Iron, Lead /Magnesium, 
Manganese, Mercury, Silver and Zinc. It enters into the composition of most 
of the acids and their salts, many of the organic bases, and all the alkaloids 
except a few. 

Oxygen is the most universally diffused element in nature, forming about one-fifth of the 
atmosphere, one-third of water, and a great part of the earth and the tissues of plants and ani- 
mals. It is a colorless, odorless, and tasteless gas, of sp. gr. 1.1057, and can be liquefied by 
subjection to extreme cold and pressure combined. It was discovered by Priestley in 1774, 
and given its name, Oxygen (acid producer) by Lavoisier in 1778. It may be obtained pure 
from many of its combinations, but is usually prepared by heating Manganese Dioxide or 
Potassium Chlorate, or preferably both together. It is furnished by manufacturing chemists 
in all large cities, compressed in iron cylinders furnished with a rubber bag and mouth-piece 
by which to administer it. 

Ozone, 3 (Unofficial), — is an allotropic form or condensed condition 
of Oxygen, three atoms of which are contained in a molecule of the former, 
instead of two as in the molecule of oxygen. Ozone exists in the atmosphere 
in the general proportion of 1 part in 10,000, but it is more abundant in the 
open country and on the ocean than in the air of cities. It is formed when 
an electric spark is passed through air, being then manifested by its peculiar 
odor. In the sick-room it may be produced by dissolving in water a mixture 
of manganese dioxide, potassium permanganate and oxalic acid. 

Official Preparations. 

Aqua Hydrogenii Dioxidi, Solution 0} Hydrogen Dioxide, (Solution of Hydrogen Per- 
oxide) commercially known as Peroxide of Hydrogen, — consists of water to which nascent 
Oxygen has been presented, whereby an additional atom thereof has entered into combina- 
tion with the hydrogen, producing H 2 2 . It is officially described as a slightly acid, aqueous 



368 OXYGENIUM. 

solution of Hydrogen Dioxide, containing when freshly prepared about 3 per cent, of the pure 
dioxide, corresponding to about 10 volumes of available oxygen. It occurs as a colorless liquid, 
without odor, slightly acidulous, producing a peculiar sensation and soapy froth in the mouth, 
and liable to deteriorate by age, heat or protracted agitation. Dose, o ss— i j [av. 5j], diluted 
with 3 to 4 parts of water. 

Aqua, Water, H 2 — is described under its own title. 

Oxides of Arsenum, Calcium, Chromium, Iron, Lead, Magnesium, Mercury, Silver and 
Zinc and the Dioxide of Manganese are described under the titles of their metallic bases. 

Unofficial Preparations. 

Acetozone, Benzozone, Benzoyl-acetyl Peroxide, — is an unstable compound, which 
undergoes hydrolysis in the presence of water, its solution containing Aceto-peracid (acetyl- 
hydrogen peroxide) and Benzo-peracid, both intensely oxidizing and germicidal bodies. It 
is marketed in the form of a powder, one-half of which is infusorial earth acting as a diluent 
and preservative. By adding gr. xxx of the powder to half a gallon of warm, distilled water, 
shaking, settling, and decanting, the solution is obtained, and this is administered internally in 
doses of o iv, up to J gallon in 24 hours. Dose of the powder, gr. iij-v, diluted with sugar of 
milk, and dispensed in capsule. 

Glycozone — is claimed to be a stable compound, resulting from the reaction between 
chemically pure glycerin and 15 times its volume of ozone; and not a mixture of hydrogen 
dioxide with glycerin. It is very hygroscopic, and must be kept tightly corked, to prevent 
deterioration. It is said to act upon diseased tissue in the same manner as Hydrogen Dioxide, 
but more slowly, and ma)' be used in full strength as an application to wounds or suppurating 
surfaces, to stimulate healthy granulations, and generally as an antiseptic surgical dressing. 
It is mixed with water (1 in 10) as a rectal injection; and may be administered internally, in 
doses of oj-ij in a wineglassful of water, in gastric affections, as dyspepsia, pyrosis, ulcer and 
catarrh of the stomach. 

Pyrozone — is the name given by a well-known manufacturer to a concentrated solution 
of Hydrogen Dioxide in Ether. It is said to contain about 50 per cent, of the dioxide and is a 
very potent and efficient oxidizer, intended for external use only. It has many applications 
in the practice of surgeons. 

Sanitas — is a proprietary solution for disinfecting purposes, containing Hydrogen Di- 
oxide, and described under Terebinthina. 

Incompatibles. 

Incompatible with Hydrogen Dioxide are: Alkalies, Albumin, Ammonia, Arsenous 
salts, Balsam of Peru, Charcoal, Chlorides, Chorine-water, Citrates of alkalies, Ferric salts, 
Glycerin, Gold salts, Hydrocyanic Acid, Hypophosphites, Iodides, Lime-water, Manganese 
Dioxide, Mercurous salts, Nitrates, Phenol, Potassium Bromide, Potassium Permanganate, 
Sulphates, Solution of Chorinated Soda, Tartrates, Tinctures. 

Physiological Action. 
Oxygen is essential to respiration, blood-formation, nutrition and tissue- 
change, in fact to life itself, and to fully describe its physiological action 
would involve a complete description of these processes, which would be a 
treatise on physiology. Applied to the unbroken skin it has no apparent 
effect, but when applied to a wounded tissue it increases the circulation therein 
and acts as a stimulant. Inhaled in the pure state (not as air) it causes very 
little constitutional disturbance. A slight sense of heat is felt in the mouth 
and may extend along the larynx, trachea and bronchi. The pulse is usually 
quickened, but it may be lessened in frequency, the appetite is increased, the 
temperature is slightly raised and the cardiac action is stimulated; a sense 
of mental exhilaration and a disposition to greater bodily activity are produced, 
but no constant influence on the excretions has been noticed. In some per- 



OXYG] Mi \i. 

sons it seems to cause nervous symptoms similar to those produced by nitrous 
oxide gas (Brunton). 

Ozone is a powerful oxidizing and destructive agent. It attacks metals, 
destroys organic substances and the coagulability of albumin and decomposes 
blood. It is highly irritant to the tissues, and sets up an acute catarrh of 
the respiratory mucous membrane if inhaled in quantity. When present 
in small quantity in the air it is breathed without unpleasant effects and 
is decidedly soporific (Binz). It is poisonous to low organisms, and is there- 
fore an energetic antiseptic and disinfectant. In animals it sometimes quickens 
and often slows respiration, and produces excitement followed by exhaustion, 
sometimes by convulsions and death. 

Hydrogen Dioxide, in fresh solution, is one of the most powerful oxidiz- 
ing agents known, by reason of the facility with which it parts with oxygen 
to oxidizable substances brought in contact with it. It is consequently a 
powerful yet non-toxic antiseptic, destroying morbid products and organ- 
ized ferments to which it is applied. In contact with a suppurating surface 
it generates a white foam, as the result of its action on the pus. This soon 
subsides, leaving the subjacent tissue cleansed of all morbid secretions. One 
part added to iooo of water containing sewage or infectious microbes is suffi- 
cient to destroy the various organisms if allowed to act thereon for 24 hours. 

Therapeutics. 

Oxygen is efficient as an application to the surface in atonic, scrofulous 
and syphilitic ulcers, also in cases of senile and other forms of gangrene. 
Its application to the scalp, by means of a rubber cap fitted to the head, has 
restored the hair in a case in which it was lost by reason of alopecia areata. 
Its principal use has been in cases of disease of the respiratory apparatus 
characterized by dyspnea, as emphysema, bronchial dilatation, phthisis and 
gangrene of the lungs, also spasmodic asthma, and asphyxia from the inhala- 
tion of toxic gases or due to opium and chloroform narcosis. It has been 
employed with benefit in uremic coma, and in the dyspnea of cardiac disease 
and that of anemia from loss of blood or from protracted suppuration. It 
has given good results in diseases characterized by defective oxidation, as 
gout and diabetes; in the latter affection the sugar sometimes disappears 
entirely from the urine during its inhalation. It has been used in the treat- 
ment of epilepsy and spasm, and is recommended in cholera. 

Ozone has been recommended in cases similar to those for which oxy- 
gen is used; also in infectious diseases, as diphtheria, in which it is expected 
to destroy the pathogenic microbes exposed to its influence. 

Hydrogen Dioxide in solution has long been employed as a bleaching 
agent for delicate fabrics, and on the human hair for the production of the 
"bleached blonde" hue so fashionable lately in certain circles of society. 
As a cleansing agent for foul wounds, ulcers, sores, and' the like, it is highly 



37<3 PAREIRA. 

efficient; and has been used with great benefit as a gargle or spray to the 
throat and nasal passages, in quinsy, croup, diphtheria, scarlet fever, ozena, 
and other morbid conditions of these parts. In diphtheria a 3 per cent, solu- 
tion as a gargle at short intervals night and day, also given internally, has ri- 
valled antitoxin in results. In colitis with dysentery, lavage of the intestine with 
a dilute solution thrice daily has proved efficient in cases where other approved 
measures had failed to make any impression. As a diagnostic agent in determin- 
ing the presence of pus it is injected into the suspected location, and indicates 
its contact with pus by causing an immediate swelling of the tissue. If such 
a swelling be cut into at once no pain is felt, and suppurating buboes have been 
successfully treated by this method in many cases. Used internally it imparts 
oxygen to the blood, improves digestion, relieves spasm of the respiratory ap- 
paratus, aborts the paroxysms of whooping-cough, and gives relief in the dysp- 
nea of chronic bronchitis. It acts well in non-febrile cases of pulmonary tuber- 
culosis by promoting digestion, palliating cough, and giving increased activity 
to chalybeate remedies, but is contraindicated in advanced febrile cases, in which 
it only hastens the fatal termination. It is recommended as a disinfectant of 
drinking water, as in the small quantity necessary for its effective action (1 in 
1,000) it does not impair the taste or other potable qualities. 

Acetozone is not toxic to the human organism, and yet it is a powerful germi- 
cide. A solution of 1 in 100,000 will kill cholera germs within five minutes 
and typhoid germs in less than fifteen; while one of 1 in 3,000 destroys all patho- 
genic organisms within a minute, and their spores after a longer time (Novy). 
It is not available as an antiseptic, on account of its proneness to break up in 
the presence of organic substances. As a germicide in the gastro-intestinal 
canal it has been used with great satisfaction in typhoid fever, dysentery, and 
Asiatic cholera. In the former disease it was used in 128 cases with a mor- 
tality of 8.59 per cent., (Harris), lowering the temperature, shortening the 
duration of the fever, and lessening the toxic symptoms more than any other 
treatment. It has been employed locally with satisfaction in gonorrhea, espe- 
cially that of the female subject, in puerperal fever, malignant edema, tinea 
tonsurans, and in accidental and operative wounds characterized by persistent 
pus formation. Thrown into boiling water it liberates oxygen and is actively 
deodorant in the atmosphere of a room; having been successfully used in this 
manner to destroy the odor of malignant variola. 

PAREIRA, Pareira, — is the dried root of Chondrodendron lomentosum, a 
climbing, woody vine of the nat. ord. Menispermaceae, with very large leaves 
and a grape-like fruit, inhabiting Peru and Brazil. It contains Pelosine or 
Cissampeline, an alkaloid identical with the Berberine of Nectandra and the 
Buxine of Buxits sempervirens (boxwood). 

Fluidextractum Pareirae, Fluidcxtract of Pareira. — Dose, njx-xlv [av. njixxx.] 
Infusum Pareirae, Infusion of Pareira (Unofficial), — 1 in 17. Dose, Bj-ij. 



PASSIF] OB \ tNC URNA I \ PI PSINUM. 

Pareira is diuretic and laxative, stimulating peristalsis and the action of 
the kidneys. It is eliminated by the kidneys, and passing over the mucous 

membrane of the genito urinary tract it acts thereon in a tonic and soothing 
manner, especially on the Madder. It is particular])- useful in chronic cystitis, 
suppurative kidney diseases, gonorrhea and gleet, hut must be used intcrnallv, 
as when injected locally for these affections it has not proved successful. For- 
merly Pareira was considered an efficient lithontriptic, and in Brazil it is used as 
a cure for the bites of poisonous serpents, being employed both internally and 
locally. 

PASSIFLORA INCARNATA, Passion-flower (Unofficial),— is an indigenous plant 
wbi< h is highly esteemed by many American physicians as a calmative, analgesic and hypnotic 
remedy. It has been administered with satisfactory results in neuralgia, chorea, spasmodic 
asthma, pertussis, hysteria, dysmenorrhea, insomnia, infantile and puerperal convulsions and 
the opium habit. A concentrated tincture is prepared from the whole plant, the dose of which 
IS ,~ss -j every 2 or 3 hours. 

PEPO, Pepo, — is the ripe seed of Cucurbita Pepo the common Pumpkin, nat. ord. Cu- 
curbitaces. The active principle is a resin contained in the endopleuron or envelope immedi- 
ately surrounding the embryo. It also contains an alkaloid Cucurbitinc, a fixed oil, starch, 
sugar, etc. There are no official preparations. Dose, of the resin, gr. xv; of the seeds, §ss- 
jss [av. 3j], beaten up into an emulsion with sugar and water. 

Pumpkin-seed is an efficient agent for the removal of tapeworm, and its use is not followed 
by unpleasant symptoms. The outer coat of the seed should be removed, and an emulsion 
then made by trituration with sugar and water. This, if taken on an empty stomach and 
followed by a brisk cathartic, will generally prove effective. Dr. Squibb maintains that the 

- should not be decorticated, but that husks and all should be swallowed. According to 

■ observers the expressed oil is equally efficient in doses of oss repeated two or three 
times and followed by a cathartic. 

PEPSINUM, Pepsin, — is the name of a hypothetical digestive principle 
in the gastric juice. As a definite body it is unknown, the various preparations 
being mere approximations and varying much from each other. It is officially 
described as a proteolytic ferment or enzyme, obtained from the glandular layer 
of the fresh stomach of the hog, and capable of digesting not less than 3000 
times its own weight of freshly coagulated and disintegrated egg albumin, when 
tested by the official process. 

Pepsin is a fine, white, or yellowish-white, amorphous powder, or thin, pale-yellow, 
translucent grains or scales, free from any off ensive odor; soluble in about 50 of water, more 
soluble in water acidulated with HC1, insoluble in alcohol, ether or chloroform. It usually has 
a slightly acid reaction, and may be neutral, but should never be alkaline. Commercial Pepsin 
is usually obtained from a solution prepared by digesting the mucous membrane scraped from 
the rennet-bags of sheep or the stomach of the pig in acidulated water for several days. It is 
then precipitated by sodium chloride (Scheffer,) lead acetate (Boudaidt), or by drying the 
peptones on glass plates (Beale). It may also be precipitated by alcohol. By Scheffer's 
process it occurs as a tough, gray, leathery substance, partly soluble in water, one grain dis- 
solving 3000 grains of albumin in a few days. Jensen's Crystal Pepsin, probably prepared 
after Bcale's method, is in yellowish, translucent scales, soluble in water, and reputed to be many 
times stronger than any other preparation yet obtained. 

A nalogous Substances. 
Pancreatinum, Pancrealin, — is officially described as a mixture of the 
enzymes naturally existing in the pancreas of warm-blooded animals, usually 



372 PEPS1NTJM. 

obtained from the fresh pancreas of the hog (Sus scroja), or the ox (Bos lanrus) 
and consisting principally of amylopsin, myopsin, trypsin, and steapsin, and 
proved to be capable of converting not less than 25 times its own weight of starch 
into substances soluble in water. Dose, gr. iij-xv [av. gr. vijss.] 

Ingluvinum, Ingluvin (Unofficial), — is obtained from the gizzard of the 
domestic fowl, and owes its activity to a peculiar, bitter principle, and not to 
any ferment corresponding with pepsin. Dose, gr. x-xxx, 

Unofficial Preparations. 

Pepsinum Saccharatum, Saccharated Pepsin, — is Pepsin 1, triturated with 9 of Sugar 
of Milk. One part should digest at least 300 parts of egg-albumin. Dose, gr. v- 5j, shortly 
after meals. 

Liquor Pepsini, Liquid Pepsin, — contains of Saccharated Pepsin 40 parts, Hydrochloric 
Acid 12, Glycerin 400, Water q. s. ad 1000 parts. Dose, 5ij-iv. 

Every manufacturer of Pepsin has his own preparation and his peculiar name therefor, such 
as Liquid Pancreopepsine, Lacto-peptine, Gluco-pepsine, Golden Scale Pepsin, Peptogenic 
Milk Powder, etc. They vary considerably in their properties, but all have the power in 
some degree of digesting albumin and fibrin. 

Lactopeptine, — is claimed to contain Pepsin, Diastase or Ptyalin, Pancreatin, Lactic 
and Hydrochloric Acids, and that 5j will digest oviij-x of albumin, fibrin, casein, or gelatin, 
will emulsionize oxvj of cod-liver oil, and convert 5 iv of starch into glucose. A proprietary 
preparation. Dose, gr. v-xv. 

Peptenzyme, — is prepared from the peptic, pancreatic, salivary, Lieberkuhn's and 
Brunner's glands and the ferment extract of the spleen and liver, slightly benzoated and mixed 
with sugar of milk and citric acid. It is claimed for it that it contains the active ferments and 
undeveloped ("mother") enzymes of all the digestive organs or glands, in the same physiological 
condition as that in which they exist in nature; that it digests food in an acid, an alkaline 
or a neutral menstruum; and that it will digest all kinds of food. It is best administered 
before meals. Dose, gr. iij-x. 

Liquor Pancreaticus, Pancreatic Solution, — prepared by digesting a finely-chopped pig's 
pancreas with 4 times its weight of dilute alcohol. It is a nearly clear alcoholic solution, with 
little taste or smell. Dose, 5j-oss. 

Unofficial Vegetable Digestives. 

Papain, Papaiva, Papayotin, — is a vegetable ferment obtained from the milky juice of 
Carica Papaya, a S. American fruit-tree of the nat. ord. Papayacea;. It is soluble in water, but 
not in alcohol, and has active digestive powers. It is composed essentially of a mixture of 
vegetable globulin, albumoses and peptone, with which are associated the ferments charac- 
teristic of the preparation. It is marketed under the name Papoid. Dose, gr. j-iij. Papaw 
Milk is the milky juice of the fruit, coagulating into two parts, a pulpy mass and a liquid serum. 
When mixed with alcohol an amorphous powder is precipitated, which when dried forms Papain, 

Bromelin, — is an active digestive ferment contained in the fresh juice of Ananassa Sativa. 
the Pineapple. It is more nearly related to trypsin than to pepsin, and is decidedly active in 
the presence of either acids or alkaline carbonates, but is most energetic in neutral solutions, 
and is a very constant and powerful digestant of vegetable and animal proteids. It com- 
pletely dissolves fibin and meat albumin in a short time, and has digested 1,000 times its own 
weight of proteids within a few hours. It is destroyed by cooking. Dose of the fresh pine- 
apple juice, oss-j. 

Taka-diastase, — is a starch-digesting enzyme obtained from Eurotinm oryzce, a mould 
of the aspergillus family which grows upon hydrolized wheat bran. Its digestive power is 
three times greater than that of the best samples of malt diastase, being capable of convert- 
ing 300 times its weight of starch into sugar within an hour. It acts in acid, alkaline, or neutral 
media. Dose, gr. j-v, with or after meals. 

Incompatibles. 

Incompatible with Pepsin are: Alcohol, Alkalies, Tannic Acid, Vegetable decoctions and 
infusions; many mineral salts precipitate it from solution. With Pancreatin are: Acids, 
Alcohol, Sodium Chloride in excess. 



Pi i'sim \i. 373 

Physiological Action and Therapeutics. 

Pepsin is not a solvent but a mixture of ferments, and is a normal constituent 
of the gastric juice, converting albuminoids (casein, albumin, fibrin, etc.) into 
peptones for assimilation, with the aid of the lactic and hydrochloric acids 
a-sociated with it. This it will do out of the body or in cavities as the rectum, 
if warmth, acidity and moisture are present. Pancreatin, on the other hand, 
i.> destroyed by acids and requires an alkaline medium in which to exercise its 
powers. As the food passes out of the stomach in 2 or 3 hours, Pepsin should 
lie administered within and Pancreatin after that period, to be effective. Pep- 
sin contains proteolytic, milk-curdling, fat-splitting and lactic acid ferments. 
Pancreatin contains Amylopsin, an amylolytic ferment, converting starch into 
glucose; Myopsin and Trypsin, proteolytic ferments, converting proteids into 
peptones in an alkaline medium; S/eapsin, which splits fats into glycerin and 
fatty acids; and a milk-curdling ferment. 

Dyspepsia in its various forms is the malady for which Pepsin is chiefly em- 
ployed, but it is also extremely useful in the apepsia of infants, gastralgia, an- 
emia, chlorosis, gastric ulcer and cancer, the diarrhea of infants and the vomit- 
ing of pregnancy. It is added to nutritive enemata, the rectum not being a 
digestive organ, and is injected into the substance of morbid growths which are 
homologous to the tissues, particularly fatty tumors, for the purpose of arrest- 
ing their growth and promoting their absorption. It has been injected into 
the bladder to break down a blood-clot, and has been suggested as an atomized 
inhalation in diphtheria and croup to digest the membrane without injuring 
the living tissues. 

Pancreatin digests albuminoids and converts starch into sugar and pro- 
teids into peptones, also emulsifies fats in the presence of an alkaline solution 
(Pepsin requiring an acid one). Prolonged contact with mineral acids renders 
it inert. It is digested by pepsin, and hence probably never passes into the 
duodenum in its own character. Pancreatin is used to partially digest (pep- 
tonize) milk, gruel, soups, and other foods, before their administration in cases 
of great digestive debility. These peptonized foods may be administered by 
the stomach or the rectum, and are valuable in intestinal dyspepsia, wasting 
diseases, and convalescence from acute affections. A teaspoonful of Pan- 
creatin solution taken after the administration of cod-liver oil will prevent the 
disagreeable eructations which are so offensive to some patients, and will aid 
the digestion of the oil. 

Papain has the power of digesting to a greater or less extent all forms of 
proteid or albuminous matter, whether coagulated or not. It converts albumin- 
oids into peptones, starch into maltose, and emulsifies fats. It has antiseptic 
power, and prevents abnormal fermentation in the stomach and intestines. 
Its digestive power is exercised in either acid, alkaline or neutral media. It 
acts more rapidly than pepsin and at higher temperatures. It is a rapid sol- 
vent of false membranes and intestinal worms; and has been injected into neo- 



374 PETROLATUM. 

plasmic tumors, dissolving their tissues in its immediate vicinity, but with much 
pain and considerable febrile reaction. Papoid has been used as a paste locally 
in diphtheria, to destroy and remove the false membrane; internally, in gas- 
tric and gastro-intestinal catarrh, the diarrhea of infancy and various dyspeptic 
conditions, with very great success. Its power over both gastric and intestinal 
indigestion renders it much more useful than either pepsin or pancreatin in 
cases of doubtful diagnosis, in which it is difficult to decide as to the location 
of the trouble. 

Taka-diastase is used with satisfaction in the so-called amylaceous dyspepsia, 
in chronic gastritis and gastro-enteritis when the patient is distressed by farin- 
aceous food, in the diarrhea and dysentery of infants, and in cases of diabetes 
due to pancreatic disease. 

Trypsin, — unlike Pepsin, will dissolve mucin, and like pepsin it is inert towards nuclein, 
horny tissues, and amyloid matter. Used as a spray on diphtheritic membrane it has proved 
a very efficient solvent. It affects albuminoids even in a slightly acid solution. 

Ingluvin, — is particularly useful against vomiting and has been found exceptionally effi- 
cient in the vomiting of pregnancy, given in 20-grain doses before meals. 

Pineapple Juice, — is one of the most efficient digestive aids at our command and has the 
advantage of being pleasant to the patient. The author directs the fruit to be cut into slices as 
required, and the juice to be squeezed out immediately before administration. It has long 
been used by the natives of South Africa as a remedy for diphtheria and diphtheritic sore throats 
with unusual success, according to the testimony of competent observers; and has been employed 
by Dr. Chambers of Calcutta in this disease with marked benefit. He had the patient sip the 
juice all day at short intervals, or else masticate slices of the fruit and swallow the juice; but as 
he employed Papaya fruit in the same cases it is impossible to give all the credit of his success 
to the pine-apple. 



PETROLATUM, Petrolatum, — is a mixture of hydrocarbons, chiefly of 
the methane series, obtained from Petroleum, by distilling off the lighter por- 
tions and purifying the residue. It is colorless or yellowish, and in the latter 
case is more or less fluorescent; amorphous, odorless and tasteless, of neutral 
reaction, insoluble in water, slightly soluble in absolute alcohol, readily soluble 
in ether, chloroform, petroleum benzin, benzene, carbon disulphide, oil of tur- 
pentine, and fixed or volatile oils. The soft variety is known commercially 
as Terraline, Cosmoline, Vaselin, Petroleum Ointment, etc., and is largely pre- 
pared from residuums or sediments deposited in tanks containing crude petro- 
leum. Besides Petrolatum itself it is official in the following-named forms, — 

Petrolatum Album, While Petrolatum, — a white, unctuous mass, without odor or taste, 
of about the consistence of an ointment. 

Petrolatum Liquidum, Liquid Petrolatum, — a colorless, oily, transparent liquid, with- 
out odor or taste, but giving off, when heated, a faint odor of petroleum. 

Paraffinum, Paraffin, — a mixture of solid hydrocarbons, a colorless, translucent ma^s. 
odorless and tasteless, and slightly greasy to the touch. 

Official Analogues. 

Benzinum, Petroleum Benzin, a distillate from petroleum, consisting of hydrocarbons, 
chiefly of the marsh-gas series; a transparent, diffusive, inflammable liquid, soluble in about 
6 of alcohol, readily soluble in ether, chloroform, etc., insoluble in water. Its vapor, mixed 
with air and ignited, explodes violently. 



nil vh . J75 

Benzinum Purificatum, Purified Petroleum Benrin, is a valuable solvent for oils, 
fais. resins, caoutchouc and some alkaloids, and a vermicide against tape-worm, Dose, . 
10 (Imps, on sugar or in mucilage. 

Benzol, Benzol (B. P.), is a mixture of hydrocarbons obtained from light coal tar oil 
and contains about 70 per cent, of Benzene, C 8 H„ and 20 t<i ^o per cent. "I Toluene, (',,1 l,,.('l I ,. 
Pose, 5 t.> 10 drops on sugar, in emulsion or 1 apsules, up to 7> jss daily. 

Physiological Action and Therapeutics. 

Petrolatum is a valuable protective dressing, and an excellent basis for oint- 
ments, having no acridity and no liability to become rancid. It is readily mis- 
cible with many active agents, as the alkaloids and phenol compounds, but 
it does not penetrate the skin so readily as animal fats and fixed oils. Un- 
combined, it forms an excellent bland application in all irritated conditions 
and injuries of the skin, and it has been used with benefit alone, or mixed with 
castor or olive oil, in chronic eczema accompanied by desquamation. Paraffin 
is employed by sub-cutaneous injection for cosmetic effects on saddle-shaped 
noses and other superficial deformities. 

Benzin taken internally in overdose is known to produce gastro-enteritis, 
and such a case is reported which terminated fatally. In the ordinary medic- 
inal doses it does not produce either vomiting or diarrhea. Benzin-poisoning 
may be produced by its inhalation, which is becoming quite a practice among 
glove-cleaners, and alcoholics have been known to take to inhaling benzin in 
place of drinking spirits. It has been used with some success externally as a 
remedy for rheumatic pain, neuralgia, itch, and prurigo; and internally as a 
vermicide against tapeworm. In pharmacy it has many uses on account of 
its power as a solvent for oils, fats, resins, caoutchouc and some alkaloids. In 
the household it is used as a solvent application for removing grease from cloth- 
ing. 

Benzol is a reliable pulmonary antiseptic, and has been successfully used 
in the treatment of whooping-cough, the vapor being diffused throughout the 
room, and proximity to a light or fire being avoided. It has made quite a 
reputation in the treatment of influenza, and has been found effectual in destroy- 
ing both head and body lice, for which purpose a single application is usually 
sufficient. It has been given internally for the destruction of trichina;, followed 
by a brisk laxative; and, mixed with lard, it is used externally in parasitic skin 
diseases, especially scabies, also in rheumatism and neuralgia. Its vapor in- 
haled has anesthetic action. 

Albolene and Glymol are two of the numerous proprietary products of petroleum. They 
are odorless, do not become rancid, and are employed as bases for ointments and as lubri- 
cants. Liquid Albolene is readily diffused in the form of a spray and is a good solvent for 
drugs intended for application to the naso-pharyngcal mucous membrane. 

PHENOL, Phenol, (Carbolic Acid), C 6 H 5 OH— is hydroxy-benzene, ob- 
tained either from coal tar by fractional distillation and subsequent purification, 
or made svntheticallv. It occurs in colorless, interlaced, needle-shaped crystals, 



376 PHENOL. 

of characteristic, aromatic odor, deliquescent on exposure to damp air, and 
acquiring a reddish tint with age and light. When copiously diluted with water 
it has a sweetish taste, and a slightly burning after-taste. It is soluble in about 
15 of water, very soluble in alcohol, ether, chloroform, benzene, glycerin, oils 
and carbon bisulphide; almost insoluble in benzin. It is melted by gentle 
heating, and is liquefied by the addition of about 8 per cent, of water. Dose, 
gr. £-ij [av. gr. j], well diluted. 

Phenol occurs in castoreum, in the urine of man and herbivorous animals, and in the prod- 
ucts of the dry distillation of various organic substances, as resin, bones, wood, and coal. Pecu- 
liarities of it are that the addition of about 8 per cent, of water liquefies it, while a further addition 
of water produces a turbid mixture, until about 15 parts of water to 1 of phenol is reached, 
when a stable and clear solution is formed. One volume of the liquefied phenol, containing 
8 per cent, of water, forms with one volume of Glycerin a clear mixture, which is not rendered 
turbid by the addition of 3 volumes of water (absence of Creosote and Cresol). 

Hitherto described as neutral to litmus paper, Phenol is now officially given a faintly acid 
reaction. Its claims to be considered an acid are, however, very feeble, as, though it combines 
with salifiable bases, it is incapable of neutralizing ihe alkalies, and its combinations are de- 
composed by the feeblest acids (carbonic, etc.), sometimes, it is asserted, even by water. 
Chemically, it is considered to be the Hydroxyl (HO) derivative of Benzene (C„H 6 ), which would 
ally it to the alcohols; but as it does not yield the same products on oxidation (yielding finally 
oxalic instead of acetic acid), it is taken as the type of a class called phenols, which are simple 
HO derivatives of the aromatic hydrocarbons. [For the chemical theory of the Benzene deriva- 
tives see the sub-title Substitutes for Quinine, under the title Cinchona.] 

Phenol is converted by concentrated sulphuric acid into Phenol-sulphonic Acid, CeHsH.SO,; 
and by nitric acid into several substitution products, the most important of which is Picric 
Acid. The reddish tint which it acquires with age and light, does not impair its properties; but 
is not accounted for satisfactorily, though supposed to be due to the presence of A urin and Rosa- 
lie Acid, impurities which form a red compound by the absorption of CO z and oxygen. 

Phenol coagulates albumin and collodion, Creosote does not. 

Official Preparations. 

Phenol Liquefactum, Liquefied Phenol, — is a liquid composed of not less than 86.4 per 
cent, by weight of absolute Phenol, and about 13.6 per cent, of water. Dose, TTjjss-ij [av.njj.] 

Glyceritum Phenolis, Glycerite of Phenol, — has of Liquefied Phenol 20, Glycerin 80. 
Dose, rpjiij— x [av. nj>y.] 

Unguentum Phenolis, Ointment of Phenol, — has of Phenol 3, White Petrolatum 97. 
For external use. 

Sodii Phenolsulphonas, Sodium Phenolsulphonate, {Sodium Sulphocarbolate), — occurs 
in transparent, rhombic prisms, soluble in 5 of water. Dose, gr. ij-x [av. gr. iv.] 

Zinci Phenolsulphonas, Zinc Phenolsulphonate, — occurs in transparent, rhombic prisms, 
soluble in 2 of water. Dose, gr. j-v [av. gr. ij.] 

Unofficial Preparations and Compounds. 

Aqua Phenolis, Water of Phenol, — hss of the glycerite of Phenol ox, to Water Oj. Dose, 
5j-iv. 

Phenol Solutions, for antiseptic surgery, are — 
5 per cent, in Water, (ttjjxxv to the 5), as a wash. Is decidedly irritant. 
2\ per cent, in Water, ( Ttjrxij to the o), for sponges, hands, or as a lotion. 
5 per cent, or less in Olive Oil, as a special dressing. 

Phenol Sodique, — is composed of Phenol, gr. clxxxviij, Caustic Soda, gr. xxxj, Distilled 
Water, §iv. 

Phenol-camphor, — has of Phenol and Camphor, equal parts. A colorless, refractive 
liquid; soluble in alcohol, ether, chloroform and oils; insoluble in water or glycerin. I'sed 
as a local anesthetic, chiefly for toothache; also in the proportion of Phenol 1, Camphor 3, as 
an application to false membrane in diphtheria, and as subcutaneous and intrapulmonary in- 
jections in phthisis. Campho-phenique is a similar preparation. (See under Camphora.) 



PHENOL. 377 

Phenol Iodatum, Iodized Phenol,- a mixture of Iodine and crystallized Phenol. (See 

under loin 

Pheno-resorcin, — is a mixture of Phenol 67 with Resorcin 33 and Water 10, forming a 
liquid which mixes readily with water, li is supposed to combine t In- virtues of both its ingre- 
dients. 

Phenosalyl, — is a clear, syrupy liquid, prepared by fusing together Phenol q parts, 
.lie Acid 1, Lactic Acid _', and Menthol 0.1. It has a pleasant odor, is very soluble in 
water, and is used in a 1 per cent, solution as an antiseptic application, and in 10 to 30 -per 
cent, solutions as a curative lotion for varicose ulcers and ulcerated gummata. It is said to be 
superior as a germicide to any one of its ingredients, and to prove much less toxic than the 
agents usually so employed. 

Aseptol, — is the trade name of a 2>Z-Z P er cent, solution of Sozolic or Ortho-phenol-sul- 
. ■'./, which is formed when Phenol is dissolved in concentrated Sulphuric Acid. Asep- 
tol occurs as a syrupy liquid which crystallizes in small deliquescent needles, decomposes when 
distilled and is very soluble in water, also in alcohol and in glycerin. It has a faint odor of 
phenol, and is asserted to be antiseptic but neither poisonous nor irritant, and hence of especial 
value in abdominal and ophthalmological surgery. It has been recommended for internal use 
as a substitute for Salicylic Acid, on account of its greater solubility, and has been employed 
in concentrated solution for the treatment of pharyngitis and diphtheritic laryngitis. Exter- 
nally it is used so diluted as to contain from 3 to 10 per cent, of the active principle. 

Aseptolin, — is a solution containing about 2J per cent, of absolute Phenol, and 0.02 per 
cent, of a pilocarpine salt named Pilocarpine-phenyl-hydroxide. It is intended for hypo- 
dermic use only, in one daily dose of 50 to 250 minims for adults, injected into the abdominal 
parietes or into the muscles of the back. 

Analogues and Derivatives. 

Creosotum, Creosote, — is a mixture of phenols and phenol derivatives, obtained during 
the distillation of wood-tar. It is described under its own title. 

Resorcinol, Resorcinol, (Resorcin) — is a diatomic phenol, which is described under its 
own title. 

Acidum Picricum, Picric Acid, Carbazotic Acid, Trinitro-phenol, C 6 H 2 OH(N0 2 ) s > 
(Unofficial), — is obtained by the action of hot nitric acid on phenol-sulphonic acid, and occurs 
in yellow scales which are soluble in 75 of water and in 10 of alcohol. Externally it is anti- 
septic, analgesic, coagulant, and in solution is non-irritant to the tissues, but is too corrosive 
for internal use. Large doses cause vomiting, anuria, strangury, and yellow staining of the 
skin and mucous membranes. A saturated aqueous solution is highly recommended as a 
local application in erysipelas and burns, and is an efficient test for albumin in the urine. 
Ammonium Picrate has been credited with antiperiodic and anthelmintic powers, and is 
highly praised in pertussis and in exophthalmic goitre, in doses of gr. j-x. 

Cresol, Cresol, C 7 H 7 .OH, — is a mixture of the three isomeric Cresols obtained from coal 
tar, freed from phenol, hydrocarbons, and water; a colorless refractive liquid, soluble in 60 
of water, miscible in all proportions with petroleum benzin, benzene, alcohol, ether, and 
glycerin. Dose, rniss-ij [a v. njrj.] 

Liquor Cresolis Compositus, Compound Solution oj Cresol, — has of Cresol 50, Linseed 
Oil 35, Potassium Hydroxide 8, Water to 100. A local application, used also as a disin- 
fectant and antiseptic. 

Creolin, Lysol, Izal, Trikresol, and Saprol {Disinfection Oil), are unofficial prepara- 
tions containing cresols, and employed chiefly as antiseptics and disinfectants. Lysoform is 
an unofficial combination of Lysol and Formaldehyde, and is credited with powerful quali- 
ties as a bactericide in 5 per cent, solution. Solutol and Solveol are also unofficial prepara- 
tions of the same class, both being soluble forms of the insoluble cresol (cresylic acid), the 
former containing sodium cresydate, the latter sodium cresotate. Solutol is strongly alkaline, 
and is unsuited to surgical use; Solveol is free from causticity, and is used for dressing wounds, 
etc., in a § per cent, solution, which is said to be more active antiseptically than a 2 per cent, 
solution of Phenol. 

Incompatibles. 

Incompatible with Phenol are: Acetanilide, Acetphenetidin (Phenacetin), Antipyrinc 
Albumin, Antisepsin, Borneol, Bromal Hydrate, Bromine water, Butyl-chloral Hydrate, 
Camphor, Chloralformamide, Chloral Hydrate, Collodion, Diuretin, Ethyl Carbamate (Ure- 
thane), Euphorin, Exalgin, Ferric salts, Gelatin in dilute solution, Hydrogen Dioxide, Lead 
Acetate, Menthol, Methacetin, Naphthol, Nitric Acid, Phenyl Salicylate (Salol), Piperazin, 
Potassium Permanganate, Pyrocatechin, Pyrogallol, Resorcinol, Sodium Phosphate, Thymol, 
Terpin Hydrate. 



378 PHENOL. 

Physiological Action. 

Phenol is antiseptic and disinfectant, somewhat antipyretic, also a local an- 
esthetic, and a depressant of the cardiac, respiratory, cerebral and spinal func- 
tions. In strong aqueous solutions it is destructive to low forms of life, rapidly 
destroying all organized ferments, both animal and vegetable. On unorgan- 
ized ferments (enzymes), such as pepsin and ptyalin, it does not act so readilv, 
but in large doses it destroys their activity, and it is an efficient parasiticide 
against certain vegetable parasites which infest the skin. The foregoing is 
true of the liquefied phenol and its aqueous and glycerin solutions, but not of 
its solutions in oils, which have no antizymotic properties. 

Applied to the skin in weak or moderately strong solutions, it produces local 
anesthesia with a sensation of numbness, which lasts for several hours. Ap- 
plied in concentrated form, it is irritant and superficially escharotic, with burn- 
ing pain of brief duration, and produces at the point of application a white spot, 
changing to red if the acid is soon removed. It does not vesicate, but if the 
application be prolonged, a white eschar or slough results, from coagulation of 
the albumin of the tissue, and this is bordered by a red zone of inflammation. 
Even a 3 per cent, aqueous solution, kept on a part for several days, has pro- 
duced dry gangrene of the tissues (Czerny). This is especially true of the fin- 
gers and toes, probably because the action of the drug on their blood-vessels 
arrests the circulation therein completely. A solution not stronger than 5 per 
cent, applied for 24 hours, caused gangrene of a finger necessitating amputation 
(Harrington) . 

Taken internally, the concentrated Phenol has the same effect on the mu- 
cous membranes as on the skin, producing white, superficial eschars, after burn- 
ing pain of short duration, in the mouth, gullet and stomach. To the latter 
viscus it is a powerful irritant, and causes a violent gastritis. In medicinal 
doses, when acted upon by the gastric secretions, it is converted into a phenol- 
sulphonate, and is so diluted by the contents of the stomach that it loses its 
antizymotic power, and is of no value as an internal antiseptic remedy. In the 
blood it probably circulates as an alkaline phenolate, in medicinal doses having 
no effect upon the circulation or respiration. Its antipyretic power is incapable 
of being utilized, requiring a dosage which would be dangerous. 

A toxic dose paralyzes the vaso-motor centre in the medulla before mark- 
edly affecting the heart. The blood-pressure and body- temperature fall; the 
respiration, at first accelerated by stimulation of the vagi, is quickly depressed 
and ultimately paralyzed; cardiac inhibition is stimulated, the heart being 
first slowed and then depressed. The anterior cornua of the spinal cord are 
first stimulated, producing convulsions; and subsequently depressed, causing 
suspension of reflexes, impaired motility and sensibility, and finally paralysis 
of both motion and sensation. The cerebrum is profoundly depressed, pro- 
ducing stupor deepening into coma, with contracted pupils. Death occurs, in 
most cases, by paralysis of respiration; in a few, by paralysis of the heart. 



PHEN01 . 37Q 

Phenol is readily absorbed and rapidly diffused; many Fatal cases having 
resulted from its external use in undiluted form. A single vaginal injection 
of a moderately weak solution has produced very severe constitutional results. 

It is partly oxidized in the blood, and partly eliminated by (he lungs and kid- 
neys. It imparts to the urine a peculiar smoky or olive-green color, which is 
not due to blood, and may be seen after moderate doses, or even as a result of 
its absorption from dressings. When ingested in a large dose, phenol itself 
may appear in the urine; but the smoky color is due to the presence of its in- 
termediate oxidation products, viz., pyrocatechin (only in alkaline urine), and 
hydrochinone, also salts of phenol-sulphonic acid and glycuronie acid. In 
poisoning thereby the sulphates are absent from the urine. 

.1 case oj poisoning by Phenol shows white, corrugated eschars in'the mouth 
and fauces, if the drug has been swallowed in concentrated form. These eschars 
are also found on the mucous lining of the esophagus and stomach, at the au- 
topsy. The patient complains of an intense, burning sensation along the same 
tract, immediately after the ingestion of the poison, and soon passes into a state 
of collapse; the skin is cold and clammy, the pupils contracted, respiration 
becomes more and more feeble and shallow; the urine, if not entirely suppressed, 
is of a dark-green color; reflexes are then abolished, stupor and coma super- 
vene, and finally the breathing ceases. The blood, after death, is dark in color, 
and coagulates imperfectly; and fatty degeneration of the liver and kidneys 
may be found. When poisoning occurs by absorption, an early symptom is 
the peculiar, smoky color of the urine. There may be pain in the lumbar region, 
indicating renal irritation, and slight restlessness or cerebral disturbance; after 
which comes the impairment of respiration and stupor. 

A toxic dose of Phenol, taken internally, is one of the most rapidly acting 
poisons known, sometimes equalling Prussic Acid in this respect. The symp- 
toms develop almost immediately and death may occur in a very few minutes; 
but usually the patient lives from one to ten hours; rarely over two days. In 
some cases, a great amendment has occurred, with restoration of consciousness, 
but after some hours sudden and fatal collapse has supervened. The minimum 
fatal dose is not determined, but §ss has frequently caused death; and doses 
as small as nivj have given rise to dangerous symptoms. Cases of suicidal 
and accidental poisoning by this drug are very frequent, by reason of the facility 
with which it may be obtained for use as a disinfectant. 

Therapeutics. 
Phenol owes much of its prominence to its having been the principal agent 
at first used in the antiseptic method of treating wounds; but its employment 
in that connection has become much restricted, and many of the most prom- 
inent surgeons have abandoned it altogether in favor of other germicides. Re- 
cent investigations have proved beyond doubt that this agent has a reputation 
as a disinfectant far above that which it deserves; that in the ordinary solutions 



3 ^O PHENOL. 

it is almost useless as a germicide though actively antiseptic; and that very 
many hours of exposure to very strong solutions are required to kill pathogenic 
germs. In the estimation of many, however, it still retains high favor as a 
surgical antiseptic lotion; and it is in general use as a disinfectant for surgical 
instruments, hospital apparatus, soiled linen, etc. The carbolic spray, formerly 
so commonly used during operations, has been entirely discarded. For disin- 
fectant purposes about drains, privies, on floors, walls, etc., Cresol is to be pre- 
ferred, having very high power as a disinfectant. 

As a local application, Phenol has extensive and varied uses. Unna calls 
it the opium of the skin, as it relieves pruritus of almost any form, if applied 
in 5 per cent, aqueous solution over the itching surface; and a lotion, com- 
posed of gr. xx to §ss each of water and glycerin, makes a very efficient appli- 
cation for the itching of jaundice. The glycerite, diluted, effectively destroys 
the fungus of tinea tonsurans or tinea versicolor, and may be applied as a stimu- 
lant to indolent ulcers, or to patches of aphthous stomatitis. Its liability to 
cause gangrene, when applied continuously to a finger or toe (see page 378), 
should be remembered when using it on those members. A one per cent, solu- 
tion in water and glycerin makes an excellent analgesic and cleansing gargle 
for the painful sore throat of tonsillitis, pharyngitis, and diphtheria. Cotton 
soaked in strong phenol and applied to the cavity of a decayed tooth will stop 
the pain, but care must be taken, by covering it with dry cotton, to prevent 
its reaching the gum, or sloughing may result. For burns and scalds a good 
application is phenolized sweet oil of 3 per cent, phenol strength, and the strong 
phenol has been applied by a brush over burned surfaces with excellent results 
in many cases. In this form it is less dangerous than in solution, as it forms a 
protective combination with the exuded blood-serum, and prevents its own 
absorption. In granular conjunctivitis a 5 per cent, solution has been effi- 
ciently applied once a week in the angles of the upturned eyelid, and acute con- 
junctivitis is greatly relieved by holding the open eye in the spray of a steam 
atomizer, the cup of which contains a 5 per cent, solution. This measure may 
also be used for acute coryza with beneficial results; or a mixture of phenol 
and tincture of iodine may be dropped on to a sponge in a wide-mouthed bottle 
and volatilized for inhalation by being wrapped in a cloth wrung out of hot 
water, or by being held in the hand. In phthisis and other chronic pulmonary 
diseases, Phenol has been much employed as a spray by inhalation, and cer- 
tainly does good therein by relieving cough and irritation of the throat. In 
these affections, Creosote is preferred both for internal and local use. For local 
anesthesia in minor surgical operations, such as that for ingrowing toe-nail or 
opening a felon, the part may be soaked for ten minutes in a 30 per cent, solu- 
tion, or the pure phenol may be brushed over the line of incision. 

As a parenchymatous injection, which should be not over jss of a 2 per cent. 
solution, Phenol has been employed with much success in combating deep- 
seated inflammations. The skin being first anesthetized by the local appli- 



PHENOL. 381 

ration of phenol, a hypodermic needle is introduced obliquely, to' the centre of 
the inflamed tissue, but should not be connected with the syringe if any blood 
escapes through it, lest the injection be introduced into a vein. This method has 
been successfully used in glandular swellings, 5 to 10 minims of the solution for 
each gland being sufficient in phlegmons of every grade and character, ery- 
sipelas, poisoned wounds, inflamed bursa?, hydrocele, chronic synovitis, buboes, 
and relapsing tonsillitis. It may be injected into the sac for the radical cure 
of hydrocele, and two minims have proved equally efficient for this purpose as 
the 30 to 90 minims formerly employed. Internal hemorrhoids have been 
cured by Phenol, one or two minims injected into each tumor once a week, in 
10 per cent, solution; but this measure may prove dangerous, and has never 
received general professional approval. Anthrax has been successfully com- 
bated by the local injection of the pure phenol, and in 3 per cent, solution it 
has been used subcutaneously in acute articular rheumatism and neuralgia 
with benefit in many cases. Tetanus has been successfully treated by subcuta- 
neous injections of Phenol in £ to 2 per cent, solutions, Bacelli and Ascoli re- 
porting 73 cases thus treated with only two deaths. The quantity administered 
daily was usually from 5 to 15 grains, but was as high as 60 to 80 grains in some 
cured cases, and a total administration of 500 grains in one, the organism prov- 
ing very tolerant of the remedy in this disease. Under the trade-name Asep- 
tolin, (see page 377), a solution was put forth some years ago containing 2f per 
cent, of phenol, and a minute quantity of a pilocarpine salt, for hypodermic 
use in curable cases of tuberculosis, malaria, and other diseases due to germ 
infection. There is nothing original in this treatment, it being a repetition of 
the phenic acid injection of Declat combined with the pilocarpine treatment 
of phthisis announced several years ago as the "discovery" of Dr. Waldstein. 
It has gone through the usual puffing methods of trade promotion, and the 
few independent reports upon its use show no evidence of any special merit 
for it in these diseases. 

Internally, Phenol is not much employed. It has been given to relieve 
flatulence and dyspepsia, and is often an efficient remedy against vomiting. 
It has proven of considerable temporary benefit in diabetes of hepatic origin; 
and has been used against intermittents, typhoid fever and various zymotic 
diseases; but is probably of no efficacy in constitutional affections. A mixture 
containing phenol and spirit of chloroform was used as an internal remedy for 
typhoid fever in India with satisfactory results, Dr. Quill of the Indian army 
reporting no deaths among those so treated during an entire year, in a country 
where this disease has usually a high mortality record. Phenol is highly praised 
by Dessau as a remedy for catarrhal affections of the 'respiratory tract in chil- 
dren, and has been used with benefit in pertussis, locally as spray, also inter- 
nally and hypodermically. 

The Phenol-sulphonates of Sodium, Potassium, etc., have been employed 
internally in the septic diseases, as the exanthemata, diphtheria, and puerperal 



382 PHOSPHORUS. 

fever, with the object of obtaining the antiseptic action of phenol without the 
dangers attending its use in efficient doses. They may be used locally with 
good results in aphthae, tonsillitis, otorrhea, gonorrhea, and for inflamed mucous 
membranes generally. 

A Cresol preparation named Creolin has been highly praised by von Esmarch 
and others as the ideal antiseptic for external use, but it has given rise to serious 
symptoms when excessively employed. As a vaginal wash in puerperal cases 
the 2 per cent, solution has given general satisfaction, and weaker ones are recom- 
mended by Parvin as a vesical wash in female cystitis. Solutions of 1 in 1000 
are employed locally in otorrhea, rhinitis, blepharitis, keratitis, and nasal ulcers. 
Internally it has been used in doses of truij-v for gastric fermentation, typhoid 
fever and dysentery, and in the chronic form of the latter disease a \ to 1 per 
cent, solution as an injection into the colon has proved very beneficial. 

PHOSPHORUS. This element, its Acids and their salts, the Phosphates 
and Phosphites, are properly studied together, as the chief aim of their medic- 
inal use is to supply phosphorus to the organism. 

Phosphorus, P, — is a non-metallic element obtained from bones, and oc- 
curs as a translucent, nearly colorless solid, of waxy lustre, and the consistence 
of beeswax, insoluble in water, to which, however, it imparts its characteristic 
odor and taste. It is soluble in 50 parts of any fatty oil, in 80 of absolute ether, 
350 of absolute alcohol, and freely in chloroform and in carbon disulphide. 
It has a disagreeable odor and taste, melts at 111 F., and in the air it emits 
white fumes which are luminous in the dark. On longer exposure to the air 
it ignites, and should be kept under water in a cool place, protected from light. 
It usually contains Arsenic and sometimes Sulphur, the limits of which are 
fixed by the official tests. Dose, gr. -3-3-0— 5V t av - 8 r - ris"-] 

Acidum Phosphoricum, Phosphoric Acid, — is a liquid composed of 85 
per cent, of Orthophosphoric Acid, H 3 P0 4 , and 15 per cent, of water, and is 
obtained by oxidizing phosphorus with nitric acid. It is strongly acid, odorless, 
colorless, and miscible in all proportions with water or alcohol. 

Acidum Phosphoricum Dilutum, Diluted Phosphoric Acid, — has of Phosphoric Acid 
10 parts in 75 of Distilled Water, and contains 10 per cent, of Orthophosphoric Acid. Dose, 
irjv-xlv [av. TTJXXX.] 

Acidum Hypophosphorosum, Hypo phosphorous Acid, — is a liquid com- 
posed of 30 per cent., by weight, of absolute Hypophosphorous Acid, H 3 PO,, 
and 70 per cent, of water. 

Acidum Hypophosphorosum Dilutum, Diluted Hypophosphorous Acid, — a liquid 
composed of 10 per cent, of the absolute acid and 90 per cent, of water. Used in the prepara- 
tion of Syrupus Hypophosphitum. Dose, ttjjv-x [av. njfviij.] 

Preparations of Phosphorus. 
Pilute Phosphori, Pills 0} Phosporus, — each contains gr. T fo of Phosphorus, dissolved 
in Chloroform, mixed with Althaea and Acacia in Glycerin and Water, and coated by shaking 
with a solution of Balsam of Tolu in Ether. Dose, j-ij [av. j.] 



PHOSPHOR! s. 383 

Tinctura Phosphori, T)wmpson's, (Unofficial), —Phosphorus gr. i, Absolute u 
7)\, Glycerin Sjss, Vlcohol ,~ii, Spt. Mentha- Piperita- njjxl. Of this 3j contains gr. J of 
Phosphorus. Dose, 7>-s ,ljss. 

Tinctura Phosphori, Bellevue Hospital, (Unofficial), Phosphorus gr. xxxij, Absolute 
loI, Sxlvj, Essence of Vanilla 5j, Oil of Orange ,~>iij, Alcohol q.s. ad oxlviij. Of this 5j 
contains gr. ,' : of Phosphorus. Dose, 5ss-j. 

Phosphites and their Preparations. 

Calcii Hypophosphis, Calcium Hypophosphite, Ca(PH 2 2 ) 2 ,— colorless prisms, or 
thin, pearly scales, of nauseous taste, soluble in 6.S of water, insoluble in alcohol. Is an in- 
(it of the Syrupus Hypophosphitum. Dose, gr. v-xv [av. gr. vijss.] 

Ferri Hypophosphis, Ferric Hypophosphite, Fe(HjPO,) 8l — a white or grayish-white 
powder, odorless and tasteless, slightly soluble in water. A ferruginous tonic. Dose, gr. 
j-v[av. gr. iij.] 

Mangani Hypophosphis, Manganese Hypophosphite, — a pink, crystalline powder, 
soluble in water, almost insoluble in alcohol. Dose, gr. j-v [av. gr. iij.] 

Potassii Hypophosphis, Potassium Hypophosphite, KH 2 PO,, — white masses, or a white 
granular powder, deliquescent, odorless, of saline taste and neutral reaction. Soluble in 0.6 
of water and in 7.3 of alcohol at 59 F. Dose, gr. v-x [av. gr. vijss.] 

Sodii Hypophosphis, Sodium Hypophosphite, NaPH,0 2 + H 2 0, — small plates, or a 
white, granular powder, deliquescent, odorless, of sweetish, saline taste, and neutral reaction. 
Soluble in 1 of water and in 30 of alcohol at 59 F. Dose, gr. v-xxx [av. gr. xv.] 

Syrupus Hypophosphitum, Syrup of Hypophosphites, — has of Calcium Hypophosphite 
4i, of Potassium and Sodium Hypophosphites ii each, per cent. Dose, 5j- oss [av. 5ij] 

Phosphates and their Preparations. 

Calcii Phosphas Praecipitatus, Precipitated Calcium Phosphate, Ca 3 (P0 4 ) 2 , — a light, 
white, amorphous powder, insoluble in water or in alcohol. Dose, gr. ij-xxx [av. gr. xv.] 

Syrupus Calcii Lactophosphatis, Syrup oj Calcium Lacto phosphate, — has of Calcium 
Carbonate 2^, Lactic Acid 6, Phosphoric Acid 3.6, per cent. Dose, oj-iv [av. 5ij-] 

Sodii Phosphas, Sodium Phosphate, Na 2 HP0 4 + i2H 2 0, — large, colorless, monoclinic 
prisms, efflorescent, of saline taste and alkaline reaction; soluble in 6 of water, in i| of boiling 
water, insoluble in alcohol. Its solubility in water is much increased^)' the addition of citric 
acid. Dose, gr. xx-5ij [av. gr. xxx]. 

. Crocq's Solution, for hypodermic use, contains Sodium Phosphate 1, Alcohol 5, Glycerin 
20, Distilled Water 23; the dose of which is tijxlv subcutaneously with aseptic precautions, 
once daily or on alternate days. Luton uses a solution of the crystallized Sodium Phosphate 
and Sodium Sulphate. These solutions are used as substitutes for the animal extracts. 

Sodii Phosphas Exsiccatus, Exsiccated Sodium Phosphate, — is the crystallized phos- 
phate allowed to effloresce, and then gradually heated to 212° F. until the salt ceases to 
lose weight. Dose, gr. x-xx [av. gr. xv.] 

Sodii Phosphas Effervescens, Effervescent Sodium Phosphate, — has of the exsiccated 
salt 20, Sodium Bicarbonate 47 J, Tartaric Acid 25 J, Citric Acid 16}. Dose, 3 j — iij [av. 3ij]- 

Liquor Sodii Phosphatis Compositus, Compound Solution of Sodium Phosphate, — has 
of the Phosphate 100, Sodium Nitrate 4, Citric Acid 13, Water to 100. Dose, 5j-hj [av. 3 ij.] 

Sodii Pyrophosphas, Sodium Pyrophosphate, Na 4 P 2 7 + ioH 2 0, — colorless, mono- 
clinic prisms, of saline taste and alkaline reaction; soluble in 12 of water, insoluble in alcohol. 
Dose, gr. x-xlv [av. gr. xxx.] 

Elixir Ferri, Quininae et Strychninae Phosphatum, Elixir of Iron, Quinine and 
Strychnine Phosphates, — has in each dose of 5j the ^ of a grain of Strychnine. Dose, 
5ss-ij [av. 5j-] 

Glyceritum Ferri, Quininae et Strychninae Phosphatum, Glycerite of the Phosphates 
oj Iron, Quinine and Strychnine, — has of Strychnine gr. 5 {y in each dose of njxv. Dose, nj>x-xx 
[av. ITRXV.] 

Syrupus Ferri, Quininae et Strychninae Phosphatum, Syrup of the Phosphates of 
Iron, Quinine and Strychnine, — has of Strychnine gr. A in each dose of 5j, and is prepared 
by mixing the Glycerite 25 with Syrup to 100. Dose, 5ss-ij [av. oj] 

Ferri Phosphas Solubilis, Soluble Ferric Phosphate, and Ferri Pyrophosphas Solubilis, 
— are described under Ferrum, page 277. 



3S4 PHOSPHORUS. 






Syrupus Phosphatum Compositus, Compound Syrup oj Phosphates, Parrish's Chemical 
Food, (Unofficial), — has in each 5, of Ferric Phosphate gr. ijss, Calcium Phosphate gr. j. 
Dose, oj-iij. 

Melachol (Unofficial), — is a proprietary preparation, advertised to contain in each fo 
eighty-five grains of Sodium Phosphate with Citric Acid and Sodium Nitrate. Dose, 5ss- 3j, 
in water. 

Glycero-phosphates (Unofficial), — have been used, especially in France. Glycero- 
phosphoric Acid is prepared by mixing Phosphoric Acid 1 part, with Glycerin ii, and gradu- 
ally heating to 374 F. When pure, it is a yellow, odorless liquid, of syrupy consistence and 
acid taste, soluble in water and in alcohol. Dose, Ttjjj-v, three times daily. The salts in general 
use are — the Glycero-phosphate of Calcium, dose, gr. ij-v; of Iron, dose, gr. j-ij; of Lithium, 
dose, gr. iij-xv; and of Sodium (in 50 per cent, solution), dose, gr. ij-iv in sodium chloride 
solution by hypodermic injection. 

Incompatibles. 

Incompatible with Phosphorus are all oxidizers. With Phosphoric Acid and the Phos- 
phates are: the Chlorides of Barium, Calcium and Magnesium in ammoniacal solutions; 
Lead Acetate, Silver Nitrate, Soluble Iron Phosphate and Pyrophosphate. With Pyrophos- 
phates are: Albumin, Ferric Choride, Gelatin, Lead Acetate, Silver Nitrate. With Sodium 
Phosphate are: Aretamide, Alkaloids, Antipyrine, Chloral Hydrate, Lead Acetate, Phenol, 
Pyrocatechin, Pyrogallol, Resorcinol, Salicylic Acid, Sodium Salicylate, also those under 
Phosphoric Acid above. With Dilute Hypophosphorous Acid and the Hypophosphites are: 
Arsenic salts, Bromine and Bromates, Chlorine and Chlorates, Chromates, Cupric salts, 
Ferric salts, Iodine and Iodates, Nitric Acid, Permanganates, Sulphuric Acid, Sulphurous 
Acid. 

Physiological Action. 

Phosphorus in small closes stimulates the brain and circulation, the func- 
tions of the stomach and the genital organs, and the growth of bones. It aids 
digestion by irritating the end-organs of the gastric nerves, but produces eruc- 
tations of hydrogen phosphide. Its fumes cause necrosis of the upper or lower 
maxillae especially in those whose teeth are decayed, but this may be prevented 
by the inhalation of the fumes from old acid turpentine. In poisonous doses 
it is a powerful irritant of the gastro-intestinal tract, causing vomiting and purg- 
ing with great depression of the vital forces. Reaching the blood as phos- 
phorus, it is partly oxidized at the expense of the oxygen of the red corpuscles, 
causes acute hemorrhages by producing fatty degeneration of the arterial walls: 
also rapid steatosis of the stomach, liver and heart, accompanied by deep jaun- 
dice; then delirium, convulsions, coma and death, the latter usually from grad- 
ual failure of the respiration and circulation. Acute yellow atrophy of the 
liver resembles phosphorus poisoning so much that it is very difficult to dis- 
tinguish between them. The effect of Phosphorus on metabolism is to increase 
the nitrogenous products, to diminish the excretion of carbon dioxide, to reduce 
the glycogen of the liver to almost nothing, and to raise the temperature. While 
generally increasing metabolism it so influences that process as to arrest it at 
the stage of the conversion of proteids into urea and oil, instead of allowing 
it to proceed to the final oxidation of oil into carbon dioxide and water, and hence 
it induces fatty degeneration of epithelial, glandular and muscular protoplasm 
throughout the body. 

Phosphoric Acid is a weak mineral acid, being much less corrosive and irri- 
tant than the others (see page 72), but in large and concentrated dose it may 
cause gastro-enteritis. It contains no free phosphorus and does not produce 
the effects of that substance, but is believed to increase the amount of phos- 



PHOSPHORUS. 385 

phates in the rod blood corpuscles. In the dilute l"orn\ il is a gastric Ionic and 
a refrigerant. 

Calcium Phosphate is an essential ingredient of all the tissues and Quids of 
the body, and forms more than 50 per cent, of the hones. Lactic and hydro- 
chloric acids dissolve it in small quantities. It increases the alkalinity of the 
blood as well as its power of holding carbondioxide, and diminishes the excre- 
tion of urea. 

Sodium Phosphate acts on the blood and on the excretion of urea similarly 
to the calcium salt. It increases secretion generally, especially that of the 
bile, being an excellent cholagogue and thereby aiding in the digestion of fats. 
In half-ounce doses it is laxative. It is a normal constituent of the blood, is 
the principal agent maintaining the acidity of the urine, and possesses the prop- 
erty of increasing the capacity of any fluid to hold carbondioxide in solution. 

The Hypophosphites are generally tonic in action, and are supposed to 
constitute a safer form in which to administer phosphorus than in the unoxid- 
ized state. They are probably converted into phosphates in the stomach. 

Therapeutics. 

Phosphorus is chiefly used to promote the nutrition of osseous and nervous 
tissue. It is useful in chronic nervous exhaustion when the nerve centres are 
implicated, also in osteomalacia, rachitis and progressive locomotor ataxia. 
In threatened cerebral softening it affects the nerve centres as no other drug 
does, and in paraplegia of myelitic origin from excessive venery it is often effi- 
cient. Progressive pernicious anemia has sometimes been arrested by Phos- 
phorus in very small doses, while in impotence of functional character there 
is no remedy so effective. In wakefulness of the aged and that due to cerebral 
anemia small doses of the pill or tincture are sometimes remarkably beneficial. 
In certain skin diseases (acne, psoriasis, lupus), it is an excellent substitute for 
arsenic. Neuralgia is often cured by Phosphorus, but large doses are necessary, 
at least gr. t '.t every four hours. A solution in Retinol is very stable, and is 
recommended for the external and internal use of the drug. 

Phosphoric Acid in the dilute form is employed as a refrigerant in fevers, 
and as a tonic to weak anemic children with the view of improving the quality* 
of the blood and promoting the growth of the bones. It has been considered 
of value in strumous affections, but is of little real benefit, except as a feeble 
digestive stimulant. 

Calcium Phosphate and the Hypophosphites are used with benefit in all 
diseases of mal-nutrition, and where the repair or development of the bones 
is required. They are particularly useful in protracted suppuration, osteo- 
malacia, rachitis, caries, scrofulosis, chronic phthisis, and in the anemia and 
bone-softening of lactation. The Hypophosphites are much employed in ner- 
vous and general debility and in chronic lung diseases, and are supposed to act 

in the same manner as free phosphorus, but without irritation. They are prob- 
26 



336 PHYSOSTIGAIA. 

ably converted into phosphates in the stomach, and hence may be expected to 
promote the growth and healing of bones, to stimulate the -hepatic and intes- 
tinal secretions, and to affect the lymphatic glands and adenoid tissue. The 
Compound Syrup of the Hypophosphites is an excellent remedy in acne in- 
durata. 

Sodium Phosphate in doses of 3j-ij thrice daily for adults (gr. x-xxx for chil- 
dren) is extremely useful as a laxative in conditions depending on catarrh of 
the bile-ducts and duodenum, as headache, jaundice, and chalky stools. Gall- 
stones may be prevented from forming by scruple or drachm doses before meals 
for months at a time. It is an efficient agent in obesity, hepatic diabetes, in- 
cipient hepatic sclerosis, chronic infantile diarrhea, cerebral debility, bilious 
sick-headache, and the pasty, white stools of ill-conditioned children. Vichy- 
water contains this salt in the proportion of gr. £ to the pint, and is considered 
a valuable water in hepatic colic and kindred conditions. Hypodermic injec- 
tions of Sodium Phosphate have been used with highly beneficial results in 
syringomyelitis and in unilateral astasia-abasia. Drs. Crocq and Luton of 
Rheims advocate the hypodermic use of this salt as a substitute for the organic 
extracts, and maintain that it is equally efficient in all cases in which these ex- 
tracts have proved to be of value. 

Glycero-phosphoric Acid and its salts are said to accelerate metabolism and the nitrog- 
enous exchanges, to promote the assimilation of albuminoids, and to increase the excretion of 
nitrogen, the oxidation of broken-up sulphur compounds and the elimination of sodium chloride. 
They may favor the assimilation of the phosphates of the food and so protect the combined 
phosphorus of the nervous system from waste (Robin). The acid is highly valued as a nervine 
remedy and has been used with benefit in neurasthenia, locomotor ataxia, phosphaturia, 
lithemia and muscular atrophy. The Iron salt is praised in anemia and chlorosis. 

PHYSOSTIGMA, Physostigma, {Calabar Bean),— is the ripe seed of 
Physostigma venenosum, nat. ord. Leguminosas, a woody creeper of Calabar, 
West Africa, where it is used by the natives as an ordeal for witches, vomiting 
after its ingestion being held to establish the innocence of the accused. It con- 
tains the alkaloids, Physostigmine (Eserine), C 15 H 21 N 3 2 ; Calabarine, a tetan- 
izer like strychnine; and Eseridine, which acts like physostigmine but is less 
powerful. The two latter may be decomposition products of physostigmine, 
which is a very unstable body. Dose, gr. j-iij [av. gr. jss.] Physostigma should 
contain not less than 0.15 per cent, of alkaloids soluble in ether. 

Preparations. 

Extractum Physostigmatis, Extract of Physostigma, — an alcoholic extract, of which 
the usual dose is from gr. j r —\, [av. gr. J], but gr. j-iv are used in tetanus. 

Tinctura Physostigmatis, Tincture of Physostigma, — 10 per cent. Dose, ttjjv-xx [av. 

TTJJXV.] 

Physostigmine Salicylas, Physostigmine Salicylate (Eserine Salicylate), — colorless, 
columnar crystals, of bitter taste and neutral reaction, soluble in 150 of water and in 12 of 
alcohol. Dose, gr. r ^- 5 V [ av - gr- TR-] 

Physostigminae Sulphas, Physostigmine Sulphate {Eserine Sulph-ate), — a white, micro- 
crystalline powder, of bitter taste, very deliquescent in moist air, very soluble in water and in 
alcohol. Dose, gr. T hri6 t av - g r - 5? ■] 



PHYSOSTIGMA. 387 

Incompatible*. 

Incompatible with Physostigma preparations are: Caustic Alkalies, Tannic Add and 
other alkaloidal precipitants (sir page 5). Physiologically incompatible arc Atropine, 
Caffeine, Chloral Hydrate, Morphine, Strychnine. 

Physioi ogical Action. 

Physostigma depresses the spinal motor centres and the respiratory centres 
in the medulla, producing loss of reflex action and increasing motor paralysis, 
hut not directly affecting sensation, the cerehral functions, or muscular irrita- 
bility. It stimulates secretion, excites nausea and vomiting, salivation and 
diaphoresis. It stimulates involuntary muscular fibre, especially that of the 
intestines, stomach and bronchial tubes, and is laxative by increasing intestinal 
peristalsis and the intestinal secretions. It slows the heart by stimulating the 
peripheral terminations of the vagus, and increases its contractile force, raising 
the blood pressure. It contracts the pupils and causes spasm of accommodation, 
by direct stimulation of the oculo-motor nerve endings, and diminishes intra- 
ocular tension. Death occurs by paralysis of the respiratory centres in the 
medulla. It is rapidly absorbed, and is eliminated chiefly by the kidneys. 

The alkaloid Physostigmine represents the action of the drug in its effects 
on the spinal centres, the eyes, and the involuntary muscles. Calabarine stimu- 
lates the spinal cord like strychnine, and interferes with the action of physostig- 
mine when present in quantity, as it may be in old specimens of the bean. Eseri- 
dine acts similarly to physostigmine, but is much less poisonous. 

Therapeutics. 

The applications of Physostigma are not many. It is efficient in consti- 
pation due to torpor of the bowels, in which condition it is usually combined 
with belladonna and nux vomica. In tetanus it has been used with advantage 
to diminish reflex excitability, but large doses (2 to 4 grains) must be given, 
and its effects must be carefully watched. In small doses it is a useful remedy 
in many nervous affections, such as locomotor ataxia, writers' cramp and the 
paraplegia due to myelitis, also in progressive paralysis of the insane, which 
is apparently retarded by it. The extract should be given in these diseases, in 
doses of gr. T ^ in pill every three hours; and if the treatment is kept up for six 
months or longer the results will prove very satisfactory, though the improve- 
ment will be slow (Murrell). While theoretically antagonistic in poisoning 
by atropine or strychnine, practically it is not of much value. 

Physostigmine (Eserine) is used locally by ophthalmologists for many pur- 
poses in affections of the eye. In a solution of gr. ij to the 3 of water dropped 
into the eye it is efficient in breaking up or preventing adhesions of the iris, 
diminishes intraocular tension, prevents suppuration after operations, contracts 
the pupil, diminishing the entrance of light in photophobia, and empties the 
vessels of the eye. It is very useful in keratitis, glaucoma, strumous ophthal- 
mia, and neuralgia of the eyeball. The salts of Physostigmine in neutral solu- 



388 PHYTOLACCA — PICHI. 

tion may be used for these purposes, as well as to counteract the effects of atropine 
on the pupil. Gelatin disks medicated therewith may be obtained in the shops, 
and are a convenient form in which to use the drug for ophthalmic purposes. 
In dose of gr. -j-J-y hypodermically it has proved remarkably efficient as an oc- 
casional substitute for morphine, after the final withdrawal of that drug in the 
treatment of its habitues. 



PHYTOLACCA, Phytolacca,— is the dried root {Poke-root) of Phytolacca 
decandra, a plant of the nat. ord. Phytolaccaceas, found in all parts of the United 
States. It contains a neutral principle Phytolaccin, and an acid Phytolaccic 
Acid, also tannin, starch, fixed oil, etc. Dose, as an alterative gr. j-v [av. gr. 
ij]; as an emetic gr. x-xxx [av. gr. xv.] 

Fluidextractum Phytolacca, Fluidextract of Phytolacca, — Dose, as an alterative 
njrj-iv [av. Ttjy'ss]; as an emetic njx-xxx [av. tijjxv.] 

Physiological Action and Therapeutics. 

Phytolacca is emeto-cathartic, acting slowly but persistently, with great 
nausea and considerable depression. It lowers the rate of respiration and of 
cardiac action, and is a motor depressant, paralyzing the spinal cord and the 
medulla, death occurring from paralysis of respiration preceded by tetanic con- 
vulsions. Several cases of poisoning by this plant have occurred. Its action 
is antagonized by alcohol, ether, opium, digitalis, and other motor-excitants. 

Alterative powers have been ascribed to Phytolacca, and competent observers 
have reported curative results from its use in malignant tumors, varicose and 
other ulcers, obstinate eczema, sycosis, favus and other skin affections, em- 
ploying it both internally and externally. It is a serviceable remedy in chronic 
rheumatism, and given internally has undoubtedly cured cases of granular 
conjunctivitis. Mastitis is sometimes aborted and suppuration of the breasts 
prevented by the use of the fluidextract internally while a solid extract is locally 
applied to the seat of the impending inflammation. In tonsillitis and diphtheritic 
sore throat, also in chronic follicular pharyngitis, it has been used with good 
results, especially when there is high fever and pains in the head, back and 
limbs. In true adynamic diphtheria it will do little good. 

Phytolacca has long been known to promote the absorption of adipose tis- 
sue, and was suggested as a remedy for obesity as early as 1858. A resinoid 
preparation of the berries is on the market as an "anti-fat" remedy, under the 
name Phytoline, the dose of which is nrx six times a day, before and after each 
meal. 



PICHI, (Unofficial), — is the shrub Fabiana imbricata, a member of the nat. ord. Sola- 
nacefe, and a native of S. America. Among the Chilians it is prized as a remedy in cystitis 
with calculi and gravel, and in chronic catarrh of the bladder. It seems to have considerable 
power over the hematuria and pain of renal calculus. It is highly praised in dyspeptic dis- 
orders. Its medicinal virtues reside in oleoresinous constituents which are insoluble in water. 



I'lc'ROTOXIMM. 389 

An extract is prepared from the Kavrs, of which the dose is gr. v-.\ in capsules. Dose of 
the fluidextract, oj» but it should not be added to water. 



PICROTOXINUM, Picrotoxin, Picrotoxic Acid, C 30 H 34 O, 3 , (Unofficial),— 
is a poisonous, neutral principle obtained from the seeds contained in the ber- 
ries (Cocculus Indicus, fish-berries), of Anamirta paniculate (Anamirta cocculus, 
Menispermum cocculus), a climbing shrub of the nat. ord. Menispermaccae, a 
native of the East Indies. The berries contain, besides Picrotoxin, a large 
quantity of fixed oil and other substances of less interest. In the shell are found 
Menispermin an alkaline principle, Paramenispermin which is neutral and crystal- 
line, and Hypo picrotoxic Acid. 

Picrotoxin occurs in colorless, flexible crystals, of bitter taste and neutral reaction, sol- 
uble in 240 of water and in 9 of alcohol, also in acids and in alkaline solutions. Dose by the 
stomach gr. „',,-.',,, cautiously. For hypodermic use a solution in water of gr. ij in oj may be 
used, in doses of gr. 55— -iV of the principle, Tljuv equalling gr. ,.,'„-. 

Unofficial Preparations of Cocculus. 
Tinctura Cocculi, Tincture of Cocculus, — 1 in 8. Dose, njjij — xv. 
Fluidextractum Cocculi, Fluidextract of Cocculus. — Dose, trgj-iij. 
Planat's Tincture of Cocculus, — 1 in 4. Dose, njjj-v. 

Incompatibles. 

Acids are chemically incompatible. Chloral Hydrate, Morphine, and general Anes- 
thetics are physiologically incompatible except to its depressant action on the heart and res- 
piration. 

Physiological Action. 
Picrotoxin at first stimulates and finally paralyzes the centres in the medulla 
oblongata, and somewhat excites the spinal cord. The first symptoms of a 
physiological dose are vomiting, salivation, sweating, rapid respiration, mus- 
cular twitching, slowed pulse, and palpitation of the heart, followed by a period 
of stupor and unconsciousness. Then occurs a series of powerful convulsions, 
commencing in tonic spasms and quickly changing to clonic contractions of 
the jaws and limbs, during which respiration is interrupted and may cease al- 
together. The body temperature is raised, the reflexes are exalted, the heart 
is slowed, the arterial tension is increased, and the respiration, at first quick- 
ened, finally becomes slow and labored. Under a toxic dose the stimulant 
effects are rapidly followed by paralysis. Death occurs usually from asphyxia, 
due partly to the convulsions and partly to the final paralysis of the respiratory 
centres; in some cases from paralysis of the heart, which is arrested in diastole. 
The spasms caused by Picrotoxin are choreic and chiefly affect the flexor mus- 
cles, — those from Strychnine are tetanic, affecting principally the extensors. 
The order, succession and character of the phenomena produced by Picrotoxin 
resemble in marked degree those of the epileptic paroxysm. Picrotoxin is 
poisonous to the lower forms of life, and is therefore powerfully antipara- 
sitic. 



39° pilocarpus. 

Therapeutics. 
Picrotoxin is used chiefly in nervous diseases. Epilepsy is somewhat amen- 
able to it, especially when the attacks are nocturnal, also in anemic cases and 
those attributable to onanism. Paralyses of several forms have been greatly 
benefited by it, especially paralysis of the sphincters, hemiplegia from cold, 
glosso-labio-laryngeal paralysis and paralysis agitans. Chorea is well treated 
by it but requires full doses. It is remarkably efficient in vaso-motor disorders 
of the menopause, and is sometimes effective in controlling the night sweats 
of phthisis and in flatulent colic, also in dyspepsia with flatulence and severe 
epigastric pain, and in vomiting with giddiness, headache and intolerance of 
light and sound. Dysmenorrhea is often benefited by Cocculus administered 
for two days before the period; and leucorrhea, when the discharge is sero-punr 
lent with lumbar pains, is frequently controlled by it. Parasitic skin diseases 
are well treated by an ointment of Picrotoxin (gr. x to the 5) which will also 
kill pedicuh, but it must be used cautiously and with special care to avoid an 
abraded surface. The tincture may be used undiluted as a wash to kill body- 
lice. Cocculus berries are used to stupefy fish, being thrown into ponds con- 
taining them. They are also employed to adulterate beer and porter in order 
to make these drinks more intoxicating. A decoction of the berries or Picro- 
toxin itself, is used for "knock-out" purposes by criminals, administered in 
beer or other intoxicating beverages. 

PILOCARPUS, Pilocarpus (Jaborandi), — the leaflets of Pilocarpus Jabo- 
randi or of Pilocarpus micro phyllus, Brazilian plants of the nat. ord. Rutacea.*, 
yielding on assay not less than \ per cent, of alkaloids. They contain the al- 
kaloids Pilocarpine, C u H 16 N 2 2 , a syrupy fluid, slightly soluble in water, and 
forming salts; Jaborine, isomeric with pilocarpine, but antagonistic thereto 
in action, and does not form crystallizable salts; Pilocarpidine, which acts like 
pilocarpine; also a volatile oil, which consists chiefly of Pilocarpene, C 10 H 16 , 
and a peculiar acid. Dose, gr. x-xlv [av. gr. xxx.] 

Preparation and Salts. 
Fluid extractum Pilocarpi, Fluidextract of Pilocarpus, — Dose, ttjx-xIv [av. itjxxx.] 
Pilocarpine Hydrochloridum, Pilocarpine Hydrochloride, — white, transparent crys- 
tals, deliquescent in the air, very soluble in water or alcohol. Dose, gr. J— J [av. gr. ;.] 

Pilocarpine Nitras, Pilocarpine Nitrate, — white, shining crystals, permanent in the air; 
soluble in 4 of water and in 60 of alcohol. Dose, gr. J-J [av. gr. i.] 

Incompatibles. 
Incompatible with Pilocarpus are: Alkaloidal precipitants (see page 5), Calomel, Po- 
tassium Permanganate. Atropine is physiologically incompatible with pilocarpine. 

Physiological Action. 
Pilocarpus is a paralyzer of the vaso-motor system, and a stimulant of the 
peripheral terminations of nerves supplying glands and involuntary muscular 



PILOCARPUS. 391 

fibre, subsequently paralyzing the latter. It is therefore a powerful diaphoretic 
and sialogogue, a cardiac depressant by stimulation of the vagus ends, also 
myotic, emetic, and under some circumstances abortifacient. Its taste is hot 
and pungent. It causes prompt and profuse perspiration (51'x-xv in quantity) 
and salivation (jx-xxvij) after a preliminary flushing of the skin. The nasal, 
bronchial and lachrymal secretions are much increased, sometimes watery diar- 
rhea occurs; the action of the heart at first increased is afterwards lowered, 
the arterial tension is reduced, and the temperature falls from i° to 4 F. Drowsi- 
ness, pallor, chilliness and debility succeed, and last several hours; the pupils 
are contracted and accommodation is impaired; elimination of urea is greatly 
increased, but not the quantity of urine; the respiratory power is lowered and 
apnea may occur from increase of the bronchial mucus. Its active principle 
is rapidly absorbed, and is eliminated by the skin, the salivary glands and the 
kidneys, the effects passing off usually in from three to six hours. Children 
are less affected than adults by proportionate doses. It causes contraction of 
the bladder, uterus and spleen, in the latter case whether the organ is enlarged 
or of normal size. The desire to urinate, which is experienced after a full dose, 
is due to the drug causing contraction of the bladder. Pilocarpus is not a diu- 
retic but tends rather to diminish the quantity of urine as a result of its power- 
ful diaphoretic action. 

Pilocarpine is the principle to which the foregoing actions are due, but Jabo- 
rine, though chemically identical, is perfectly antagonistic thereto in its effects 
on the heart, pupils, lungs and salivary glands, acting precisely like atropine 
on these organs. 

Therapeutics. 

Pilocarpus is used with benefit in dropsies, especially the renal form, also 
in eclampsia of renal origin, in uremia, pleuritis, meningitis 'and other inflam- 
mations of serous membranes, but is contraindicated when from any cause 
there is a weak heart. In diabetes insipidus it reduces the quantity of urine 
remarkably, relieving the kidneys by throwing their work on the skin. In the 
acute and chronic forms of Bright's disease it has been used with advantage, 
but being very depressant it must be employed with great caution in this dis- 
order. For alopecia it is the most efficient remedy known, stimulating the 
skin and improving the color and condition of the hair. In agalactia it stimu- 
lates the secretion of milk, and it often gives prompt relief in parotitis. Ptyal- 
ism is frequently relieved by minute doses of Pilocarpine (gr. ^), which, act- 
ing specifically on the same gland, may correct its morbid action, and similar 
doses used thrice daily will check profuse perspiration. The hypodermic use 
of Pilocarpine will arrest a paroxysm of spasmodic asthma and is equally effi- 
cient in hiccough. Atropine-poisoning is best combated by the use of Pilocar- 
pine hypodermically. 

Diphtheria has been treated with Pilocarpine successfully, Guttmann hav- 
ing reported eighty-one cases without a single death; but other clinicians have 



392 PIMENTA — PIPER. 



not found it so efficient, and Lashkewilz and Jacobi condemn it absolutely 
In children above the age of five years, in whom the condition of the heart does 
not contraindicate it, this drug often gives pronounced satisfaction in detach- 
ing the false membrane and preventing its reformation; but care must be taken 
to give full support by food and alcohol throughout its use, and to avoid it alto- 
gether in cases which manifest cardiac weakness or great depression. In ery- 
sipelas it is often highly efficient, and for the purpose of breaking up a common 
cold it is one of the best agents at our command. For the latter purpose the 
fluidextract of Pilocarpus may be used in doses of ^x-.^j according to age, 
given at bed-time and repeated once or twice during the night if necessary. 
Children bear it well in all its physiological actions. 

Ophthalmologists employ Pilocarpine with most excellent results in the 
amblyopia of alcoholism and that from the abuse of tobacco, in detachment of 
the retina, chronic iritis, keratitis, glaucoma, hemorrhage into the vitreous, 
atrophic choroiditis, white atrophy, to promote resolution and absorption in 
inflammatory conditions with exudation, and instead of physostigmine as a 
myotic. Pilocarpine is highly efficient as an aid to sorbefacient remedies in 
removing inflammatory exudations and promoting the absorption of effusions. 
When iodides and mercurials are being used for these purposes their action is 
greatly aided by this drug administered occasionally for a few days at a time. 
It has been suggested by Waldstein as a remedy in phthisis for the purpose of 
inducing leucocytosis and stimulating glandular activity, and is one of the in- 
gredients in a "cure" for consumption named Aseptolin, (see page 381.) 

PIMENTA, Allspice, — is the dried, nearly ripe fruit of Pimenta officinalis, a West Indian 
tree of the nat. ord. Myrtaceae. The berries contain a Volatile Oil which is official, a green 
fixed oil, fat, tannin, gum, resin, etc. Dose, gr. x-xl [av. gr. xv.] 

Oleum Pimentae, Oil 0} Pimenta, — the volatile oil, colorless or pale yellow, of aromatic 
odor, pungent taste and slightly acid reaction. It contains Eugenol 65 per cent, (see under 
Caryophyllus, page 208); and is a constituent of Bay Rum. Dose, njjij-v [av. njiij.] 

Allspice is a warm, aromatic stimulant, very useful as a condiment, improving digestion 
by increasing the vascularity of the gastric mucous membrane and by stimulating the salivary 
secretion. The oil is an agreeable remedy for flatulence, nausea, and intestinal colic, and is 
used to prevent the griping of purgatives and to cover the taste of nauseous medicines. 

PIPER, Pepper, {Black Pepper), — is the dried, unripe fruit of Piper nigrum, or Pepper- 
vine, a perennial plant of the nat. ord. Piperaceae, growing in India, Siam, Java, and Borneo. 
It contains a base, Piperine, which is official, also agreen, acrid, concrete oil, a balsamic volatile 
oil, starch, lignin, gum, extractive, etc. Dose, gr. v-xx [av. gr. vijss.] 

Oleoresina Piperis, Oleoresin oj Pepper, — contains almost all the volatile oil and acrid 
resin extracted by acetone, with but little of the Piperine. Dose, gr. £— j [av. gr. ss.] 

Piperina, Piperine, C 17 H 19 N0 3 , — a feeble base obtained from Pepper, and other plants 
of the Piperaceae. Occurs in colorless or pale-yellowish prisms, of neutral reaction, almost 
insoluble in water, slightly so in ether, but soluble in 30 of alcohol. Dose, gr. j-x [av. gr. iij.] 

Piperidinum, Piperidin (Unofficial), — is produced by the hydrolysis of Piperine, or 
synthetically by reducing pyridine by nascent hydrogen. It occurs as a colorless, limpid liquid, 
and is a powerful base. The Acid Tartrate is a white, crystalline powder, readily soluble in 
water, the dose of which is gr. x-xv. 

Pepper when applied to the skin acts as an irritant; internally its effects are similar to those 
of other aromatics, being a warm carminative and stimulant, increasing slightly the action of 






PIP] R \/IM \l. 






the heart, stimulating the kidneys soirfewhat, and toning up the mucous membrane of the 
urinary and intestinal passages, by which channels it is eliminated. It has been though 
possess antiperiodic power, and was formerly much employed in intermittents. Its ■ 
medicinal use is to correct flatulence, and to excite action of the stomach, being 
monly taken as a condiment with food. It is occasionally employed in gleet, bul mo 
tensivelv in hemorrhoids and other diseases of the rectum. Its at live constituents are the con 
crete oil or resin and the volatile oil, Pipeline having very slighl action on the system except as 
an antiperiodic and antipyretic, qualities which it certainly possesses. 

Piperidin Tartrate increases the solvent power of serum for sodium biurate to a much 
greater extent than Piperazin, Lysidin, or Urotropin, and has been employed as a solvent for 
gouty deposits, uric acid gravel and calculi. 

PIPERAZINUM, Piperazin, Diethylene-diamme, C.,H 10 N, (Unofficial),— is 
a synthetical basic compound formed by the action of ammonia upon ethylene 
bromide or chloride; and occurs as a white, crystalline powder, soluble in water 
and liquefying when exposed to the air, from which it absorbs water and carbon 
dioxide. Dose of the base or its hydrochloride, gr. v-xv. It may be injected 
hypodermically in 3 to 5 per cent solution. 

Incompatiblcs. 

Incompatible with Piperazin are Acetanilide, Acetphenctidin (Phenacetin), Alkaloidal 
salts, Alum, Butyl-chloral Hydrate, Chloral Hydrate, Copper Sulphate, Ferric Chloride, 
Ferrous Sulphate, Mercuric Chloride, Phenol, Phenocoll, Picric Acid, Potassium Perman- 
ganate, Quinine, Silver Nitrate, Solution of Arsenic and Mercury Iodide, Sodium Salicylate, 
Spirit of Nitrous Ether, Tannic Acid. 

A nalogues. 

Lycetol, Dimethyl-piperazin Tartrate (Unofficial), — is a uric acid solvent, which is said 
to combine the solvent properties of Piperazin with the alkalinizing and diuretic effects of a 
tartrate. The dose is gr. xv-xxx daily, administered in carbonated water or in the form of 
lemonade. 

Lysidin (Unofficial), — is a base obtained by the action of sodium acetate upon ethylene- 
diamine hydrochlorate, and said to possess a solvent power on uric acid five times greater 
than that of Piperazin. It has been tried in cases of chronic gout with excellent results. The 
stiffness of the joints was lessened, and a conspicuous reduction occurred in the tophi around 
the joints, and on the epiglottis in one case. The dose is 5 ss- 5 ijss of the 50 per cent, alkaline 
solution in a glassful of carbonated water. 

Piperidin Tartrate, — a powerful solvent of sodium biurate, is described above, under 
the title Piper. 

Hexamethylenamine (Urotropin), — a uric acid solvent, is described under Formalde- 
hyde, page 284. 

Piperazin possesses the valuable property of forming with uric acid a very 
soluble compound, piperazin urate being seven times more soluble in water 
than is lithium urate, the former requiring but 50 parts and the latter 368 parts 
of water for solution. It is non-toxic, and devoid of powerful physiological 
effects, being well borne without ill results, even when administered for pro- 
longed periods. It is non-irritant to mucous membranes, is readily absorbed 
from the stomach, and circulates in the blood unchanged, reaching the parts 
affected by gouty deposits in a condition in which it neutralizes and dissolves 
the latter, thus facilitating their removal from the body. 

The administration of Piperazin in gout promptly reduces the redness and 
swelling of the affected joints, and is frequently followed by a discharge of 
gravel. The minimum daily dosage for this purpose is about 15 grains, which 



394 PISCIDIA — PIX. 

should be dissolved in half a pint of water, and the solution should be addec 
to a pint or more of any convenient darbonated water, and taken in divided 
doses through the day. It gives marked relief in the pruritus of the uric acid 
diathesis due to the irritation of imperfect nitrogenous elimination. In solution 
it may be introduced into the bladder in order to dissolve vesical calculi of the 
uric character, and in gout it may be locally employed by hypodermic injection. 
A one per cent, solution, applied locally to open gouty sores, relieves the pain 
and reduces the inflammation. It should be tried in rheumatic arthritis of 
difficult diagnostic differentiation. As a solvent for uric acid and urate con- 
cretions Piperazin has been highly praised by many observers and its efficacy 
disputed by many others. It is patented, which fact, together with its extremely 
high price, prevents its general use. It is supplied in vials containing 10 grammes 
(150 grains), which is sufficient for ten days' dosage and may be prescribed in 
Sviij of water, of which solution the daily dose would be 5j (equal to i8| grains), 
taken in a quart or more of any carbonated water during the day in broken 
doses. 



PISCIDIA, Jamaica Dogwood (Unofficial), — is the barkof the root of Piscidia erythrina, 
a tree of the nat. ord. Leguminosae, growing in the West Indies. It occurs as a tough, fibrous 
bark, of heavy, narcotic odor, and contains a yellowish, resinoid substance named Piscidin. 
Its active principle has not been isolated. A fluidextract is on the market, of which the dose 
is 5ss-j, carefully increased. 

Piscidia has a narcotic effect on many animals, and has been used in Jamaica for many 
years to stupefy fish, so that they may be easily taken. It produces muscular relaxation, 
incoordination of movement, lowered sensibility, increased action of the heart and increase 
of the arterial tension by stimulation of the vaso-motor centre. Soon however the heart is 
weakened, vascular tension falls, and a tetanoid state results from stimulation of the spinal 
cord, with reduced reflex action. On the brain its effects resemble those of Opium, but it 
causes deep sleep without any unpleasant after results. It relieves pain in less degree how- 
ever than Opium does, but its hypnotic action is greater. It also relieves cough and spasm, 
produces diaphoresis and salivation and dilates the pupil. From toxic doses death occurs 
by asphyxia in animals. In man its action is probably the same, but in decidedly less marked 
degree. 

Piscidia is used chiefly as a general nervous sedative. Its hypnotic and anodyne powers 
are somewhat uncertain, but have in many cases been very decided. It is useful in whooping- 
cough and spasm, and has proved almost specific in many cases of neuralgia, while in others 
it has caused great gastric distress without the least anodyne effect. 



PIX, Pitch, — is a resinous exudation from the stems of certain trees of the 
genera Pinus (pines) and Abies (firs and spruces), and may also be obtained 
as a residue of the distillation of tar. Its chief constituents are Resin and a 
Volatile Oil which is a mixture of several isomeric terpenes in varying propor- 
tions. The only official form is — 

Pix Liquida, Tar, — a product obtained by the destructive distillation of 
the wood of Pinus palustris and other species of Pinus, nat. order Pinaceae. 
It is thick, viscid, semi-fluid, blackish-brown, of acid reaction, terebinthinate 
odor, and sharp, empyreumatic taste; slightly soluble in water, soluble in al- 
cohol, in oils and in a solution of potassa or of soda. Its principal constituents, 
are Oil of Turpentine, Creosote, Phenols, Pyrocatechin, Acetic Acid, Acetone 



PIX. 



.595 



Xylol, Toluol, Methylic Alcohol, and Resins. By distillation it yields an acid 
liquor Pyroligneous Acid, and an empyreumatic oil (see Oleum Picis Liquids 
below), the residue being pitch. Dose, n\,v-xx [av. gr. vijss], in pill, up to 
,~ij daily. 

Pix Burgundica, Burgundy Pitch, — the prepared resinous exudation of Abies excelsa, 
(ho Norway Spruce, a native of Europe and Northern Asia. It occurs in hard, brittle, opaque 
or translucent mass, with a shining, eonchoidal fracture, almost entirely soluble in glacial 
acetic acid; is very fusible, and at the body-heat it softens and becomes adhesive. It is mildly 
stimulant to the skin, and is used as a basis for plasters. 

Pix Canadensis, Canada or Hemlock Pilch (Unofficial), — is the prepared resinous exu- 
dation of Abies canadensis, the Hemlock spruce of the U. S. and Canada. Its properties are 
much the same as those of Burgundy Pitch. 

Preparations. 

Oleum Picis Liquidae, Oil of Tar, — a volatile oil distilled from Tar. Dark, reddish- 
brown (almost colorless when fresh), of tarry odor and taste and acid reaction, readily soluble 
in alcohol. Contains a great variety of compounds, including Cresols, Guaiacol, Phenol, 
Xylol, Toluol, Pyrocatechin, Methylic Alcohol, and Acetone. Dose, ngj-v [av. ltjfiij.] 

Syrupus Picis Liquidae, Syrup of Tar, — has of Tar \ per cent.; and is a sweetened Tar- 
water. Dose, 5ss-ij [av. oj.] 

Unguentum Picis Liquidae, Tar Ointment, contains of Tar 50 Parts, Yellow Wax 
15, Lard 35. Is irritating unless mixed with finely levigated chalk. 

Infusum Picis Liquidae, Tar Water (Unofficial), — made by shaking Tar 1 with Water 4 
frequently during 24 hours, decanting and filtering. Dose, Oss-j daily. 

Vinum Picis Liquidae, Wine of Tar (Unofficial), — Tar Sxvj, Glycerin, White Wine, 
Honey, aa oviij, Acetic Acid oj, Boiling Water Ovj, shaken together and digested in a 
closed vessel for two hours at 150 to 160 F., then macerated for a few days, frequently shaken, 
strained and filtered. Dose, 5j-iv. 

Oleum Pini Sylvestris, Oil of Scotch Fir (Unofficial), — a colorless, fragrant oil, distilled 
from the leaves of Pinns Sylvestris, resembling Turpentine in action. Used by inhalation 
( 5ss to Oj of boiling water), or locally. 

Concentrated Extract of Pinus Canadensis (Unofficial), — is an aqueous, non-irritant 
astringent, prepared from the Abies Canadensis or Hemlock Spruce. It is said to have a 
specific tonic action upon mucous membranes. Two kinds are sold, one being called the 
White Extract, in reality a golden yellow, and the other the Dark Extract, the former intended 
for use when it is desirable to avoid staining the linen. This preparation received the endorse- 
ment of Dr. J. Marion Sims, and has been extensively employed, both locally and internally, 
as a topical application in uterine and vaginal catarrhs, and as a systemic remedy in catarrhal 
inflammation of the gastro-intestinal and broncho-pulmonary mucous membranes. 

Physiological Action and Therapeutics. 
Tar is a complex mixture of resins and hydrocarbons, containing creosote 
and phenol, which give it irritant qualities. Internally it is 'expectorant, and 
produces gastro-intestinal irritation, sometimes severe headache, giddiness and 
febrile phenomena. It is eliminated chiefly by the kidneys, which it stimulates 
and may congest, causing increased diuresis. Externally it is a decided stimu- 
lant to the skin, often giving rise to considerable irritation and pain. It is anti- 
septic and in most of its effects it resembles the turpentines. Tar is used as 
a local application in chronic scaly skin diseases, especially psoriasis and chronic 
eczema. As an atomized inhalation it is of decided benefit in bronchitis, pharyn- 
gitis, laryngitis and winter cough. Internally it may be employed with advan- 
tage in these affections, also in hemorrhoids, bronchial catarrh, and phthisis. 



396 PLANTAGO — PLUMBUM. 

The best preparation for internal administration is the syrup, which is a sweet- 
ened tar-water, the sugar forming with the tar a soluble compound. 

Burgundy Pitch has been dismissed from the pharmacopoeia, its place as 
a basis for plasters being now taken by Lead Plaster. It is a gentle rubefacient 
when applied to the skin, but in some persons if used extensively it causes a 
vesicular and pustular inflammation. Locally as a plaster it is beneficial in lum- 
bago, chronic rheumatism, chronic pleurisy, painful joints, and superficial 
neuralgia, protecting the part from variations of temperature, and perhaps by 
gentle pressure stimulating the lymphatics and promoting absorption. A vol- 
atile oil from the Hemlock Spruce has been used as an abortifacient, with dan- 
ger to the life of the subject. Pitch is supposed to have a special influence on 
the rectum, and in pill with tar has been used as a remedy for hemorrhoids. 

PLANTAGO, Plantain (Unofficial), — is the leaf of Plantago major and Plantago lanceo- 
lata, nat. ord. Plantaginaceas, the common ribbed grass. The pounded leaves applied as a paste 
or the dry leaf powdered, are actively hemostatic, stopping hemorrhages speedily. Among the 
ancients it had a good reputation as a remedy for toothache and earache, which still adheres 
to it in Switzerland and other parts of Europe. In many other painful affections it is extremely 
efficient, especially in mastitis, rhus-poisoning, erysipelas, burns, scalds, wounds and bruises. 
A poultice of the leaves may be applied to the affected part, and an infusion administered inter- 
nally. A fluidextract is sold in the shops, of which the dose is njv-xv. 

PLUMBUM, Lead, Pb, — is a soft solid metal, which occurs in nature 
chiefly as a sulphide (galena), also as carbonate, phosphate and sulphate, and 
as an oxide rarely. It resists the action of air, some strong acids, and pure 
water free from air, but aerated water oxidizes and dissolves it in small quantity. 
Its official salts are as follows: — 

Official Salts oj Lead. 

Plumbi Acetas, Lead Acetate, (Sugar of Lead), — Pb(C 2 H 3 2 )2+3H 2 0, — colorless, shin- 
ing, prismatic crystals or scales, efflorescent, of faintly acetous odor and acid reaction, and a 
sweetish, astringent and metallic taste. Soluble in 2.3 of water and in 21 of alcohol at 59 F., 
in 0.5 of boiling water and in 1 of boiling alcohol. Dose, gr. ss-ij [av. gr. j.] 

Plumbi Iodidum, Lead Iodide, Pbl 2 , — a heavy, bright, citron-yellow powder, odorless 
and tasteless, fusible and volatilizable by heat; soluble in about 2000 of water at 59 F., and in 
about 200 of boiling water. Used externally as an ointment. May be given internally in doses 
of gr. \ twice daily. 

Plumbi Nitras, Lead Nitrate, Pb(N0 3 ) 2 , — colorless, opaque, octahedral crystals, odorless, 
of sweetish, astringent and metallic taste and acid reaction; soluble in 2 of water at 59 F., 
almost insoluble in alcohol. Used locally as an astringent and deodorizer in solutions up to 1 
per cent., also as an escharotic and a disinfectant. 

Plumbi Oxidum, Lead Oxide, {Litharge), PbO, — a heavy, yellowish, or reddish-yellow 
powder, odorless and tasteless; insoluble in water or alcohol, almost but wholly soluble with 
slight effervescence in dilute nitric acid. When heated in contact with charcoal it is reduced 
to metallic lead. Used as Lead Plaster and sometimes with oil as an external application. 

Preparations. 

Liquor Plumbi Subacetatis, Solution oj Lead Subacetale, (Goulard's Extract), — an 
aqueous solution containing about 25 per cent, of the salt, prepared from Acetate of Lead 18, 
Oxide of Lead n, and Distilled Water to 100. It is a clear, colorless liquid, of sweetish, 
astringent taste and alkaline reaction, and when added to a solution of acacia it produces a 
dense, white precipitate. • Used locally as an astringent and cooling lotion, diluted usually 
with an equal quantity of water. 



PI I'Ml'.l \l. 



397 



Liquor Plumbi Subacetatis Dilutus, Diluted Solution oj Lead Subacetate, ( Lead 1 1 ater ) , 
has of the preceding 4, in Distilled Water to 100. Used locally as a mildly astringent and cool 
ing lotion. 

Ceratum Plumbi Subacetatis, Cerate oj Lead Subacetate, (Goulard's ( erate) — has of the- 
solution of Lead Subacetate 20 per cent., with Camphor 2, Wool Fat 20, Paraffin 20, Whiti 
Petrolatum 38. An astringent application. 

Emplastrum Plumbi, Lead Plaster, — has of Lead Acetate 60, Soap 100, each dissolved 
in hot water, mixed, and the liquid decanted. It is pliable and tenacious, and forms the basis 
of other plasters. 

Emplastrum Adhaesivum, Adhesive Plaster, — has of Rubber 2, Petrolatum 2, Lead 
Plaster 96. 

Unguentum Diachylon, Diachylon Ointment, — has of Lead Plaster 50, Olive Oil 49, 
Oil of Lavender Flowers 1. Used locally in eczema and other cutaneous disorders. 

Unguentum Plumbi Carbonatis, Ointment 0} Lead Carbonate, (Unofficial), — has of the 
Carbonate in very fine powder 10, Benzoinated Lard 90. Used as a dressing for burns. 

Lncompatibles. 

Incompatible with Lead Salts are: Alkalies, Mineral Acids and their salts, Albuminous 
solutions, Opium, Potassium Iodide, Vegetable Acids, Vegetable Astringents, Waters con- 
taining lime, sulphates, carbonates, and carbonic acid gas. With Lead Acetate are: Acids, 
Acetamide, Alkalies, Bromides, Carbonates, Chloral Hydrate, Chlorides, Chromates, Cyanides, 
Glucosides, Gums, Hydrochloric Acid, Iodides, Opium, Phenol, Pyrocatechin, Pyrogallol, 
Resorcinol, Salicylic Acid, Sodium Phosphate, Sodium Salicylate, Sulphates, Sulphides, 
Sulphites, Tannic Acid, Urea, Urethane, Vegetable dcoctions, infusions and tinctures. With 
Solution oj Lead Subacetate are: Acacia, Acids (organic), Albumin, Alkaloids, Antipyrine, 
Glucosides, and otherwise like Lead Acetate. 

Physiological Action. 
Lead salts are all more or less poisonous, but metallic Lead is inert until 
converted into a soluble salt by the acids of the stomach. The Acetate in large 
doses is emetic, so that acute lead-poisoning therefrom is rare. Its chief phenom- 
ena are intense gastro-intestinal irritation, vomiting, paralysis, coma and col- 
lapse. Chronic lead-poisoning, Phtmbism, has its principal sources in pure 
water conveyed by leaden pipes, the use of hair dyes, handling of printing-type, 
and working in the smelting of lead ores. It produces loss of appetite, emacia- 
tion, pallor and constipation, followed by slowing of the heart's action, and 
accompanied by violent colic, muscular impairment evinced by paralysis of the 
extensor muscles of the forearm (drop- wrist), impaired sensibility and albu- 
minuria. Occasionally aphonia, vertigo, gastralgia, headache, stupor and con- 
vulsions are manifested. Rheumatism without fever or tenderness in the joints, 
which however are red and swollen, is a frequent symptom. A blue line (sul- 
phide) is seen along the margins of the gums in those who do not clean their 
teeth. Neuralgic troubles may arise and amblyopia often occurs from impair- 
ment of the optic nerve. The metal becomes deposited in the affected muscles 
and other tissues, and probably acts by impairing the isolating power of the 
nerve-fibres, thus enfeebling the nerve-currents. It also produces contrac- 
tion of the smaller vessels, and may affect any muscles of the body, also the 
brain, producing delirium, coma, and convulsions. Abortion is a frequent 
result, either through an influence on the muscular tissue of the uterus, or from 
a toxic action on the fetus. Death may occur from extension of the paresis to 



398 PLUMBUM. 

the muscles of respiration, from gradual impairment of nutrition, or from con- 
vulsions and coma, a form of disease known as Lead-encephalopathy. 

Astringency is the chief quality of the lead salts; they lessen secretion, con- 
tract muscular tissue and then destroy its contractile power, slow both the 
heart and the respiration, and in time destroy the red blood-corpuscles. Lead 
enters the blood as an albuminate, in which form it is retained by the tissues. 
It is slowly excreted by the liver, kidneys, skin and mammary glands. That 
which escapes by the bile is reabsorbed by the bowel, and is again excreted by 
the intestinal glands, escaping with the feces as a sulphide. It lessens the ex- 
cretion of uric acid. 

Therapeutics. 

Lead salts are chiefly used as astringents and hemostatics. The solution 
of the Subacetate diluted with 4 parts of glycerin and water is locally employed 
in many skin-diseases, especially in eczema, lichen, impetigo, and erythema; 
also in catarrhal discharges of muco-purulent character from the ear, vagina, 
and urethra, particularly gonorrhea and leucorrhea. Inflammations of ex- 
ternal parts are constantly treated by the lotion of Leadwater and Laudanum 
(liquor plumbi subacetatis dilutus 7 parts to 1 of tinctura opii). Though the 
constituents of this lotion are chemically incompatible it is a valuable sedative 
and astringent. The Acetate, in 2-grain doses every three hours, is an effi- 
cient internal styptic in various hemorrhages, particularly in hemoptysis, hem- 
atemesis, and gastric ulcer, as it lowers the action of the heart and constringes 
the vessels. Its astringent action is well manifested in bronchorrhea and other 
pulmonary affections with excessive secretion. It is well used in diarrheas, 
gr. ij with gr. j of powdered opium in choleraic diarrhea, and smaller doses 
for the summer complaint of children. In caseous pneumonia the Acetate is 
highly recommended as the best remedial agent, combined with opium and 
digitalis; and in cardiac hypertrophy it may be used to lower the action of the 
heart. It is serviceable in whooping-cough with profuse bronchial secretion 
and in humid asthma. 

The Carbonate is only used externally to protect irritated surfaces, as ery- 
thema, erysipelas, and intertrigo, in which it may be dusted over the surface 
if unbroken. The official ointment, or white paint mixed with Unseed oil, is 
an excellent application to burns or scalds, but if applied on the broken cuticle 
it may prove rapidly poisonous. The Iodide is employed externally as an oint- 
ment to enlarged lymphatic glands and enlarged spleen, also for chronic eczema 
and psoriasis. It has been used internally to reduce a malarial spleen. 

The Nitrate is an efficient application to fissured nipples, gr. x to 5) of glyc- 
erin. In powder, dusted over unhealthy granulations, and sanious ulcers 
resulting from onychia, it gives prompt relief after a brief period of pain, and 
is said to have cured epithelioma when used in the same manner. In solution 
(gr. x to the §) it is a most efficient deodorizer against the fetor from gangren- 



PODOPHY] I ill PO] VGON1 u. 

ous sores, ozena and other offensive discharges. The Oxide is employed in the 
manufacture of plasters and most of the other salts of load. It may be used 
BS an external application mixed with sweet oil in superficial hums, but care 
should be taken that it is applied only to the unbroken cuticle. It is not em 
ployed internally. 

PODOPHYLLUM, Podophyllum (May Apple),— is the rhizome of Podo- 
phyllum peltatum, the Mandrake, an herbaceous perennial of the nat. ord. 
Herberidacea?, growing in the woodlands of Canada and the United States, 
having a pale-green stem, with a single white flower at its summit. Its active 
principle is a Resin which is official and contains two isomeric glucosides, Podo- 
phyllotoxin and Picropodopliyllin ; also podophyllinic acid and protocatechuic 
acid. Podophyllum probably contains the alkaloid Berberine, which is found 
also in Berberis, Hydrastis and other plants. Dose, gr. v-xx [av. gr. vijss.] 

Preparations. 
Fluidextractum Podophylli, Fluidextract of Podophyllum, — Dose, njjj-xx [av. njjvijss.] 
Resina Podophylli, Resin of Podophyllum, — is prepared by maceration and percola- 
tion in alcohol, and precipitation by acidulated water. Soluble in all proportions in alcohol, 
soluble in ether, chloroform, and solutions of soda or potassa. Dose, as a laxative, gr. j*j— i 
[av. gr. T l jj]; as a purgative, gr. $-j [av. gr. J]. It is an ingredient of the Vegetable Cathartic 
Pills (see page 247). 

Pilulae Podophylli, Belladonnas et Capsici, Pills 0} Podophyllum, Belladonna and 
Capsicum, — have in each pill gr. \ of the resin, with Extract of Belladonna gr. J, and Cap- 
sicum gr. J. Dose, j-ij pills [av. j.] 

Podophyllum is a tonic-astringent and resin-bearing purgative, having action 
similar to that of jalap but slower, like calomel taking 6 to 10 hours to produce 
its cathartic effect. It increases the intestinal secretions and the flow of bile, 
causing copious watery stools, with considerable griping pain and some nausea. 
The powder is irritant to the respiratory passages and to the skin. The Resin 
is an excellent purgative in cases of habitual constipation or portal congestion 
and a useful cholagogue. Laxative effects are produced by small doses but 
grain-doses are necessary for its full action. It should be combined with hyoscy- 
amus, belladonna or cannabis indica, in order to counteract its griping tendency. 
It is an efficient derivative in cases of catarrhal or malarial jaundice, and is 
recommended in very small doses for prolapse of the rectum, remittent fevers 
of children, dyspepsia, hepatic derangement, bilious vomiting and headache, 
and in the vomiting and diarrhea of gastro-enteritis. 

POLYGONUM, Smart-weed, Water-pepper (Unofficial), — is the plant Polygonum 
Hydropiperoides, hat. ord. Polygonaceje, indigenous to the United States, having narrow, 
lanceolated leaves and slender spikes of whitish flowers. It contains Tannin and an active 
principle, Poiygonic Acid, which is green, crystallizable, insoluble in water, but soluble in 
alcohol, ether, and chloroform. Dose, of the Extract, gr. j-v; of the Fluidextract, iipx-xxx 
or more. 

Smart-weed has a pungent, acrid taste, producing a sensation of heat in the stomach, and 
a peculiar tingling throughout the system. It stimulates the action of the heart, raises the 
arterial tension, increases the warmth of the surface, promotes the cutaneous, bronchial and 
renal secretions and the menstrual flow. It is an efficient diuretic, emmenagoguc and aphro- 
disiac. The juice applied to the skin excites inflammation and vesication. 



400 PONGAMIA — POTASSIUM. 

Amenorrhea from functional inactivity of the uterine system is remarkably benefited by 
this remedy in oss doses of the fluidextract four times daily for a week before the expected 
period. It has considerable influence over functional impotence, but produces aching pains 
in the hips and loins, and a sense of weight and fullness within the pelvis. It has been used 
with benefit in diarrhea, dysentery and gravel, also locally in mercurial salivation and the 
sore mouth of nursing women. 

PONGAMIA, Kurung Oil (Unofficial), — is a yellow oil expressed from the seeds of 
Pongamia glabra, an Indian tree of the nat. ord. Leguminosae. It has been used for many 
years in India for skin affections, and in professional hands has proven an excellent applica- 
cation in pityriasis versicolor, rubbed in twice daily. It promises to be a valuable remedy 
in parasitic diseases of the skin, is not irritating and does not discolor the surface to which 
it is applied. 

POTASSIUM, Kalium, K, — is represented by a number of official salts, 

which are colorless or white, sometimes anhydrous, and generally soluble in 

water. The metal itself is not official. The chief source of its salts is the ash 

remaining after the combustion of plants or trees, which contains the Carbonate, 

from which most of the other salts are prepared. There are also two subsidiary 

sources, — the Nitrate, found native, and the Bitartrate, which under the name 

of Crude Tartar or Argol is deposited during the fermentation of wine. It is 

distinguished from all other bases (except magnesium, sodium and ammonium) 

by not being precipitated by ammonium sulphide or ammonium carbonate. 

It is positively known by the violet color it imparts to flame, by its very sparing 

solubility when converted into the bitartrate, and by its precipitation by platinum 

perchloride. 

Potassium Salts and their Preparations. 

Potassii Hydroxidum, Potassium Hydroxide, Potassa, KOH,— a very deliquescent, 
white, hard and dry solid, of very acrid and caustic taste and strongly alkaline reaction, soluble 
in 0.5 of water and in 2 of alcohol. It is a powerful and deeply-acting escharotic, and should 
be kept in well-stoppered bottles made of hard glass. 

Liquor Potassii Hydroxidi, Solution oj Potassium Hydroxide, Liquor Potassa', — is an 
aqueous solution, containing about 5 per cent, of the hydroxide, and prepared by dissolving 
6 of the latter in 95 parts of distilled water. It is a clear, colorless, odorless liquid, of acrid 
and caustic taste, and strongly alkaline reaction. Dose, njv- oss, [av. ttexv], well diluted with 
water. 

Potassii Acetas, Potassium Acetate, KC 2 H 3 2 , — a white, satiny, crystalline mass, very 
deliquescent, odorless, of pungent, saline taste, and a neutral or faintly alkaline reaction, sol- 
uble in 0.4 of water and in 1.9 of alcohol at 59° F. Dose, gr. v- oj [av. gr. xxx.] 

Potassii Carbonas, Potassium Carbonate, K 2 C0 3 , — a white, crystalline or granular 
powder, very deliquescent, odorless, of alkaline taste and reaction, soluble in 1 . 1 of water at 
59 F., insoluble in alcohol. Dose, gr. ij-xx [av. gr. xv.] 

Potassii Bicarbonas, Potassium Bicarbonate, — KHCO3, — colorless prisms of saline and 
alkaline taste and alkaline reaction, soluble in 3.2 of water at 59 F., decomposed by boiling 
water, almost insoluble in alcohol. Dose, gr. v-xlv [av. gr. xxx.] 

Potassii Chloras, Potassium Chlorate, KCIO3, — colorless prisms or plates, of pearly 
lustre, of cooling, saline taste and neutral reaction, soluble in 16.7 of water at 59 F. and in 
1.7 of boiling water; slightly soluble in mixtures of alcohol and water, insoluble in absolute 
alcohol. Dose, gr. j-x [av. gr. iv.] 

Potassium Chlorate should be kept in glass-stoppered bottles, and great caution should 
be observed in handling the salt, as dangerous explosions are liable to occur when it is mixed 
with organic matters (cork, tannic acid, sugar, etc.), or with sulphur, antimonium sulphide, 
phosphorus, or other easily oxidizable substances, and either heated directly or subjected to 
trituration or concussion. It should not be mixed with glycerin in the presence of a free acid. 
[For the combination of this salt with the tincture of the chloride of iron, see page 226.] 



POTAss II \l. 4 OI 

Gargarysma Potassii Chloratis, Potassium Chlorate Gargle (Unofficial), has of the 
-.1I1 3ji in Glycerin ,~>iv and Water to ,lvj. 

Trochisci Potassii Chloratis, Troches 0} Potassium Chlorate, each troche contains 

about 2] grains of the sah, with sugar and tragacanth. Dose, 1 iij, slowly dissolved in the 
mouth. 

Potassii Citras, Potassium Citrate, K^CjHsOj + rLO, — transparent, prismatic crystals, 
odorless, of cooling, saline taste, and neutral reaction, soluble in 0.6 of water, very soluble in 
boiling water, sparingly soluble in alcohol. Dose, gr. x-xxx. [av. gr. xv.] 

Potassii Citras Effervescens, Effervescent Potassium Citrate, — consists of the Citrate 
20, Sodium Bicarbonate 47.7, Tartaric Acid 25.2, and Citric Acid 16.2. Dose, oj-ij [av. 5j ], 
in a glass of water, as an effervescing drink. 

Liquor Potassii Citratis, Solution 0} Potassium Citrate, — contains about 9 per cent, of 
the anhydrous salt, together with small amounts of citric and carbonic acids. Prepared by 
dissolving Citric Acid 6, and Pot. Bicarb. S, each in water 40, filtering the solutions separately, 
and adding in each case enough water to bring to 50 parts, then mixing the two together. Dose, 
3ss-3j or more [av. 5iv]. 

Potassii Nitras, Potassium Nitrate {Saltpetre, Nitre), KN0 3 ,— colorless, transparent 
prisms or a crystalline powder, of pungent, cooling and saline taste and neutral reaction; 
soluble in 4 of water at 59° F. and in 0.4 of boiling water; almost insoluble in alcohol. Is a 
constituent of Argenti Nitras Mitigatus. Dose, gr. v-xx [av. gr. vijss.], well diluted. 

Potassii Silicas, Potassium Silicate, Soluble Glass, K,Si0 3 (Unofficial), — is used in solu- 
tion of a syrupy consistence for the preparation of immovable dressings for fractured limbs, 
etc. [See under Silicates.] 

Potassii Sulphas, Potassium Sulphate, K 2 S0 4 , — colorless, hard, rhombic prisms, of sharp, 
saline and bitter taste and neutral reaction, soluble in about 9.5 of water at 59 F., and in 4 of 
boiling water, insoluble in alcohol. Dose, gr. x-xlv [av. gr. xxx.], well diluted. 

Potassii Bitartras, Potassium Bitartrate, (Acid Tartrate oj Potash, Cream oj Tartar) 
KHC 4 H 4 8 , — colorless rhombic crystals, or a white, gritty powder, of acidulous taste and acid 
reaction; soluble in about 201 of water at 59 F., and in about 16.7 of boiling water, very 
slightly soluble in alcohol. Is a constituent of Pulvis Jalapa; Compositus. Dose, as a diuretic, 
gr. xx- 5 j [av. gr. xxx]; as a purgative oss-j. 

Potassii et Sodii Taxtra.s, Potassium and Sodium Tartrate, (Rochelle Salt), KNaC 4 H,O e - 
+ 4H ; 0, — colorless, rhombic crystals, or a white powder, of cooling and slightly saline and 
bitter taste, and neutral reaction; soluble in 1.4 of water at 59 F., very soluble in boiling 
water, almost insoluble in alcohol. Is a constituent of the following preparation. Dose, oj-iv 
[av. oij] 

Pulvis Effervescens Compositus, Compound Effervescing Powder, Seidlitz Powder, — 
each powder has of the preceding salt about 120 grains, of Sodium Bicarbonate 40 grains, 
mixed in one paper; and of Tartaric Acid 35 grains in another paper. Dose, 1 to 2 pair, dis- 
solved separately in water and the solutions poured together. 

The Arsenite is described under Arsenum, — the Bromide under Bromum, — the Di- 
chromate under Cromii Trioxidum, — the Iodide under Iodum, — the Cyanide and Ferro- 
cyanide under Acidum Hydrocyanicum, — the Hypophosphite under Phosphorus, — the 
Permanganate under Manganum. 

Incompatibles. 

Incompatible with Liquor Potassii Hydroxidi are: Acids, Acid salts, Metallic salts; 
Preparations of Ammonia, Belladonna, Hyoscyamus, and Stramonium. With Potassium 
and Sodium Tartrate are: Acids, Ammonium Chloride, Barium salts, Calcium salts, Lead 
salts, Magnesium Sulphate, Potassium Sulphate, Silver Nitrate, Sodium Sulphate. With the 
Acetate are: Mineral Acids. With the Carbonate and Bicarbonate, see page 205. With 
ihe.Chlorate, see above Potassium Chlorate, also under Chlorum. With the Citrate, see under 
Limox. With the Nitrate see under Ac. Nitricum. With the Sulphate see under Ac. Sui.- 

PHURICUM. 

Physiological Action. 
Potassium Hydroxide, like other caustic alkalies, destroys the tissues by com- 
bining with their water, dissolving the albumin and saponifying the fats, and 
converting the tissue to which it is applied into a moist, gray slough, with con- 
siderable surrounding inflammation. Internally it acts as a powerful corrosive 
27 



4^2 POTASSIUM. 

poison, destroying the mucous membrane of the parts with which it comes in 
contact, and giving rise to intense pain, diarrhea, convulsions and delirium. 
Unless speedily rejected or neutralized it causes death from inflammation of 
the larynx, from the gastro-intestinal lesions, or after some time from stricture 
of the esophagus. Liquor Potassii Hydroxidi, containing over 5 per cent, of 
the hydroxide, possesses in a degree the same caustic properties, and should 
never be administered undiluted. It neutralizes the acids in the stomach, 
and in the blood exists chiefly as the carbonate, being eliminated with the urine 
which it renders alkaline. If its use be continued too long it impairs the blood, 
and renders the subject anemic. 

Potassium Salts in medicinal doses act chemically on the contents of the 
stomach, neutralizing its free acids, and disordering digestion if long admin- 
istered. They increase the saliva, promote oxidation, and stimulate the retro- 
grade metamorphosis of the body, and are therefore waste-producers. In large 
dose they are cardiac depressants, paralyzant to muscular tissue, poisonous 
to protoplasm especially nerve tissue, and injurious to the ozonizing function 
of the blood. The Bicarbonate, taken on an empty stomach, enters the blood 
unchanged, meets the neutral phosphate of sodium and is decomposed, acid 
phosphate of sodium being formed which renders the urine more acid. On a 
full stomach it is decomposed by the acids of the gastric juice, increases the 
alkalinity of the blood and makes the urine less acid. The salts of potassium 
with vegetable acids enter the blood in their own form, are there decomposed, 
forming free C0 2 , and are converted into alkaline carbonates, in which form 
they are eliminated, alkalinizing the blood and the urine. They are diuretics 
also, increasing the urinary water and solids, but decreasing the uric acid by 
causing increased oxidation. The mineral salts are not decomposed in the 
blood, but are eliminated in their own form, the Nitrate being a most active 
diuretic, the Chlorate often irritating the kidneys, depressing the heart, caus- 
ing albuminuria, and impairing the ozonizing function of the blood. In large 
doses these salts decompose the red blood-corpuscles and paralyze the motor 
ganglia of the heart. The Chlorate does not part with its oxygen in the system, 
as formerly believed. The Sulphate is chiefly purgative in its action, but acts 
harshly, and in overdoses has caused death. 

The action of the remaining Potassium salts is described under the titles 
of their acid and other constituents, to which their effects are chiefly referable. 

Therapeutics. 

Potassium Hydroxide is used locally to destroy morbid or cicatricial tissue, 
to cauterize the wounds resulting from bites of animals or stings of insects, to 
form issues or to open deep-seated abscesses, or to destroy chancres, malignant 
pustules, nevi, and warts. 

Liquor Potassii Hydroxidi is used internally as a free alkali to neutralize 
excess of acid in the stomach, blood and secretions, and as an antilithic in the 



POTASSIUM. 403 

uric acid diathesis, also for acne, boils, and obesity. Locally it is employed 
to soften the nail in in-growing toe-nail, and diluted to relieve pruritus and to 
remove scales in various skin-diseases. The Carbonate is diuretic, antacid 
and antilithic, but is seldom used internally being too irritant, and the Bicar- 
bonate having all its virtues without its objectionable qualities. Locally a 
solution (3j to the 5) is said to be effectual as a remedy for pruritus vulvae, and 
one of half the above strength is used in freckles, sunburn and tan of the epi- 
dermis, in moist eczema and the itching of urticaria. 

The Bicarbonate is the most frequently used alkaline carbonate. It is 
employed internally and well diluted for its sedative effect on the stomach to 
relieve the pain and eructations of gastric dyspepsia, to correct hyperacidity, 
and in gastric catarrh to render the mucus less viscid and more easily expelled. 
For its effects after absorption it is used in diabetes, gout and rheumatism, 
to neutralize free acid in the tissues and thereby economize the alkalies of the 
blood; in cystitis and gonorrhea, to correct excessive acidity of the urine and 
soothe the inflamed surfaces; in gall-stones and jaundice, to lessen duodenal 
irritation; and in bronchitis and bronchial catarrh, to promote expectoration. 
Some practitioners rely on it as a febrifuge, and commend it highly in fevers. 
Locally it is employed as a lotion for acne, acute eczema, and fetid perspiration 
of the feet and axillae. 

The Acetate and Citrate are good purgatives in doses of gij to giv, and in 
smaller doses are employed as alkalinizers of the blood and urine and as diu- 
retics. Of the vegetable potassium salts the Acetate is the most certain diu- 
retic, and also promotes the flow of bile, the Bitartrate is the most active cath- 
artic, while the Citrate is the most reliable diaphoretic and the best to alkalin- 
ize the urine, it having the least injurious effect on the blood and on the diges- 
tion. In lithemia the first and last of these salts are given to promote oxida- 
tion, and by keeping the urine alkaline they may reduce small calculi of the 
uric acid variety. In acute rheumatism and fevers they act as antacids in the 
blood, as febrifuges by promoting diaphoresis, and as sedatives to the general 
nervous system. As an agreeable laxative no preparation surpasses the Bi- 
tartrate in 2 to 4 drachm doses made into a paste with orange marmalade or 
any other conserve. It is used as a diuretic in general cardiac dropsy and in 
acute desquamative nephritis. In cases of acute dysentery with scorbutic 
symptoms, as seen among miners and sailors, a full purgative dose of this salt 

- or more) has acted most beneficially as a preliminary to other treatment, 
and in many cases has proven to be the only remedy required. In the acute 
diarrhea of soldiers it is usually promptly curative. Being an acid salt its in- 
ternal administration will in many cases acidify an alkaline urine. 

Potassium Chlorate is employed locally in solution (^ss to the 5) as a deo- 
dorant and detergent wash in inflamed, ulcerated and aphthous conditions of 
the mouth. On unhealthy mucous membranes it exercises an alterative action 
for the better, but if long used it will keep up a state of chronic irritation. In 



404 PRUNUM. 

mercurial salivation it is of benefit, and in dilute solution (gr. x to the 3) is an 
efficient application to unhealthy sores and ulcers, as a wash for foul sinuses 
or cavities, and as an injection in chronic affections of the bladder. The pow- 
dered salt may be applied to aphthae, and dusted over epithelioma will alter the 
action, diminish the pain, check the growth and promote cicatrization. In- 
ternally this salt has been administered with the idea that it parts with its oxygen 
in the system, but it is now acknowledged that it is excreted unchanged. As 
it may set up congestion and irritation of the kidneys it is highly dangerous in 
large doses or if used for any length of time, but is constantly administered 
with benefit in acute tonsillitis, diphtheria, chronic bronchitis, purpura, hem- 
aturia, ovarian tumor, pseudo-membranous laryngitis, scarlatina, typhoid fever 
and chronic cystitis. It is believed to have an almost specific power to limit 
the pharyngeal inflammations of childhood, and the formation of pus in cer- 
vical adenitis of infancy. Advocated half a century ago by Simpson for the 
treatment of habitual miscarriage, its use for this condition has been revived 
by Jardine and Remy, who find that it exercises a beneficial influence on the 
endometrium, and has the power of preserving the life of the fetus and bring- 
ing about normal parturition, if its administration is commenced in the third 
month of pregnancy and continued without interruption until full term. When 
used internally it should be given in small doses, gr. iij-x, up to gr. xx in 24 hours 
for an infant, gr. xxx in 24 hours for a child of 2 to 4 years, and £iss for an adult 
in the same time, and the action of the heart and the kidneys should be care- 
fully watched. It should never be prescribed with potassium iodide lest the 
poisonous iodate be formed, nor with the syrup of the iodide of iron, lest it 
liberate iodine and cause severe gastritis. Strong acids and acid sulphates de- 
compose it, and it forms explosive compounds with easily oxidizable substances, 
as sugar, sulphur, tannin, sodium or potassium hypophosphites, catechu, gly- 
cerin, etc. For the combination of Potassium Chlorate with the tincture of the 
chloride of iron, as a gargle, see under Chlorum. 

The Nitrate has been much employed as a refrigerant diaphoretic and diu- 
retic in febrile and inflammatory affections, especially in inflammation of the 
trachea and bronchi, pneumonia and rheumatism, but its action is uncertain, 
and it is now giving place in these disorders to more efficient agents. The 
Sulphate is used in teaspoonful doses in water as an hepatic stimulant and a 
mild cathartic, increasing the secretions of the intestinal glandular apparatus. 
Its action is sometimes harsh, and death has resulted from overdoses. Potas- 
sium and Sodium Tartrate is the aperient agent in Seidlitz Powders. In doses 
of sss-j it is a gentle and cooling laxative, and in drachm doses frequently re- 
peated it is used to render the urine alkaline and as an antilithic. 

The therapeutics of the other Potassium Salts are described under the re- 
spective titles of their more active bases. 

PRUMUM, Prune, — is the partly dried, ripe fruit of Prunus domestica, the Plum tree, 
nat. ord. Rosaceae, indigenous to Western Asia, but cultivated in most countries of temperate 



PRUNUS VIRGIN] \\ \. 405 

climate. Prunes contain sugar, pectin, albumin, malic acid and salts. They arc a constituent 
of Confectio Sennae. The root-bark contains a glucoside Phloridsm, which causes glycosuria 

in animals (see below, under PRUNUS VlRGINIANA). 

Prunes are laxative and nutritious, and are freely used as a food and sweetmeat, but in 
excess may give rise to flatulent colic from the indigestibility of their skins. Slewed prunes is 
U excellent dish for constipation in children, and may he made more effective by the addi- 
tion of a little Senna. 



PRUNUS VlRGINIANA, Wild Cherry,— is the hark of Prunus serotina, 
a large forest free of the nat. ord. Rosacea?, growing in Canada and the United 
States. On maceration in water it develops a distinct odor of bitter almonds. 
It contains tannin, gallic acid, resin, starch, etc., also Amygdalin and Emulsin, 
which by their mutual reaction in the presence of water, produce Hydrocyanic 
Add and a Volatile Oil resembling that of Bitter Almond. The root-bark con- 
tains a glucoside, Pkloridzin, found also in the same part of the apple, pear 
and plum trees. Dose of the powdered bark, gr. xx-xlv [av. gr. xxx.] 

Preparations. 

Fluidextractum Pruni Virginianae, Fluidextract of Wild Cherry. — Dose, njxx-xl 
[av. ntjxxx.] 

Infusum Pruni Virginianae, Infusion of Wild Cherry, — 4 per cent. Dose, oss-iij 
[av. 5ij.] Should be made with cold water. 

Syrupus Pruni Virginianae, Syrup of Wild Cherry, — 15 per cent. Dose, 5ss-jss 
[av. 5j.] 

Incompatibles. 
Incompatibles are as for Tannic Acid and Hydrocyanic Acid (see pages 70 and 74). 
Hot Water is incompatible in making the preparations, as it destroys the ferment emulsin. 

Physiological Action and Therapeutics. 

Wild Cherry is an aromatic bitter tonic, increasing appetite, aiding diges- 
tion, and thus promoting the constructive metamorphosis. The presence of 
a volatile oil gives it a local stimulating action on the alimentary canal in com- 
mon with serpentaria, cascarilla and other members of the same class. Hydro- 
cyanic Acid, being yielded by it in the presence of cold water, imparts a seda- 
tive action to its preparations, calming irritation and diminishing nervous ex- 
citability. Very large doses reduce the action of the heart. 

Phloridzin administered by the mouth or hypodermically causes glycosuria, 
acetonuria, and a great increase in the nitrogen metabolism. The glycosuria 
differs from that of true diabetes in the fact that the sugar of the blood is not 
increased, this agent affecting not the general metabolism of the body, but only 
the renal epithelium, which it renders more permeable to sugar. It is employed 
as a test for renal sufficiency. 

Wild Cherry preparations are used with benefit in catarrhal conditions of 
the bronchial mucous membrane, also in the hectic of phthisis and scrofula, 
with palpitation of the heart and a debilitated stomach; a collection of symp- 
toms often observed in consumptive subjects, for whom it is a very useful pal- 
liative. Cough is supposed to be especially amenable to its influence, and hence 



I 



406 PULSATILLA. 

it has become a matter of daily routine to prescribe the syrup as an ingredient 
of cough-mixtures. The infusion is an excellent stomachic tonic, and mav 
be administered with benefit in dyspepsia and in convalescence from acute 
disease. 



PULSATILLA (Unofficial) ,— is the herb, collected soon after flowering, of 
Anemone Pulsatilla and Anemone pralensis {Pulsatilla nigricans), the Pasque- 
flower or Meadow Anemone, small herbal plants of the Ranunculaceae, to which 
order Aconite also belongs. They inhabit Europe and Siberia, and have large, 
purple flowers, which are inodorous and very acrid. Pulsatilla contains an acrid 
yellow oil, which in the presence of water is gradually changed into A nemonin, 
C 10 H 8 O 4 , or Pulsatilla camphor, the active principle, and Anemonic Acid, a 
white, crystalline, tasteless and apparently inert substance, which is formed 
also by the action of alkalies on Anemonin. The herb should be carefully 
preserved and not kept longer than one year. Dose, gr. j-v. 

Anemone patens or Pulsatilla nultaliana, is an inhabitant of the United States, sometimes 
has whitish-colored flowers, and was formerly one of the official sources of the drug. 

Preparations. 

A tincture may be prepared according to the pharmacopceial directions for Tinctura: 
Herbarum Recentium (i part in 2 of alcohol), the dose of which is fij^-Tigx, several times a 
day. The imported German homeopathic tincture contains equal parts of the expressed juice 
and alcohol, and is an efficient preparation; but tinctures or fluidextracts made from the 
imported dried plant are not trustworthy. 

Anemoninum, Anemonin, C 10 H 8 O 4 , (Unofficial), — a volatile, unstable, camphoraceous 
principle, crystallizable, soluble in chloroform and in hot alcohol, almost insoluble in water 
and in ether. Dose, gr. \-\ in pill; but much larger doses may be taken without incon- 
venience, as much as two grains having produced no physiological symptoms in man (Schroff). 

Incompatibles. 

Incompatible with Pulsatilla and Anemonin are: Alkalies (caustic), Metallic Salts, Tan- 
nic Acid. 

Physiological Action. 
Pulsatilla is an active irritant when locally used; the oil vesicates the skin, 
and the fresh juice produces tingling and burning sensations in a part to which 
it is applied. It may excite a violent dermatitis, with a vesicular or pustular 
eruption, and inflammation and even gangrene of the entire limb has followed 
the application of the bruised root to the calf of the leg for rheumatism. In- 
halation of its dust has produced itching of the eyes, colic, vomiting and diar- 
rhea; and swallowing the fresh herb may cause severe irritation of the gastro- 
intestinal mucous membrane. The fresh juice applied to the tongue gives 
rise to tingling and burning sensations followed by numbness, symptoms very 
like those caused by Aconite. Internally administered Pulsatilla is diuretic, 
diaphoretic and emmenagogue, and also acts as a cardiac and vascular sedative, 
lowering the action of the heart, the arterial tension and the body-temperature. 
In overdoses it strongly affects the mucous membranes, and produces nausea 



PULSATILLA. 407 

and vomiting, slimy diarrhea, bloody urine, profuse and offensive sw< ats, 1 oryza 
and cough; also vesicular and pustular eruptions on the skin, peculiar pains 
in the eyes and dimness of vision. Its primary action is that of a spinal irri- 
tant, secondarily it produces exhaustion and paralysis of both motion and 
sensation. Stupor, coma and convulsions may be caused by a toxic dose, also 
paralysis of the cord and medulla. Most of these effects have been observed 
on rabbits, and the pharmacology of the drug is not yet accurately worked out. 
The homeopathic writers credit it with specific influence on the synovial mem- 
branes, the veins, the ears, and the generative apparatus of both sexes. 

Anemonin was discovered in 1771 by Storck, and its effects have been studied 
to some extent on animals. Applied to the conjunctiva it caused slight inflam- 
mation, and placed on the human tongue it left a slight burning sensation. When 
melted, its vapor produced intense inflammation of the eyes and pricking sen- 
sations in the tongue followed by numbness and white patches. The symptoms 
following its internal administration in fatal doses were a slow and feeble pulse, 
slow respiration, lowered body-temperature, frequent diarrhea, paralysis of 
first the hind- and then the fore-legs, dyspnea, mydriasis followed by myosis, 
stupor and death without convulsions. The absence of the latter is thought 
to be due to a paralyzing action of this principle on the cerebral motor centres, 
as in poisoning by extract of Pulsatilla convulsions are always present. The 
autopsies showed congestion and edema of the lungs, also marked hyperemia 
of the cerebral and spinal membranes, especially in the vicinity of the medulla. 
The heart walls were relaxed, and its cavities and the great vessels filled with 
dark and clotted blood, while the blood elsewhere was fluid. The liver, spleen, 
kidneys and abdominal viscera were found to be healthy. 

Therapeutics. 
The ancient writers credited different species of Anemone with many medi- 
cinal virtues, but the modern use of this drug dates from the time of Baron 
Storck and his contemporaries (1770-1800) who highly praised the Pulsatilla 
nigricans as a remedy for corneal opacities, cataract, paralysis, rheumatism, 
amenorrhea, melancholia, secondary syphilis, old ulcers and scaly skin diseases. 
Later therapeutists differ widely as to the medicinal value of this drug, some 
giving it extravagant praise and others finding no efficacy in it. It is quite 
possible that no effects whatever would be obtained if an old preparation or 
even a fresh one from the dried herb were employed. It has proved very effi- 
cient in acute catarrhal affections of the mucous membranes, especially rhinitis 
and conjunctivitis, in the early stage of the purulent ophthalmia of children 
and in gonorrheal ophthalmia, also in subacute and chronic bronchitis of deli- 
cate persons accompanied with profuse mucous expectoration, and in chronic 
catarrh of the bladder. It is used with benefit in chronic nasal catarrh with 
a thick though bland discharge, also in acute and subacute inflammation of the 
middle ear and the lining of the external auditory canal so often seen in chil- 



408 PULSATILLA. 

dren, where the membrane is red and swollen, with severe pain, and later on a 
thin, acrid discharge, which is often bloody and soon becomes puriform. In 
these affections medium doses ("lv) of the tincture may be given internally 
every four hours to adults, and a lotion composed of gj-ij in 3VJ of warm water 
may be applied to accessible parts. A similar use of this agent has been of de- 
cided benefit in many cutaneous affections, especially eczematous eruptions, 
syphilides, and indolent ulcers. 

In acute and chronic dyspepsia, characterized by gastric catarrh or sub- 
acute gastritis with a white-coated tongue, no taste or a greasy sensation in 
the mouth, nausea, flatulence, heart-burn, sick headache, anorexia, depressioni 
and diarrhea, Pulsatilla is a very efficient remedy, given in medium doses, rr\,v 
of the tincture every four hours. It does good service in intestinal catarrhs, 
shown by passive, mucous diarrhea with little pain, which are frequently seen 
in the febrile affections of childhood, especially measles, mumps, chicken-pox 
and remittent fever. 

Pulsatilla is generally credited with specific therapeutical action on the gen- 
erative organs of both sexes. Epididymitis and orchitis have been often con- 
trolled and entirely dissipated by its administration in very small doses, a few 
drops of the tincture in a glass of water, of which gj is given every two hours 
(Piffard, Sturgis). In more than 24 cases of acute uncomplicated epididymitis, 
doses of two drops of the tincture every two hours gave immediate relief, the 
patients wearing a suspensory bandage but not being confined to bed (Borcherin). 
Doses of five drops aggravated this disorder, while those of "l T V even- three 
hours proved curative (Piffard). In functional amenorrhea, in scanty or de- 
layed menstruation, and in suppression thereof from fright or cold, in ovaritis 
and in simple leucorrhea with back-pains and nervous depression, it has been 
found an excellent remedy. Dysmenorrhea has been removed in several cases 
by two-drop doses of the tincture given thrice daily for several days before the 
menstrual epoch (Piffard). Extravagant opinions as to its virtues in the puer- 
peral state, and during parturition are promulgated by the homeopathists, and 
their authorities on materia medica credit this drug with power to rectify false 
presentations during labor by causing version of the child. 

Besides the catarrhal affections of the ocular mucous membrane already 
mentioned, Pulsatilla has remedial power in certain affections of the eyelids. 
Its internal administration is said to effectually blight a stye if given early, but 
will not prevent its recurrence. It is an efficient remedy in recent blepharoph- 
thalmia, with profuse lachrymation and meibomian secretion; and it is said 
to stop twitching of the lids accompanied by photophobia. It has been used 
with decided benefit in the earache of children and in recent catarrhal deafness, 
also in acute cerebral and spinal meningitis, eclampsia from various causes, 
asthma, subacute rheumatism of the small joints, acute rheumatic gout, left- 
sided clavus, hemicrania and infra-mammary pain. Denian used this drug 
with benefit in several nervous affections, and concludes that it is a direct seda- 



PYRI 111 Kl \1 — QUASSIA. 40c; 

live of nervous irritability, but only indirectly a sedative to the circulation. 
Tucker found it especially serviceable in the nervous headache produced by 
overtaxing the mind. An extract of the root has proved to be an efficient tenia- 
fuge. Coughs which are loose by day, but dry and tickling in character on 
lying down at night, are greatly benefited by small doses of the tincture frequently 
repeated; and Anemonin, in doses of gr. ss-j, has been extremely useful in whoop- 
ing cough and coughs of irritative character. 



PYRETHRUM, Pellitory, — is the root of Anacyclus Pyrethrum, a plant of the nat. ord. 
Composita 1 , native of Northern Africa, but cultivated in Europe. It contains an alkaloid 
Pyrethrine, also inulin, tannin, mucilage, etc., with a brown Resin and two fixed oils. Dose, 
as a masticatory, gr. x-xlv [av. gr. xxx.] 

Pyrethrum Roseum, Persian Pellitory (Unofficial), — is indigenous to Western Asia, and 
resembles Chamomile in appearance. The flower-heads arc used in powder to kill insects, 
4 grains killing a fly in a vial in 2 or 3 minutes. 

Tinctura Pyrethri, Tincture of Pyrethrum, — 20 per cent. Not used internally. 

Pellitory is an irritant sialogogue. When chewed it causes a pricking sensation in the 
tongue and fauces, with heat, acridity, pungency and a copious flow of saliva and buccal mucus. 
Large doses may cause bloody diarrhea, tetanoid spasms, accelerated pulse, and profound 
stupor. Applied to the skin it acts as a rubefacient, the powder inhaled as a sternutatory. 
It stimulates the local nerves and vessels of the mouth and salivary glands by direct irritant 
action, but soon depresses the nerves and blunts their sensibility. 

Pellitory is chewed as a masticatory and sialogogue in paralysis of the tongue, rheumatic 
and neuralgic affections of the head and face, and pain from carious teeth. Its powder has 
been recommended as a sternutatory in chronic catarrh of the frontal sinuses. As a gargle or 
lotion ( oiij to Oj) it is very useful for relaxed uvula and as a mouth-wash. When used for 
toothache a few drops of the tincture should be inserted into the cavity on cotton or wool. 
Used as a sialogogue it is an efficient agent to secure the rapid elimination of Iodine from the 
system in chronic poisoning thereby. 



QUASSIA, — is the wood of Picrasma excelsa, or of Quassia amara, trees of 
the nat. ord. Simarubaceae. The former is known commercially as Jamaica 
quassia, and the latter as Surinam quassia. The wood is turned into cups, 
which are sold under the name of quassia- or bitter-cups. It contains a bitter 
principle, Quassin, C 31 H 42 9 , which is crystalline, soluble in hot alcohol and 
in chloroform, slowly in cold water, faster in alkaline or acidulated water. Dose 
of the powdered wood, gr. v-xv [av. gr. vijss.] 

Preparations. 
Extractum Quassiae, Extract oj Quassia, — aqueous. Dose, gr. j-iij [av. gr. j.] 
Fluidextractum Quassiae, Fluidextract of Quassia. — Dose, ttjjv-xv [av. rr^viij.] 
Tinctura Quassiae, Tincture of Quassia, — 20 per cent. Dose, TT£v-oj [av. njxxx.] 
Infusum Quassiae, Infusion of Quassia (Unofficial), — made with cold water ox, Quassia 

chips 5j, macerated for \ hour and strained. Or water poured into a quassia-cup and left 

standing will give a good infusion. Dose, o j-iij- 

Physiological Action and Therapeutics. 
Quassia is a simple bitter, having no flavor, but is intensely bitter and less 
agreeable than either gentian or chiretta. It is fatal to flies and fish, and makes 
an excellent anthelmintic enema against the thread-worm. A concentrated 



41 QUILLAJA — RESORCINOL. 

preparation is poisonous to rabbits and dogs, and has produced very alarming 
narcotic symptoms in a four-years-old child. Its action is that of a bitter stom- 
achic tonic, as described under Calumba. 

The preparations of Quassia contain no tannin and hence may be prescribed 
with salts of Iron. It is employed in atonic dyspepsia with pain after eating, 
and vomiting or regurgitation of food, also in atonic diarrhea depending on 
indigestion or an irritable condition of the intestinal mucous membrane. It 
is useful in convalescence to promote the appetite and digestion, and with sod- 
ium bicarbonate in gastric vertigo. It has been used as a feeble antiperiodic, 
and in hysteria its repulsiveness is an aid to its medicinal action. The strong 
infusion as an enema is an effective remedy against the thread-worm (oxyuris 
vermicularis) . 

QUILLAJA, Soap Bark, — is the inner bark of Quillaja Saponaria, a tree of the nat. ord. 
Rosacea?, indigenous to Peru and Chili. It contains calcium sulphate crystals, also starch 
and the glucoside Saponin, C 32 H 54 18 , a white, amorphous, sternutatory powder, soluble in 
water and in dilute alcohol. The official preparations are — 

Fluidextractum Quillajae, Fluid-extract of Quillaja, — Dose, trjj— v [av. njjiij.] 

Tinctura Quillaja^, Tincture oj Quillaja, — 20 per cent. Dose, ttjjv-xxx. 

Quillaja in powder is sternutatory and causes the water in which it is macerated to froth, 
making emulsions of oils, and being used instead of soap for washing purposes in various 
affections of the skin, also to stimulate the growth of the hair in alopecia. Its properties are 
due to the glucoside Saponin, which is found also in Senega and a number of other plants, 
and is a violent irritant of the respiratory passages, a local anesthetic, an antipyretic, a power- 
ful paralyzant of the heart and respiration, and a poison to the voluntary muscles. It has not 
been made use of in practical medicine. 

A decoction of the bark (5 in 200) has been employed in doses of 3 j-ij according to age, as 
a substitute for Senega in the treatment of diseases of the respiratory organs where a pleasant 
expectorant is indicated. Its expectorant properties are well established, and children take it 
readily. It does not provoke diarrhea or vomiting, and has a sweetish, agreeable taste. 

RESORCINOL, Resorcinol, Metadioxybenzene, C 6 H 4 (OH) 2 , — is a diatomic 
phenol, isomeric with Pyrocatechin and Hydroquinone, obtained usually by 
the reaction of fused sodium hydroxide upon sodium metabenzene-disulphonate. 
It occurs in colorless, needle-shaped crystals, very soluble in water, alcohol, 
ether, or glycerin. Dose, gr. j-x [av. gr. ij]; as an antipyretic gr. v every 2 
hours, or gr. xv-xxx, not repeated. 

Unofficial Analogues. 

Hydroquinone, Para-dihydroxy-benzene, C e H 4 (OH) 2 , — isomeric with Resorcinol, crys- 
tallizes in rhombic, colorless prisms which are slightly soluble in water, readily so in alcohol and 
in ether. It is obtained from Arbutin, a glucoside constituent of Uva Ursi and other Ericaceae, 
also from Anilin. It is an efficient antipyretic, without injurious effects so far as observed, 
but its influence is only temporary. Dose, as an antipyretic, gr. xv-xx, best given in alcohol. 
Gr. xl have been given without disagreeable effects. 

Pyrocatechin, Catechol (Ortho-dihydroxy-benzene), — also isomeric with Resorcinol, is 
one of the acid constituents of coal tar, and is obtained also from wood tar and from kinic 
acid. It is a fair antipyretic, but its use has been abandoned on account of its by-effects. 

Incompatibles. 

Incompatible with Resorcinol are: Acetamide, Acetanilide, Albumin, Alkalies, Antipyrine, 
Borneol, Camphor, Euphorin, Exalgin, Ferric Chloride, Menthol, Methacetin, Potassium Iodide 



RESORCINO] 411 

in alkaline solution, Spirit of Nitrous Ether, Crethanc. With II ' ydroqitinone are: Chlorine- 
water, Chromic Trioxide, Ferric Chloride, Nitric Acid. 

Physiological Action. 
Resorcinol resembles Phenol in action, but is less toxic. Locally it is irri 
tant and mildly escharotic, and is vesicant to mucous membranes. Used as 
an ingredient of hair-dye it caused in one case 16 attacks of erysipelas in three 
years. Like phenol it is a universal poison, and is antiseptic, disinfectant, and 
parasiticide. Internally it is diaphoretic, antipyretic, depressant to the heart 
and respiration, and a narcotic poison in sufficient quantity. In doses of 20 
to 40 grains it causes sensations of heat, discomfort and oppression, followed 
by profuse perspiration and languor; if fever be present the temperature of the 
body is lowered several degrees but rises again after a rigor in from 2 to 4 hours. 
A dose of 60 grains produced giddiness and violent perspiration, with marked 
anxiety, and finally collapse and unconsciousness. Larger doses (150 grains) 
have produced deafness, dizziness, salivation, confused vision, vertigo, uncon- 
sciousness, general clonic convulsions and tetanic rigidity of the muscles of 
the neck, with no decline of temperature in feverless subjects. Toxic doses 
(gr. xv to each 35 ozs. of weight) cause in animals trembling succeeded by epi- 
leptiform convulsions, which increase in severity and then decline; the respira- 
tion is quickened and enfeebled, the heart's action becomes rapid, weak, and 
irregular, and death results from paralysis of respiration, the drug paralyzing the 
motor tracts in the spinal cord but not affecting the general sensibility. It is 
eliminated chiefly by the urine which it colors a bluish-violet hue, and with great 
rapidity, about one hour serving for its excretion. 

Therapeutics. 
Resorcinol has been employed internally as an antiseptic and an antipy- 
retic, but being unreliable in the latter respect and highly dangerous it is now 
discredited as an internal remedy, though it has been commended in various 
gastric and intestinal inflammations. It is a valuable local application in many 
affections of the skin and mucous membranes. As an application to rodent 
ulcer, tuberculous and other ulcerations of the larynx, in diphtheria, tonsillitis, 
pharyngitis, and chronic rhinitis, strong even supersaturated solutions are em- 
ployed with increasing satisfaction, being highly efficient and quite painless. 
Applied to the peri-laryngeal mucous membrane, in 0.33 per cent, solution, 
with an acidulated solution of quinine given internally, it has been very useful 
in the treatment and prophylaxis of pertussis. A 2 per cent, solution has given 
satisfaction as a local antiseptic application to wounds, parasitic skin diseases, 
cystitis, gonorrhea, anthrax, and syphilitic sores of unhealthy character. As 
a spray a similar solution is well applied to catarrhal or ulcerative affections 
of the respiratory passages. It may be applied in undiluted form to chancres, 
papillomata and carbuncles. A saturated ethereal solution is a good applica- 
tion where the caustic action of the drug is required. 



412 RHAMNUS PURSHIANA — RHEUM. 

A paste consisting of equal parts of Resorcinol and Zinc Oxide has been 
applied to the face to promote peeling of the skin in the treatment of acne ros- 
acea. In three or four days the skin becomes like parchment, when the ap- 
plication must be stopped, in order to avoid the cracking of the skin which be- 
gins at that stage. A dressing of gelatin, glycerin, zinc oxide and hot water 
is then applied, covered with cotton wool. In a few more days the dressing 
comes off, bringing the epidermis with it. Some few dangerous and unfavorable 
results have followed this method, but a number of very satisfactory cases are 
reported. Freckles and other superficial spots on the skin may be remove 
by the same treatment. 

Resorcinol exercises a powerful influence on recent cell infiltration, and 
is very successful in subacute and chronic eczema with much thickening from 
exudation, also in seborrhea, psoriasis and pityriasis. It is an efficient applica- 
tion in the parasitic skin diseases, as scabies and tinea. 

RHAMinJS PURSHIANA, Cascara Sagrada, (Chittem Bark, Sacred Bark),— is the bark 
of Rhamnus Purshiana, the California Buckthorn, a small tree of the nat. ord. Rhamnaceae, 
growing on the Pacific Coast of the United States. It contains a Volatile Oil, a neutral crys- 
talline substance, several Resins, with tannic, malic and oxalic acids. It has been found 
very serviceable in the treatment of chronic gout and chronic constipation, given in gradually 
diminished doses. It produces large, soft and painless evacuations, and the bowels are said to 
act naturally and regularly after its disuse. Dose, gr. x-xxx [av. gr. xv.] 

Another species of the same order, Rhamnus Frangula, is official under the title Frangula, 
which see. 

Extractum Rhamni Purshianae, Extract of Cascara Sagrada, — Dose, gr. j-vj [av. gr. iv.] 

Fluidextractum Rhamni Purshianae, Fluidextract of Cascara Sagrada, — Dose, ngx-xxx 
[av. tixv.] 

Fluidextractum Rhamni Purshianae Aromaticum, Aromatic Fluidextract 0} Cas- 
cara Sagrada, — Dose, ttjjx-xxx [av. igjxv.] 

Cascara Cordial, — is a trade preparation, intended as a remedy for constipation, dys- 
pepsia and hemorrhoids, and as a pleasant excipient for nauseous and bitter drugs. A similar 
preparation may be made by combining the fluidextract with the official Elixir Aromaticum in 
the proportion of oj to oij> of which the dose is oj or more. 

RHEUM, Rhubarb, — is the dried rhizome of Rheum officinale, Rheum 
palmatum, or probably other species of Rheum, nat. ord. Polygonaceae, grown 
in China and Thibet, where records of its medicinal use date from 2700 b. c. It 
contains three closely related anthracene derivatives, Chrysophan, yielding Chry- 
sophanic Acid, Emodin, and Rhein, which are the cathartic principles; also 
several bitter resins, a variety of tannic acid, calcium oxalate, starch, sugan 
pectin, and other plant constituents. The species of rhubarb cultivated in the 
United States are devoid of cathartic power, but their leaf-stalks are used as a 
fruit. Dose of the powdered root, as a stomachic gr. j-v; as a purgative, gr. 
x-xxx [av. gr. xv.] 

Preparations. 
Extractum Rhei, Extract of Rhubarb. — Dose, gr. j-x [av. gr. iv.] 
Fluidextractum Rhei, Fluidextract of Rhubarb. — Dose, ttjjx-xxx [av. ttjxv.] 
Pilulae Rhei Compositae, Compound Pills 0} Rhubarb, — each pill contains of Rhubarb 
about 2 grains, Aloes ij, Myrrh 1, Oil of Peppermint j-$ grain. Dose, j-v pills [av. ij.] 



Kill I \l. 



413 



Tinctura Rhei, Tincture of Rhubarb, has of Rhubarb ao, Cardamom 1, Glycerin io, 
Alcohol and Water to 100. Dose, 7>ss iij [av. oj-] 

Tinctura Rhei Aromatica, Aromatic Tincture of Rhubarb, bas of Rhubarb 20, Cin- 
namon 4, Cloves 4, Nutmeg 2, Glycerin to, Alcohol and Water to 100. I>..sr, wv\ 3j [av. 
ii(x.\x.| 

Syrupus Rhei, Syrup of Rhubarb, lias of the Fluidextract 10, Spirit of Cinnamon 0.4, 
Potassium Carbonate 1, Glycerin 5, Water 5, Syrup to 100. Dose, for an infant, ,"j; for 
Older children, S ij— iv [av, r>ij-l 

Syrupus Rhei Aromaticus, Aromatic Syrup of Rhubarb, — has of the Aromatic Tincture 
15. Syrup S5. Dose, as the Syrup. 

Pulvis Rhei Compositus,0>w/>i>KN</ Powder of Rhubarb, — has of Rhubarb 25, Magnesia 
65, Ginger 10. Dose, a teaspoonful [av. gr. xxx.] 

Mistura Rhei et Sodse, Mixture of Rhubarb and Soda, — has of Sodium Bicarb. 3J, 
Fluidextract of Rhubarb i§, Fluidextract of Ipecac J, Glycerin 35, Spirit of Peppermint 3§, 
Water to 100. Dose, oss-iv [av. oj] 

Incompatibles. 

Incompatible with Rhubarb preparations are: Mineral Acids, Catechu infusion, Cin- 
chona infusion, Galls infusion, Lead Acetate, Lime-water, Mercuric Chloride, Silver Nitrate, 
Tartar Emetic, Zinc Sulphate. 

Physiological Action and Therapeutics. 

Rhubarb is classed among the tonic-astringent and resin-bearing purgatives, 
agents which increase the circulation of the glandular appendages of the in- 
testinal canal and stimulate the muscular layer of the bowel. In small doses 
(gr. j-v) its action is that of a gastric tonic and an intestinal astringent, the in- 
fluence of the bitter principle and the rheo-tannic acid probably predominating. 
In larger doses (gr. xxx-lx) its cathartic action prevails, producing in 6 to 8 
hours copious yellow, pultaceous stools, with some griping and considerable 
hepatic stimulation. After the cathartic principle is expelled, the astringent 
quality of its tannin asserts itself and constipation is likely to result. The 
yellow color of the stools is partly due to the rhubarb pigment and partly to 
excess of bile, the drug having marked cholagogue properties, probably due to 
its resin Phaeoretin. Its pigment stains the milk, urine and sweat, the milk 
acquiring a bitter taste and purgative properties. The cathartic action of Rhu- 
barb may be obtained from its application locally to ulcers, by being rubbed 
into the moist skin, or applied to the abdomen as a poultice. 

Rhubarb is highly esteemed as a cathartic for children, from the mildness 
of its action; though occasionally producing quite severe griping, it never in- 
flames the gastro-enteric mucous membrane. The tonic and astringent action 
following its catharsis makes it a valuable agent in diarrheas due to the pres- 
ence of irritating matter in the bowel, and to correct atonic indigestion accom- 
panied by diarrhea. For hemorrhoids with constipation its gentle action makes 
it peculiarly suitable, its astringent after-effect being entirely overcome by 2- 
to 4-drachm doses of olive oil nightly. It may be combined with a mercurial 
or with sodium bicarbonate, the latter being supposed to overcome its astrin- 
gent action and to disguise its taste in some degree. In small doses the tinc- 
ture is a very efficient stomachic tonic, improving appetite, increasing the flow 
of the gastric juice, assisting digestion, and promoting the action of the liver 



414 RHUS AROMATICA — RHUS TOXICODENDRON. 

without producing cathartic results. The preparations most in use for children 
are the Aromatic Syrup and the Mistura Rhei et Sodae. 

RHUS AROMATICA, Sweet Sumach (Unofficial), — is an indigenous shrub of the nat. 
ord. Terebinthaceae, growing about 5 feet high, and having yellow flowers in spikes. The 
root-bark contains a volatile oil, several resins, fat, tannin, etc. A fluidextract is prepared 
from the bark of the root acccording to the general pharmacopoeia! rule, and may be given 
in doses of ttjjx-xxx, every 2 or 3 hours. 

Rhus Aromatica has astringent properties, and seems to possess a selective action upon the 
urinary tract. Its action is not yet clearly made out. Therapeutically it has been used with 
advantage in cystitis, night-sweats, hematuria, menorrhagia, diabetes insipidus, diarrhea and 
dysentery. As a remedy for incontinence of urine in children it has attracted considerable 
attention, having been extremely efficient in doses of ttjxv of a good fluidextract four times 
daily, administered in glycerin and water, or any other suitable excipient. It is reported to be 
equally effective in hysterical enuresis of adults, but larger doses ( njxx-xxx several times a 
day) are required. Diabetes insipidus is remarkably benefited by its continued use, and even 
in diabetes mellitus its employment has occasionally seemed to have been curative. 

RHUS GLABRA (Smooth Sumach), — is the dried fruit of Rhus glabra, an indigenous 
shrub of the nat. ord. Anacardiacece, growing in rocky and barren soil to a height of 8 to 12 
feet. The leaves and bark have an astringent and bitter taste, and are also used medicinally. 
It contains tannin, coloring matter, also potassium and calcium malates. 

Fluidextractum Rhols Glabrae, Fluidextract of Rhus Glabra. — Dose, trjv-xxx [av. 

ITJJXV.] 

Sumach-berries form a useful acidulous and astringent drink or gargle in catarrhal phar- 
yngitis, stomatitis, and aphthae. An infusion ( 5 j to the pint) or the official fluidextract may 
be used as a wash and dressing for ulcers and wounds. Internally they are useful remedies for 
mild catarrhal affections of the stomach and bowels. 



RHUS TOXICODENDRON, Poison Ivy (Unofficial),— is the fresh leaves 
of Rhus radicans, a plant of the nat. ord. Anacardiacece, indigenous to Canada 
and the greater part of the eastern United States. This climbing plant is not 
by itself a distinct species, but a variety of the erect shrub, Rhus Toxicodendron, 
the poison oak, formerly official as a source of the drug; both of which when 
wounded exuding a poisonous, acrid, milky juice, which turns dark on expos- 
ure. The poisonous principle of the plant is Toxicodendric Acid, which is vol- 
atile, and also exists in Rhus venenata the swamp sumach, Rhus pumila, and 
Rhus diver siloba, the first of which is probably the most poisonous of the four. 
The dose of the leaves is generally placed at gr. j-iv, but if old and dry they will 
generally prove to be inert. 

Tinctura Rhois Toxicodendri, Tincture 0} Rhus Toxicodendron (Unofficial), — may 
be prepared according to the formula of the Pharmacopoeia for Tincturae Herbarum Recentium 
(tinctures of fresh herbs), one part of the fresh leaves to two of Alcohol. Dose, njl r 1 -<t~ 'HE.' j - 

Extractum Rhois Toxicodendri, Extract of Rhus Toxicodendron (Unofficial), — has 
been used in France in large doses. It is probably inert. 

Physiological Action. 
The effects of Rhus Toxicodendron upon the skin are familiar to all who 
have suffered from contact with poison-oak or ivy. Some persons are so sus- 
ceptible to this poison that the exhalations from the plant will produce on them 
its characteristic action. Others are apparently insusceptible to its influence, 



R1CIN1 OI.EUM. 415 

and can with impunity rub the juice into their skin, or even chew its leaves. 
The action of the plant when locally applied is that of a cutaneous irritant, 
causing redness and swelling of the affected parts, with a vesicular eruption 
and intolerable itching, which may spread rapidly over the surface of the body 
and extend to the mucous membranes, producing conjunctivitis, redness and 
tumefaction of the mouth and throat, thirst, cough, nausea and vomiting, vertigo 
and stupefaction. Colicky pains are experienced in the abdomen, are worse 
at night and are aggravated by food and drink. Diarrhea may occur, with 
tenesmus and bloody stools, also diuresis, bloody urine, or even complete re- 
tention. Fever with delirium is frequently present, and may be typhoid in 
character, or intermittent with profuse perspiration. Pains of rheumatoid 
type are experienced throughout the body, but particularly in the joints and 
lumbar region, apparently intensified by rest and heat. The fibrous structures 
are evidently the seat of its selective action, and a sensation of numbness in 
the lower extremities is frequently experienced. Similar phenomena attend 
its internal administration, but fatal results have not followed in any case of 
poisoning recorded. The effects of the poison usually last from ten to fifteen 
days, and are then followed by desquamation of the epidermis. 

Therapeutics. 
Rhus Toxicodendron was used medicinally by Dufresnoy in France and by 
Alderson in England about the close of the eighteenth century. The attention 
of the former was attracted to it by the accidental poisoning of a student who 
was afflicted with chronic eczema, which disappeared on the subsidence of 
the Rhus symptoms. It is a favorite remedy with the so-called homeopathists, 
who ascribe to it extraordinary virtues in acute cutaneous affections of vesicular 
type, subacute and chronic rheumatism, vesicular erysipelas and typhoid fever. 
Among regular authorities it has met with very little favor as a remedial agent, 
though Phillips recommends it strongly in rheumatic affections of the fibrous 
tissues, erythema and erysipelas, eczema, herpes zoster and pemphigus. Pif- 
fard corroborates these opinions of its therapeutical value, and states that when 
rheumatic pain is worse at night prompt relief may be expected from Rhus. It 
was used by Dufresnoy in paralyses with some success, and Eberle reports a 
case of paralysis in which it proved curative. It is admitted by many observers 
to be a useful remedy in paralytic affections of the lower extremities depending 
on a rheumatic diathesis, or resulting from exposure to cold and wet. As an 
external application it is efficacious in sprains and other affections of ligaments 
and tendons, extensive but superficial burns, stings of insects and chilblains. 
For these affections a lotion of about 3ss of the tincture to a pint of water is 
usually employed. 

RICINI OLEUM, Castor Oil, — is a fixed oil expressed from the seeds 
of Rkinits communis, a tree of the nat. ord. Euphorbiaceas, indigenous to India, 



41 6 RICINI OLEUM. 

but extensively cultivated in the United States. The oil is an almost color- 
less, transparent, viscid liquid, of faint odor, bland or slightly acrid taste, neu- 
tral reaction, soluble in an equal weight of alcohol. It consists mainly of Ric- 
inolein, the glyceride of ricinoleic acid, also palmitin, stearin and myristin in 
small quantities, and an acrid principle. The seeds contain a highly toxic 
ferment or phytalbumose named Ricin, and an alkaloid, Ricinine, which seems 
to be inert. Dose, 3ij-§j [av. 3iv.] 

Administration. 

The nauseous smell is best concealed by the Essential Oil of Bitter Almonds. Emulsions 
are not a success. Capsules containing the requisite dose are easily obtained. In the absence 
of these the best way to administer a dose of oil is to smear the sides of a clean wineglass with 
very thick cream, then pour in the oil, covering it with a little more cream. A teaspoonful 
of cream being then taken into the patient's mouth, he is directed to bolt the dose at one gulp. 
Some prefer it floated on orange-juice, strong coffee, gruel or wine. One of the best vehicles 
for it is foaming beer. Glycerin increases its purgative power, when given conjointly. If the 
mouth be chilled by broken ice immediately before taking the oil, the taste of the latter will be 
imperceptible. 

Physiological Action and Therapeutics. 

Used externally pure Castor Oil is perfectly bland. Internally administered 
it is non-irritant until it reaches the duodenum, where it is decomposed by 
the pancreatic juice setting free the Ricinoleic Acid, which produces purgation 
by a mildly irritant action on the bowel, stimulating the intestinal glands and 
muscular coat, but not the liver. It is a simple purgative, acting in four to six 
hours, producing one or more liquid stools without pain or tenesmus, and fol- 
lowed by a sedative effect on the intestines. The leaves are believed to pos- 
sess galactagogue properties when locally applied as a poultice to the breasts. 
Ricinoleic Acid enters the blood and the tissues, and is excreted with the various 
secretions of the body, imparting its purgative qualities to the milk of the nurs- 
ing mother. Ricin, given either hypodermically or by the mouth, produces 
violent gastro-enteritis, nephritis and cystitis, also inflammation of the mucous 
lining of the biliary duct. To it are ascribed the jaundice and anuria observed 
in some cases of poisoning by castor-oil seeds. 

Castor Oil is one of the best of the simple purgatives, and is used when 
a free evacuation of the bowels is alone indicated, or when only a laxative action 
is desired, as in the constipation of typhoid fever, in pregnancy and post-partum 
conditions, diarrhea from the presence of irritating matter in the bowels, and 
after operations on the abdominal or pelvic organs. It is often used as a pur- 
gative for children, also for the aged and infirm. Infants bear a larger relative 
dose than adults, probably from their ability to digest a greater quantity of 
what is taken. It is employed with great benefit as a laxative in irritation or 
inflammation of the bowels, in hemorrhoids, inflammatory or spasmodic affec- 
tions of the genito-urinary organs, nephritis or cystitis, gonorrhea, calculi, and 
stricture of the urethra and rectum. In cases of dysentery 10 to 20 drops of 
laudanum may be added to each dose to counteract the pain, tenesmus and 
exhaustion resulting from the frequency of the passages. If much depression 



ROSA. 417 

exists, as shown by lowered arterial tension and a dry, glazed tongue, 5 drops 
of oil of turpentine should also be added. 

Castor Oil is much used in the puerperal state and greatly abused. There 
is considerable evidence in support of the charge that it induces hemorrhoids 
by congesting the rectal vessels. Its purgative action is milder in proportion 
to the purity of the sample employed. Externally, the pure oil is employed 
as a local sedative and protective, as in neutralizing the effects of lime upon 
the conjunctiva. The leaves of the castor-oil plant are used to promote the 
secretion of milk. They may be applied to the breast in poultice, and a decoc- 
tion or fluidextract given internally at the same time. 



ROSA, Rose, — is represented in official pharmacy by the petals of one 
species and the volatile oil from another. 

Rosa Damascena, Damask Rose, — is the source of the official Oil of Rose, 
which is distilled from the fresh flowers. This variety of the nat. order Ros- 
acea? is largely cultivated in Roumelia, on the southern slope of the Balkan 
mountains, from which section comes nearly all of the oil supplied to commerce. 

Rosa Gallica, Red Rose, — is the petals of Rosa gallica, collected before 
expanding. They contain an aromatic oil, tannic and gallic acids, Quercitrin, 
coloring matter, salts, etc. 

Preparations. 

Oleum Rosae, Oil of Rose, Altar. of Rose, — is a volatile oil distilled from the fresh flowers 
of Rosa damascena. It is a pale-yellowish, transparent liquid, having a strong odor of rose, a 
sweetish taste and a slightly acid reaction, but slightly soluble in alcohol. It consists of an 
aromatic oxygenated ebeopten and an odorless solid stearopten (rose-camphor). Being very 
expensive it is much adulterated with other volatile oils. It is used chiefly for perfuming cos- 
metic preparations, ointments and lotions, and as the basis of the following three preparations. 

Aqua Rosae Fortior, Stronger Rose Water, (Triple Rose Water), — is water saturated with 
the volatile oil of Rose petals. An agreeable excipient and flavoring agent. Dose, 5ss-iv 
[av. 5ij] 

Aqua Rosae, Rose Water, — consists of equal volumes of the preceding and distilled water, 
mixed together immediately before use. It is an ingredient of Mistura Ferri Composita. 
Dose, 5j- oj [av. 5iv.] 

Unguentum Aquae Rosae, Ointment of Rose Water, (Cold Cream), — has of Stronger 
Rose Water 19, Expressed Oil of Almond 56, Spermaceti 12J, White Wax 12, and Sodium 
Borate i. 

Fluidextractum Rosae, Fluidextract of Rose, — prepared from Red Rose with glycerin 
and diluted alcohol. Dose, ttjjv- oj [av. ttjjxxx.] 

Confectio Rosae, Confection of Rose, — has of Red Rose 8, Sugar 64, Honey 12, Stronger 
Rose Water 16, beaten together into a mass. Dose, gr. x- oj- 

Mel Rosae, Honey of Rose, — has of the Fluidextract 12, and Clarified Honey to 100. 
Dose, oj— ij [av. 5j-] 

Syrupus Rosae, Syrup of Rose, — has of the Fluidextract i2§ per cent. Dose, oj-ij 
for flavoring. 

Red Rose is an ingredient of Pil. Aloes et Mastiches. The Confection is an ingredient 
of Pil. Aloes et Ferri. 

Rose Water has no strictly medicinal properties, but is an agreeable excip- 
ient for lotions, collyria and urethral injections. The ointment, commonly 
termed cold cream, is a pleasant emollient and protective agent, generally used 
28 



418 ROSMARINUS — RUMEX. 

for chapped hands and other superficial skin affections. Red Rose is classed 
among the astringents, as it contains an appreciable amount of tannic and gallic 
acids. A compound infusion, containing sugar and dilute sulphuric acid, was 
formerly official, and is used as an agreeable gargle for the throat and mouth 
in inflamed and ulcerated conditions. The chief uses of the rose preparations 
are as vehicles for other agents, or to impart flavor and odor to extemporaneous 
prescriptions. 

ROSMARINUS, Rosemary, — the source of the official oil of Rosemary, is the fresh 
flowering tops of Rosmarinus officinalis, a shrub of the nat. ord. Labiatas, cultivated for the sake 
of its large, pale-blue flowers. They are pungently aromatic and somewhat camphoraceous, 
and contain the volatile oil, a little tannin, some resin and a bitter principle. 

Oleum Rosmarini, Oil of Rosemary, — is the volatile oil distilled from Rosemary, a col- 
orless or yellowish liquid, having the characteristic odor of the plant and a camphoraceous 
taste; readily soluble in alcohol. It should yield, on assay, not less than 5 per cent, of ester, 
calculated as bornyl acetate, and not less than 15 per cent, of total Borneol. Dose, ttjjj-v 
[av. njnij.] 

Rosemary was formerly considered emmenagogue, galactagogue and diuretic, but is now 
never employed in substance. Its oil is somewhat stimulant and carminative, and in excessive 
quantity has caused death. It is chiefly used as an external stimulant in liniments and lotions, 
especially to the scalp in alopecia, where it is supposed to increase the blood-supply to the 
hair bulbs and is usually combined with cantharides. Inhaled it reduces the body-temper- 
ature and gives the urine a violaceous odor. 

RUBUS, Rubus, — is the dried bark of the rhizome of Rubus villosus, the common 
Blackberry, Rubus nigrobaccus, or Rubus cuneifolius, nat. ord. Rosacea?. It contains more 
than 10 per cent, of Tannic Acid. Dose, gr. x-xxx [av. gr. xv.] 

Fluidextractum Rubi, Fhcidextract of Rubus. Dose, gr. x-xxx [av. gr. xv.] 

Syrupus Rubi, Syrup of Rubus, — has of the Fluidextract 25, Syrup 75. Dose, 3ss-ij 
[av. 3j.] 

Syrupus Rubi Aromaticus, Aromatic Syrup of Rubus (Unofficial), — contains Rubus, 
Cinnamon, Cloves and Mace. Each fl 5 has 30 grains of the drug. Dose, 3j-iv. 

Blackberry-bark derives its virtues from its tannin. It is strongly astringent, and may be 
used in decoction, wine or the above-named preparations. It is highly esteemed in summer 
and infantile diarrheas. 



RUBUS IDiEUS, Raspberry, (Unofficial), — is the fruit of Rubus idceus, the Raspberry 
bush, nat. ord. Rosacea?. It contains sugar, malic and citric acids, proteids, pectin, etc., also 
a Volatile Oil consisting of compound ethers, to which the odor is due. Its sole use in medi- 
cine is to prepare a pleasantly flavored syrup. The closely allied, light-red fruit of Rubus 
strigosus, the wild Red Raspberry, and the purplish-black fruit of Rubus occidentalis, the 
Thimble-berry, may be employed in place of the raspberry. 

Syrupus Rubi Idaei, Raspberry Syrup, (Unofficial), — has of Raspberries and Sugar any 
convenient quantity, boiled (but not in tinned vessels) and strained. Dose, ad libitum. It 
has a bright-red color, a fruity, agreeable odor, a pleasant, acidulous taste and an acid reaction. 
It has no special medicinal virtues, but forms an agreeable flavoring for mixtures, and mixed 
with water a pleasant drink in febrile conditions. 

The leaves of the wild Red Raspberry (Rubus strigosus) are considerably astringent, and in 
infusion, o j to the pint, are a popular domestic remedy for diarrheas. 

RUMEX, Yellow Dock (Unofficial), — is the root of Rumex crispus, and of some other 
species of Rumex, plants of the nat. ord. Polygonacea?, growing as common weeds along road- 
sides. Several species of Rumex have sour leaves, and are popularly called Sorrel to distinguish 
them from the others which are called Dock. The official root contains tannin, mucilage, starch, 
calcium oxalate, and two principles named Rumicin and Lapathin, which 'are shown to be 



KM I'A. 



I"; 



[dentical with ( 'hrysophanic Acid. Its constituents are neeu ly identico] with those of Rhubarb 
Dose, gr. x\ T> i 

Fluidextractum Rumicis, Fluidextraet oj Rumex (Unofficial), Dose, m»w - 3j. 

Decoctum Rumicis, Decoction oj Rumex (Unofficial), — 3ij of the fresh root, or 5j of 
the dry root, to Oj of water. Dose, 5j-ij- 

Rumex is astringent, tonic and laxative, and lias also been considered alterative and anti- 
scorbutic. It is employed in chronic cutaneous disorders, glandular swellings, and other 
symptoms of the strumous diathesis. It seems to possess a selective action on the mucous 
membrane of the larynx, and in many cases of laryngeal irritation with catarrhal symptoms, 
dry. violent cough, and a sense of soreness behind the sternum, it will give relief. The 
Rumex Acetosa has a popular reputation as a local application for cancer. 



RUTA, Rue (Unofficial), — the leaves of Ruta graveolens, an herbaceous 
perennial of the nat. ord. Rutaceae, growing wild throughout Southern Europe, 
and frequently cultivated in gardens for its yellowish flowers. The fresh leaves 
only should be used, and as drying impairs their qualities the oil is generally 
employed in medicine. 

Oleum Rutse, Oil oj Rue (Unofficial), — the volatile oil distilled from Ruta graveolens; a 
colorless, or greenish-yellow liquid, of disagreeable but aromatic odor, pungent acrid taste 
and neutral reaction, soluble in an equal weight of alcohol. Dose, njjj-ij. 

Physiological Action and Therapeutics. 

Rue is an active irritant, the oil applied locally producing heat, inflamma- 
tion and vesication. Administered in full medicinal dose it causes a sensation 
of heat in the stomach and skin, increases the action of the heart, and stimu- 
lates the bronchial, cutaneous and renal secretions. The odor of the oil is dis- 
tinctly perceptible in the breath, sweat and urine. After a toxic dose of the 
oil violent gastro-enteritis results, with extreme prostration, convulsions, stran- 
gury and suppression of the urine, and the symptoms of a narcotic poison ensue 
if the dose is large enough. Abortion may be produced by large doses, but 
with great danger to life. Rue is an efficient emmenagogue, and in men 
aphrodisiac; it is also considered antispasmodic and carminative. 

The Oil of Rue is employed internally in amenorrhea, menorrhagia, and 
metrorrhagia, hysteria, convulsions and flatulence. As an emmenagogue it is 
efficient when the condition is one of functional inactivity of the uterus and 
ovaries. In small doses it has been well used in metrorrhagia from debility and 
after abortion. A decoction of the fresh leaves is often employed by injection 
against thread-worms, and internally to remove lumbricoid worms. Exter- 
nally the same preparation has been applied to the chest in chronic bronchitis, 
also in various scaly eruptions and glandular enlargements. Used as an aborti- 
facient it has frequently caused death, preceded by symptoms of irritant and 
narcotic poisoning. Even in poisonous doses its abortifacient action is very 
uncertain, so that only the most ignorant criminals employ it with such pur- 
pose. It was formerly official but has been dismissed from the pharma- 
copoeia. 



420 SABAL — SABINA. 

SABAL, Sabal, — is the partially dried ripe fruit of Serenoa serrulata, the 
Saw Palmetto, nat. ord. Palmae. Dose, gr. x-^j [av. gr. xv]. There are no 
official preparations, but a fluidextract is given in doses of jjj three or four times 
a day. 

Elixir Saw Palmetto and Santal Compound (Unofficial), — each fluidounce represents 
Saw Palmetto berries oij, Corn-silk 5ij, Sandal-wood gr. xxx. Dose, 5j-iv, three to six 
times a day. 

Sanmetto (Unofficial), — is a similar preparation to the preceding. 

Sabal is sedative, nutritive and tonic. It seems to have some specific action 
on the tonsils and the prostate gland, and has been used with much benefit 
in the enuresis of old men, enlargement of the tonsils, spasmodic croup, chronic 
sore throat, and gonorrhea. The compound elixir is highly praised in the late 
stage of gonorrhea, in prostatic enlargement, incontinence of urine, vesica! 
catarrh, irritable bladder, and urethritis. Sabal is one of the latest additions 
to the pharmacopoeia. 

SABINA, Savin, — the tops of Juniperns Sabina, a small evergreen shrub 
of the nat. ord. Coniferae, growing in Northern Europe, Asia and America. 
It closely resembles Red Cedar (Junipenis virginiana), but is distinguished 
from the latter by its smaller size and by its larger fruit. It contains a volatile 
Oil which is official, also tannin, resin, extractive matters, chlorophyll, etc. 
Dose, gr. v-x [av. gr. vijss.] 

Preparations. 

Fluidextractum Sabinae, Fluidextract of Savin. — Dose, ttjjij-x [av. ngv.] 

Ceratum Sabinae, Savin Cerate (Unofficial), — may be prepared by incorporating the 
Fluidextract 25, in Resin Cerate 90, melted and cooled. 

Oleum Sabinae, Oil of Savin, C 10 H le — a volatile oil distilled from the fresh tops of Savin; 
existing in the fresh tops in the proportion of 2J per cent., and in the berries 10 per cent. 
It is a colorless or yellowish liquid, isomeric with oil of turpentine, having a peculiar, 
terebinthinate odor, a pungent camphoraceous taste and neutral reaction; soluble in an 
equal volume of alcohol. Dose, ttjjj — ij [av. njj.] 

Physiological Action and Therapeutics. 

Externally the action of Savin resembles that of Turpentine, except that 
it is more irritant, the oil producing vesication if applied sufficiently long. In- 
ternally a full medicinal dose causes heat sensations, nauseous eructations, 
flatulence, increased cardiac action, stimulation of the cutaneous, bronchial 
and renal secretions, irritation of the kidneys, hyperemia of the ovaries and 
uterus, and increased menstrual activity. In large doses it produces hem- 
aturia, dysuria, and intense gastro-enteritis, with violent vomiting and purg- 
ing. Toxic doses produce the symptoms of an irritant and narcotic poison. 
It may originate uterine contractions in the pregnant female, but its abortifa- 
cient effect can only be produced by a quantity sufficient to endanger life. The 
oil diffuses into the blood and is excreted by the various excretory channels. 

As an emmenagogue Savin is highly esteemed by many authorities. Phillips 
considers it "one of the most certain and powerful" agents of this class, "with 



SACCH \ki \i. 421 

the additional advantage that it can be given with perfecl freedom from risk 
of doing harm." So irritant an agent, however, requires the exercise of greal 
caution in its use. It has been found extremely efficient in dysmenorrhea when 
not due to mechanical causes; also in menorrhagia and hemorrhage after abor- 
tion. In chronic gout and the joint affections of chronic rheumatism, it was 
formerly much employed. Externally the Cerate is used to prolong the dis- 
charge from blisters, setons or issues, and to stimulate the healing of indolent 
ulcers. For these purposes it is considered safer than canlharides, as its pro- 
longed employment does not bring on strangury or vesical irritation. As a 
caustic it is efficient for the destruction of warts and other excrescences, and 
the moistened powder is used as a paste on venereal condylomata, in combina- 
tion with burnt alum or cupric subacetate. The Oil is the most efficient prepa- 
ration for internal administration. 

SACCHARUM, Sugar, C l2 H 22 O n , — is the refined sugar obtained from 
Saccharum officinarum, the sugar-cane, a perennial plant of the nat. order 
Gramineas, indigenous to India and adjoining countries but cultivated in trop- 
ical regions throughout the world. It is also obtained from various species 
or varieties of Sorgluim, nat. order Gramineas, and from one or more varieties 
of Beta vulgaris, the sugar-beet, nat. ord. Chenopodiaceae. It is present in sev- 
eral other grasses, as Zea Mays, (maize), also in the juice of various trees (maple, 
birch, palm, etc.), and in many roots. 

Sugar occurs in white, dry, hard, crystalline granules, permanent in the air, odorless, of 
purely sweet taste and neutral reaction, soluble in 0.5 of water and in 175 of alcohol, in 0.2 of 
boiling water and in 28 of boiling alcohol, insoluble in ether. The saturated aqueous solu- 
tion is miscible with water in all proportions. 

Other Sugars. 

Saccharum Lactis, Sugar 0} M ilk, {Lactose), C 12 H 22 O u + H 2 0, — is one of the constituents 
of the milk of mammals, and is officially described as a peculiar crystalline sugar obtained from 
the whey of cow's milk bv evaporation and purified by re-crystallization. Occurs in white, hard, 
crystalline masses, yielding a gritty, white powder, odorless, permanent in the air, of faintly 
sweet taste and neutral reaction, soluble in about 6 of water and in 1 of boiling water, insoluble 
in alcohol, ether or chloroform. 

Glucose, Dextrose, Grape-sugar, Starch-sugar, C 6 H 12 6 (Unofficial), also known as 
liver-sugar, diabetic sugar, — forms yellowish nodules or crystals, very soluble in water and in 
alcohol, has a sweet taste less marked than that of cane-sugar, may be obtained artificially from 
cane-sugar or from starch, by boiling with a dilute mineral acid, or by the action of diastase, a 
vegetable ferment formed during the germination of grain. Boiling solutions of the alkalies 
convert it into a brown substance (melassic acid). 

Levulose, Fruit-sugar, C 6 H 12 O fi (Unofficial), — frequently found with grape-sugar in 
fruits, also in honey. See also Diabetin, on next page. 

Inosit, Phaseo-mannit, C 6 H, 2 O c -l- 2EUO (Unofficial), — exists in the juise of some meats, in 
asparagus, etc. Is very sweet, but does not undergo alcoholic fermentation. 

Allied Substances. 

Theriaca, Treacle, Sugar-house Molasses (Unofficial), — is the uncrystallizable residue of 
the process for refining sugar, a thick, brown, fermentable syrup, very sweet and of sp. gr. about 
1.40. 

Amylum, Starch, C 6 H 10 O 6 , — when boiled with dilute mineral acids or when subjected to 



422 SACCHARUM. 

the action of diastase, ptyalin, or pancreatin, is converted into glucose. (See the article 
Amylum, page 123). 

Benzosulphinidum, Benzosulphinidc, Saccharin, {Glusidum, B. P.), the anhydride of 
ortho-sulpha mide-benzoic acid, — occurs as a white, crystalline powder, having an intensely 
sweet taste, even in dilute solutions; soluble in 250 of water, and in 25 of alcohol at 77 F., 
in 24 of boiling water, readily soluble in ammonia water, in alkali hydroxide solutions, and in 
a solution of sodium bicarbonate with evolution of C0 2 . Dose, gr. ss-v [av. gr. iij.] 

Preparations. 

Syrupus, Syrup, — has of Sugar 85, Distilled Water to 100. 

Sugar is an ingredient of Pil. Ferri Carbonatis, Pil. Ferri Iodidi, Ferri Carbonas 
Saccharatus, Mistura Ferri Composita, Pulvis Cretan Compositus, Pulvis Glycyrrhizae Com- 
positus, also the Troches, Syrups, Compound Syrups, etc. 

Physiological Action and Therapeutics. 

Sugar is employed in pharmacy and therapeutics chiefly as a vehicle, a 
corrigent, a preservative and an antiseptic. Syrups protect the active ingred- 
ients against putrefaction, but not always against fermentation. They also 
protect certain ferruginous preparations against oxidation. As an ingredient 
in troches, powders and extemporaneous mixtures sugar is used to cover the 
taste or to make insoluble substances more easily miscible with water. It in- 
creases the solubility of lime in water. As a food it possesses well-known prop- 
erties, being a nutrient to adipose tissue and a respiratory fuel, and is decidedly 
diuretic in its action upon healthy kidneys. Sugar and sugar-forming food 
constitute more than one-half of the nourishment needed by a healthy person, 
and when withheld or diverted as in diabetes, the patient is actually starved 
and undergoes progressive and rapid emaciation. Levulose is found to be 
more easily consumed in the system than cane-sugar, and in the treatment of 
diabetic patients may be used with benefit for some time. Heretofore its cost 
has been very great, but it is now being manufactured in large quantities and 
sold at a reasonable price, under the trade-name Diabetin. 

Sugar of Milk is the least soluble of all sugars in water, but is soluble in 
alcohol. It enters into alcoholic fermentation with difficulty. In the presence 
of decomposing albuminous matter and under certain other influences, it under- 
goes the lactic fermentation, which results in the formation of lactic acid, car- 
bon dioxide and alcohol. It readily reacts with the reduction tests. 

Sugar of Milk is a powerful diuretic, especially in cardiac dropsy, in which 
See considers it "the best and most certain diuretic we possess, the excretion 
of urine caused by it being greater than that due to any other drug." He found 
that it acts similarly to Caffeine though more powerfully, while possessing none 
of the disadvantages of the latter. Its diuretic action is but slight in cases where 
extensive renal disease exists, and it has no power over dyspnea. 

Sugar of Milk is used in the triturations, also in Dover's powder, as a diluent. 
Being much harder than sugar it is considered a valuable excipient for powders 
requiring the minute subdivision of their medicinal constituent. It is less 
sweet than sugar, and being less apt to ferment in the stomach and bowels is 
better than the latter for use with infants' food. 



SAI.ICINl \1. 423 

Benzosulphinide (Saccharin), when pure is about 500 times sweeter than 
sugar, and imparts a distinctly sweet taste to 70,000 times its weight of wakr; 
but the commercial article is standardized to about 300 times the sweetening 
power of sugar. It is not a food, but has no injurious action on man, and is 
eliminated in the urine and the saliva without change. It is used as a 
substitute for sugar in the food of diabetics and subjects of hepatic disease 
and corpulence; also to cover the taste of nauseous drugs and as an internal 
antiseptic in cases of cystitis with decomposing urine. A grain of Saccharin 
sweetens 6 to 8 duidounces of liquid. It may be used to a maximum quantity 
of 30 grains per diem. It is rendered soluble by mixing with it two-thirds its 
quantity of sodium bicarbonate. It is an efficient antiseptic. 

Dulcin, Sucrol, Para-phenetol-carbamide (Unofficial), — is a urea derivative of phenetidin 
and occurs in colorless crystals which are soluble in 800 of water, 55 of boiling water, 25 of alco- 
hol, also in ether. Its sweetening power is about 200 times that of sugar. In reasonable doses it 
is harmless, does not cause any decomposition of the blood, or give rise to the great disgust 
engendered by Saccharin on prolonged use. Its great insolubility is its chief disadvantage. 
Dose, gr. ss-ij, up to a daily maximum of 30 grains. 

Saxin, — is a similar product of English manufacture, said to be 600 times sweeter than 
sugar. 

SALICINUM, Salicin, C 13 H l3 ; , — is a glucoside obtained from several 
species of Salix, the Willow, and Populus, the Poplar, trees of the nat. ord. 
Salicacea;. It is found also in Gaultheria procumbens, the wintergreen, nat. 
ord. Ericaceae; and in Betula lenta, the sweet birch, nat. ord. Betulaceae; the 
volatile oils of which, distilled from the leaves of the former and from the bark 
of the latter, consist almost entirely of methyl salicylate (see next page). 

Salicin occurs in colorless or white and silky, shining crystalline needles, or a crystalline 
powder, odorless, of very bitter taste, permanent in the air, of neutral reaction; soluble in 28 
of water and in 30 of alcohol, in 0.7 of boiling water and in 2 of boiling alcohol; almost insoluble 
in ether or chloroform. Dose, gr. x-xxx [av. gr. xv.] 

Salix Nigra, the Pussy Willow (Unofficial), — grows along streams in the Southern 
States. A fluidextract is on the market, and may be used in doses of 3ss thrice daily, as a 
sexual sedative. 

Acidum Salicylicum, Salicylic Acid, HC 7 H 5 3 , — is a monobasic organic 
acid, existing naturally in combination in various plants, but generally pre- 
pared synthetically from phenol. It occurs in light, fine, white, prismatic needles, 
or a crystalline powder, odorless, of sweetish, afterwards acrid taste and acid 
reaction, permanent in the air; soluble in about 450 of cold water, but readily 
soluble in water containing 8 per cent, of Borax or 10 per cent, of Sodium Phos- 
phate. It is soluble in 2$ of alcohol, in 14 of boiling water, in 2 of ether, in 80 
of chloroform, and is very soluble in boiling alcohol. Dose, gr. v-xv [av. gr. 
vijss\] 

Salicylic Acid is a derivative of Salicin, probably by double oxidation ; but may also be 
considered as a substitution-derivative of Benzene, formed by replacing 2 atoms of its hydrogen, 
the one by hydroxy!, and the other by carboxyl. It is obtained therefore either synthetically by 
combining the elements of Phenol with these of Carbonic Acid, and subsequent purification, 
—or from natural Salicylates as the Oil of Wintergreen and Sweet-Birch, — or from Salicin, 
by heating with caustic potash and treating with hydrochloric acid. The acid prepared from 



424 SALICINUM. 

natural sources is purer and more efficient than that prepared artificially, and will often be 
tolerated by a patient who cannot bear the latter. 

Official Salicylates. 

Lithii Salicylas, Lithium Salicylate, LiC 7 H 4 3 , — a white, or grayish-white powder, 
odorless, sweetish, very soluble in water and in alcohol. Dose, gr. v-xxx [av. gr. xv.] 

Sodii Salicylas, Sodium Salicylate, NaC 7 H 5 3 , — a white, amorphous powder, soluble in j 
of water and in 6 of alcohol, also in glycerin. Dose, gr. v-xxx [av. gr. xv.] 

Strontii Salicylas, Strontium Salicylate, — a white, crystalline powder, soluble in 18 of 
water and in 66 of alcohol. Dose, gr. v-xxx [av. gr. xv.] 

Methylis Salicylas, Methyl Salicylate, (Artificial Oil of Wintergreen), — is an ester, 
produced synthetically; and is the principal constituent of Oil of Gaultheria and Oil of 
Betula. It is] soluble in all proportions in alcohol [or glacial acetic acid. Dose, njv-xxx 
[av. irjxv], suspended in sugared water. 

Phenylis Salicylas, Phenyl Salicylate, Salol, C 13 H 10 O 3 — is the salicylic ester of phenyl, 
and occurs as a white, crystalline powder, odorless and almost tasteless, nearly insoluble in 
water, soluble in io of alcohol, and very soluble in ether, chloroform and oils. On being 
warmed with an alkali it splits up into Salicylic Acid 6o, and Phenol 40. Dose, gr. v— xv 
[av. gr.vijss], frequently repeated, in compressed tablets or in cachets, or suspended by muci- 
lage of acacia or of tragacanth. 

Physostigminae Salicylas, Physostigmine Salicylate, — is described under Physostigma. 

Oleum Betulze, Oil of Betula, (Oil 0} Sweet Birch), — is a volatile oil distilled from the 
bark of Betula lenta, the Sweet Birch. It is identical with Methyl Salicylate (see above), 
and nearly identical with Oil of Gaultheria. Russia leather derives its odor from this oil. 
Dose njv-xxx [av. itjjxv.] 

Oleum Gaultheria, Oil of Gaultheria, Oil of Wintergreen, — consists almost entirely of 
Methyl Salicylate, and is nearly identical with the preceding. It is described under the title 
Gaultheeia. 

Unofficial Salicylates and Other Derivatives. 

Aspirin, Acetyl-salicylic Acid, — occurs as a white powder, soluble in 100 of water. It 
is said to be more efficient than the salicylates, and to cause less gastric irritation. It has 
been used most efficiently in acute articular and muscular rheumatism, gout, pleurisy, poly- 
neuritis, chorea and neuralgia. Dose, gr. v-xv, thrice daily. 

Malakin, Salicyl-para-phenetidin, — is a condensation product of salicylic aldehyde and 
p-phenetidin, occurring in bright yellow needles, almost insoluble in water or alcohol, and 
decomposed by dilute mineral acids. Its action is that of salicylic acid, but its effects are very 
mild, — hence its name (from fiaXaKoc, mild). It has proved valuable in acute rheumatism 
and other febrile affections, as an antipyretic and analgesic. As it may be given for a 
long time without causing any disturbance, it is of especial service in habitual headaches. 
Dose, gr. viij— xv, repeated about six times in 24 hours. 

Mesotan, — the methyl-oxymethyl ester of salicylic acid, is a yellow fluid, miscible in all 
proportions with alcohol, ether and oils. It contains 71 per cent, of salicylic acid, is readily 
absorbed by the skin, and is used with friction as an external remedy in rheumatism, either 
pure or mixed with an equal quantity of olive oil. 

Rheumatin, is the trade name of a salicylate of saloquinine, and occurs in tasteless 
needles, sparingly soluble in water. It is used with benefit in acute articular rheumatism 
and trigeminal neuralgia. Dose, gr. x-xxx, up to 3j daily. 

Salipyrin, Antipyrine Salicylate, Ci 8 H 18 N 2 4 , — is produced by the combination of Sali- 
cylic Acid 57.7, and Antipyrine 42.3 parts. It is a white, crystalline, odorless powder, very 
soluble in alcohol, insoluble in water. Its claims to preference are based upon its comparative 
harmlessness ( Sijss having been taken within 3 or 4 hours without the slightest ill effect), 
but 2 doses of gr. xv four hours apart caused serious effects in one case. Dose, gr. x-xx 
every hour or 2 hours until 5ij have been taken. It is best administered in wafers, as a 
powder, or in mixture, rubbed up with glycerin and flavored with raspberry syrup. 

Salophen, Para-amido phenol Salicylate, — contains the equivalent of nearly 5 1 per cent, 
of Salicylic Acid, and occurs as minute, white, crystalline scales, odorless and tasteless, insol- 
uble in water, soluble in alcohol; decomposed by alkalies into salicylic acid and acetvl-para- 
amido-phenol; also decomposed by the organism as demonstrated in the urine. Dose, gr. 
v-xv, up to 5j or jss in the 24 hours. 



SAI [C3NUM. 425 

Saloquinine, Salochinin, — the quinine ester of salicylic acid, occurs as a tasteless, 1 rystal- 
linc powder, insoluble in water. It is said to possess the virtues of quinine as well as 1 
of salicylic acid, and is used efficiently as an antipyretic and anti-neuralgic. Dose, gr. x-xxx, 
thrice daily. 

Urasol, Acetyl-methylene Di-salicylic Acid,— is a proprietary preparation, said to contain 
Salicylic Acid 75, Vcetic Acid 16, and Formaldehyde S per cent. It occurs as an insoluble, 

yellowish-white powder, and is claimed to have SOlvenl power on uric acid, to he free from 

toxic, irritant or depressant qualities, and to have been used with benefit in rheumatism, gout, 
cystitis, pyuria, typhoid fever and scarlet fever. Dose, gr. v-x every hour, or gr. xv-xx 
every 3 or 4 hours, to a daily average of oij- 

Incompatible^. 

Incompatible with Salicylic Acid and the Salicylates are: Acids (mineral), Exalgin, Ferric 

salts, Lead Acetate, Lime-water, Potassium Iodide, Quinine salts, Sodium Phosphate, Spirit 

of Xitrous Ether, Urethanc. With Salol are: Alkalies with heat, Borneol, Bromine-water, 

Camphor, Chloral Hydrate, Euphorin, Exalgin, Ferric Chloride, Naphthalene, Phenol, 

• Fyrocatechin, Resin, Thymol, Urethane. 

Physiological Action. 

Willow-bark is highly astringent, antiperiodic and feebly tonic, but is never 
employed medicinally owing to its bulk. Salicin is a bitter tonic, also anti- 
fermentive, antiseptic and highly destructive to low organisms. It has slight 
antiperiodic power and is feebly antipyretic. It prevents the reaction between 
umygdalin and emulsin, also that of ptyalin on starch. It is well borne by the 
stomach, seems to be devoid of toxic power on man, and is mainly excreted 
as salicylic, salicyluric and salicylous acids, being first changed in the bowel 
into saligenin and glucose. 

Salicylic Acid is an energetic antipyretic, antiseptic and germicide. Locally 
it is anhydrotic and stimulant, its prolonged contact with the skin causes swell- 
ing and exfoliation of the epidermis, the cast-off flakes being thicker in direct 
proportion to the strength of the preparation employed. It is irritant to mucous 
membranes, and when inhaled it causes sneezing and cough. In small doses 
it stimulates the stomach, heart and respiration, but moderate quantities derange 
the stomach, causing nausea and vomiting; while large doses depress the heart's 
action and the respiration after a primary excitation of both, lower the arterial 
tension, relax the vessels, produce free perspiration, and reduce the tempera- 
ture in fever. It causes symptoms resembling those of cinchonism, including 
a sense of fulness in the head, roaring and buzzing in the ears, disturbances of 
sight and hearing, excessive sweating, dilated pupils, and delirium. A toxic 
dose produces extreme dyspnea, a slow and laboring pulse, depression of the 
heart and arterial tension, and gradual failure of the respiration, until death 
occurs from asphyxia. Large doses continued for some time may produce 
bed-sores from depression of the circulation, but do not affect the peripheral 
nerves as to either motion or sensation. In the blood it is first changed to 
sodium salicylate, but a portion is again set free and uniting with glycocoll 
forms salicyluric acid, coloring the urine green. It is slowly excreted with the 
secretions generally, especially in the urine, sweat, saliva, and bile. It stimu- 
lates the kidneys, at the same time disinfecting them and increasing the acid- 
ity of the urine, but may so irritate the kidneys as to produce albuminuria and 



426 SALICINUM. 

hematuria. It largely increases the elimination of urea and uric acid. It is 
destructive to the torula and other low organisms, and prevents alcoholic fer- 
mentation, also that caused by the organic ferments (pepsin, ptyalin, etc.). 
In solutions containing bacteria it will prevent their development if present 
in the proportion of 1 in 1,500, and will destroy them in the strength of 1 in 
250 (Bucholz). 

Sodium Salicylate is remarkably antipyretic in doses of gr. xv, given 4 or 5 
times in 24 hours. It is a powerful diaphoretic, and an efficient cholagogue, 
and is supposed to possess the curious property of increasing the fluidity of the 
bile, at the same time that it promotes its secretion, other cholagogues increas- 
ing the proportion of solids therein. (Brunton.) It greatly increases the eli- 
mination of uric acid and urea, and in other respects it acts like the acid, but- 
with less energy. Its antiseptic and germicidal powers are nearly equal to those 
of salicylic acid. 

Phenyl Salicylate (Salol) is decomposed in the small intestine, and in 
overdoses may produce the tinnitus aurium and other symptoms of salicylic 
acid, as also the smoky urine and other effects of phenol. As an antipyretic 
it ranks high, and acts with sufficient power to depress the temperature below 
the normal point. It causes profuse sweating and sometimes depression when 
so employed. It increases nitrogenous elimination, and though itself but feebly 
germicidal it is one of the most efficient intestinal disinfectants, the products 
of its decomposition in the intestinal canal being active germicides. 

Therapeutics. 

The Salicin derivatives are employed chiefly in acute and subacute rheu- 
matism, in which they possess great power to modify and overcome the severe 
symptoms, though exercising no permanent influence on the causative factors 
of the disease. They are most suitable to strong and vigorous patients, and 
if they do not relieve the symptoms quickly their use should be abandoned. 
The activity of Salicin depends probably on its conversion into salicylic acid 
in the organism, which being slow and imperfect, this agent is not suitable for 
rapid results, and is seldom employed. 

Salicylic Acid is irritant to the stomach and for internal use has been largely 
displaced by its sodium salt, though some clinicians believe it to be more effi- 
cient in rheumatic fever than any salicylate. It is much used by dermatologists 
as a local application in skin diseases characterized by much thickening of the 
epidermis and in the parasitic skin affections. It is the active ingredient of corn 
remedies, and is a useful application in gangrenous wounds, eczema of the 
hands or feet, cancer, burns, and fetid perspirations, in the last affection being 
used in solution with borax. 

Sodium Salicylate is more soluble than the acid and less irritant to the stom- 
ach, while in doses about 50 per cent, larger it is equally efficient. It is em- 
ployed in 3- to 5-grain doses internally after meals, to arrest gastric fermentation 



SA] [CIN1 M. 



437 



and to prevent acidity and flatulence. It is used instead of the acid in acute 
inflammatory rheumatism, muscular rheumatism, phlebitis, rheumatic neuritis 
and other irregular forms of rheumatism, with immediate benefit in most cases, 
and it sometimes gives temporary relief in chronic rheumatism. In gout and 
its manifestations, especially migraine and sciatica, it frequently proves highly 
effective; and it has been used with satisfaction in cases showing a tendency 
to the formation of gall-stones. It is useful in the glycosuria of gouty subjects, 
and in the nervous irritability of lithemic persons. It is ranked as almost speci- 
fic in pneumonia by many practitioners, and is very efficient in non-syphilitic 
inflammations of the eye-ball, whether rheumatic or not, especially interstitial 
keratitis, if given in large doses, gr. j for each pound of body weight. It is highly 
efficient in quinsy, and has been commended as an alterative diuretic for the 
removal of serous pleuritic effusions. When large doses are prescribed the 
patient should be kept in bed, and brandy, strychnine, and digitalis should be 
administered to counteract its depressant action. The salicylates are contra- 
indicated in meningeal inflammation or congestion, middle ear disease, renal 
insufficiency, albuminuria, and nephritis. 

Lithium Salicylate is believed to be particularly applicable in lithemia, 
gout, rheumatic arthritis, and the various manifestations of the uric diathesis. 
Strontium Salicylate is not apt to derange the stomach, but is too slow in its 
action to be of value when a rapid and powerful influence is desired. In 5- 
grain doses it is one of the best intestinal antiseptics, giving better results 
than salol or naphthalene. In 10 to 15 grain doses it is one of the most effi- 
cient salicylates for chronic gout and lithemia with intestinal indigestion (Wood) . 

Phenyl Salicylate (Salol) is efficient for duodenal catarrh, catarrh of the 
bile-ducts and catarrhal jaundice; also in the bilious form of sick-headache, 
and in some forms of neuralgia. Its greatest power is manifested in acute 
rheumatism, in which many clinicians maintain that it has no superior, if given 
in 15- to 30-grain doses, up to 2 drachms in the 24 hours, and continued for 
some time after the acute symptoms have subsided. In large doses, it is 
liable to induce symptoms of phenol poisoning, w r hich may be met by admin- 
istering sodium sulphate or any other sulphate. In all affections associated 
with micro-organisms in the intestines, as acute diarrhea^ cholera, dysentery, 
and typhoid fever, it has done most excellent service, even in Asiatic cholera. 
It is a remedy of very great value in typhoid fever, disinfecting the ulcerated 
intestine it promotes the healing process and hinders reinfection. It is highly 
praised in epidemic influenza (grippe), having proved itself remarkably efficient 
in recent epidemics of that affection. It proves an efficient disinfectant in catarrh 
of the bladder, its constituents being excreted with the urine and coming in 
contact with the vesical mucous membrane for a considerable length of time. 
It is much quicker in its action upon the urine than ammonium benzoate, as 
in a day or two ordinarily the urine loses its foul odor and alkalinity and be- 
comes clear. Dissolved in Retinol, it is considered especially useful in sub- 



428 SALVIA — SAMBUCUS. 

acute cystitis, having conquered cases in which other remedies have proven 
ineffectual. It has been successfully employed as a remedy in diabetes and in 
variola, given in doses of 15 grains three or four times daily. Its therapeutic 
value depends chiefly upon its property of splitting up in the alkaline fluids of 
the intestine into Salicylic Acid and Phenol compounds, whereby it effects the 
thorough antisepsis of the intestinal tract and performs the work of its constit- 
uent elements upon the organism. Externally it is employed as an antiseptic 
and deodorant powder against impetigo, eczema, sycosis and other skin dis- 
eases; and has done good service as an insufflation in the treatment of ozena. 
In spirituous solutions (5 per cent.) it is used with various flavoring agents in 
the preparation of mouth-washes and dentifrices, and it enters into the composi- 
tion of soaps, face powders, and other toilet articles. A mixture of equal parts 
of Camphor and Salol, heated together, has given good results in the treatment 
of suppuration of the middle ear, giving no pain and setting up no inflammation 
of the part. 

Salophen is tasteless and non-toxic, while probably equal to salol in efficiency. 
It has been used with great satisfaction in acute rheumatism, rheumatic arth- 
ritis, typhoid fever, cholera, neuralgia, sciatica, gastro-enteritis, pyelitis and 
cystitis. In long-standing sciatica a 10 per cent, solution hypodermically into 
the gluteal muscles has given good results. It has been employed with decided 
benefit in intestinal dyspepsia with flatulence, also in gastrectasis for the relief 
of the fermentive disturbances to which the dilated stomach is liable. 

Salipyrin has given excellent results in acute and chronic rheumatism, rheu- 
matic sciatica, neuralgia and influenza; and has proved efficient in metror- 
rhagia from various causes, given in doses of 15 grains thrice daily up to a daily 
maximum of 2\ ounces in some instances. In 50 such cases treated by Orth- 
man no unpleasant effects were observed, but Scharfe reports a case of serious 
poisoning by two doses of 15 grains each, taken four hours apart. As it is 
not obtainable in this country, by reason of a legal conflict between its patentees 
and those of antipyrine, its constituents may be administered in conjunction 
in the proportion of Salicylic Acid 3 and Antipyrine 2, in proper dose for each 
case, with just as good results as are afforded by Salipyrin itself (Squibb). 

SALVIA, Sage, — the leaves of Salvia officinalis, the common garden Sage, a perennial 
plant of the nat. ord. Labiate, native in Southern Europe but cultivated in our gardens for 
its strong, fragrant odor. They contain tannin, resin, etc., and a volatile oil which consists 
of Salviol, C 10 H 16 O, camphor and terpenes. There are no official preparations. Dose of 
the powdered leaves, gr. xx-xlv [av. gr. xxx], in infusion. 

Sage is aromatic, stimulant, tonic, astringent and a vulnerary. It was highly esteemed 
in ancient times, and even yet is popular as a domestic cure-all with many people. In infu- 
sion it may be used as a beverage in febrile conditions and to check sweating, also for the 
night-sweats of phthisis. Like other members of the same class it has a slight influence over 
enteralgia and flatulence. It makes a good astringent and stimulating gargle. 

SAMBUCUS, Elder, (Unofficial), — the flowers of Sambucus canadensis, the common 
Elder, a shrub of the nat. ord. Caprifoliaceae. The plant contains a small quantity of a vola- 
tile oil, also a resin and valerianic acid. The common Elder of Europe (S. nigra) is more of a 
tree, and is official in the Br. Phar. Dose, gr. xxx- 5 j, in hot infusion. 



SWi'.l 1\ \KI \. 



429 



Elder-flowers are stimulant and diaphoretic, also diureti* in some degree. The berries 
are diaphoretic and laxative, while the inner bark is a hydragogue cathartic and in large 
doses emetic. Formerly the inspissated juice of the berries was employed as an alterative 
in rheumatism and syphilis, but the Bowers are now used only for flavoring purposes. Elder- 
flower Water (Aqua Sambuci, B. P.) is an excellent vehicle for collyria and lotions. 



SANGUINARIA, Blood-root,— is the dried rhizome, collected in autumn, 
of Sanguinaria canadensis, a perennial plant of the nat. ord. Papaveracea?, 
which grows throughout the United States, being one of the earliest and most 
beautiful of the spring flowers. It has a single white flower on an erect stalk, 
the petals often tinged with rose or purple. It contains the alkaloids San- 
guinarine, C^H^NO^ Chekrythrine, found also in Chelidonium, Protopine, 
present also in Opium, and Homochelidonine; with citric and malic acids, resins, 
gum, etc. The salts of its alkaloids are of brilliant red and orange colors and 
are soluble in water. Dose of the powdered root as an expectorant, gr. j-v 
[av. gr. ij]; as an emetic, gr. x-xxx; best given in pill. 

Preparations. 

Fluidextractum Sanguinariae, Fluidextract of Sanguinaria. — Dose, njjj-v [av. itjjss] 
as an expectorant and stimulant; njx-lx as an emetic, cautiously. 

Tinctura Sanguinariae, Tincture oj Sanguinaria, — strength 10 per cent. Dose, as an 
expectorant, ttjjv-xxx [av. tijjxv]; as an emetic oj-iij- 

Sanguinarina, Sanguinarine, C 20 H 15 NO 1 (Unofficial), — is the chief alkaloid and prob- 
ably the active principle of the plant. Dose, as an expectorant, gr. j?-}; as an emetic gr. h 
repeated in 10 minutes will produce vomiting after the second or third dose. As found in 
commerce it is generally a mixture of the alkaloids. 

Incompatibles are: Alkalies, Tannic Acid, Metallic salts, and other alkaloidal precipi- 
tants. 

Physiological Action. 

Sanguinaria is sternutatory, sialagogue, expectorant and emmenagogue, a 
systemic emetic, a cardiac paralyzer, a violent irritant, an acro-narcotic poison 
and an alterative. Its taste is bitter and acrid. It causes violent sneezing 
when inhaled, increases secretion by irritating the secretory organs as it is elim- 
inated, and in full doses produces salivation, catharsis and vomiting with 
great depression. Overdoses are violently irritant, the heart's action being at 
first increased, together with the arterial tension, then markedly depressed, 
and finally paralyzed by stimulation of its inhibition. The reflexes are lowered 
by paralysis of the spinal centres, muscular contra ctility is impaired, the pupils 
are dilated, the temperature is lowered, cold sweats, great thirst and collapse 
supervene, and death occurs by paralysis of the cardiac and respiratory centres, 
often preceded by convulsions. Locally used, Sanguinaria is a feeble escharotic. 

Sanguinaria is a member of the poppy family, and its alkaloids bear a close 
resemblance to those of opium. Sanguinarine causes tetanus and high excite- 
ment, and stands between codeine and thebaine in its action on the central 
nervous system. It causes violent peristalsis of the bowel, increases the saliva, 
and is emetic and expectorant. Chelerythrine paralyzes the central nervous 
system without producing any preliminary stimulation, has the same action as 



43° SANTALUM ALBUM. 

protopine and cryptopine on the muscles (see page 363), and first irritates and 
then paralyzes the sensory nerve-endings. Homochelidonine resembles morphine 
in its effects on the central nervous system, but has less stimulant action. 

Therapeutics. 

Sanguinaria is used in small doses of the tincture as a gastric tonic and an 
hepatic stimulant in atonic dyspepsia, duodenal catarrh and that of the biliary 
ducts with jaundice. Affections of the respiratory tract are often benefited 
by it, especially asthma, acute bronchitis and chronic nasal catarrh, in which 
expectorant doses (gtt. x) of the tincture should be given, and in the latter affec- 
tion the powdered drug may be used as a sternutatory. A decoction forms an 
efficient gargle in the sore-throat of scarlet fever. Sanguinaria is a serviceable 
remedy in chronic bronchitis and in amenorrhea of functional character, also 
in functional impotence from irritability of the organs, with daily seminal losses 
and relaxation of the genitalia. By many practitioners it is considered a speci- 
fic emetic in croup, but others look upon it with disfavor as too uncertain and 
harsh in its action. It has been thought to have alterative properties, and hence 
is frequently used with Stillingia and other plants in the treatment of strum- 
ous and syphilitic affections. In pneumonia of typhoid type and in pleuro-pneu- 
monia it has undoubtedly been of great service in many cases. 

Locally, the powdered root is well employed as an application to foul ulcers 
and fungous granulations, also by insufflation to nasal polypi, and for chronic 
hypertrophy of the nasal mucous membrane. 

Sanguinarine has been used with good results in pneumonia, bronchitis and 
atonic dyspepsia. Doses of gr. -^ to \ are expectorant without irritating the 
stomach, and still smaller doses (gr. -£$ to -j 3 ^) are stimulating to the gastric and 
intestinal secretions. 



SANTALUM ALBUM, White Sandalwood,— the source of the official Oil 
of Santal, is not itself official. It is a tree of the nat. ord. Santalaceae, having 
its habitat in India but now nearly exterminated there. Santahim cilrinum, the 
yellow Sandalwood, from the Hawaiian and Fiji Islands, is more commonly 
met with in commerce. 

Oleum Santali, Oil 0} Santal, (Oil of Sandalwood), — a volatile oil distilled from the wood 
of Santalum album; a pale-yellow liquid, soluble in alcohol, of peculiar and aromatic odor, 
pungent taste and acid reaction. Dose, ttjjv-xv [av. njviij], in emulsion or capsules. 

Sandalwood is a very agreeable perfume. The Oil is astringent to mucous 
membranes, producing dryness of the fauces, thirst, colic, and a sense of ful- 
ness in the renal regions. In concentrated form it is a local irritant, but the 
effects of large doses have not been studied. It is extensively used in chronic 
bronchitis and in gonorrhea, forming the contents of proprietary capsules which 
are sold for the cure of the latter disease in all drug stores. As found in the 



SANTALUM RUBRUM — SANTONICA. 43 I 

shops it is extensively adulterated with oil of cedar and is a very unreliable 
remedy. 



SANTALUM RUBRUM, Red Saunders, — is the heart-wood of Ptcrocarpits santalinus, 
a tree of the nat. ord. Lcguminosa:, native in India. It comes in chips or as a coarse powder, 
nearly inodorous and tasteless, not imparting any red color to water when macerated in it, but 
coloring alcohol, ether and alkaline solutions a bright red. The wood has no medicinal 
properties and is employed solely for the purpose of coloring alcoholic preparations. It is a 
constituent of Tinctura Lavandulae Composita. 



SANTONICA, Levant Wormseed, — is the dried unexpanded flower-heads 
of Artemisia pauciflora, a small, perennial plant of the nat. ord. Compositae, 
which grows in Asia Minor, and contains a volatile oil and the peculiar, crys- 
talline principle Santonin. Dose, gr. x-lx. 

Santoninum, Santonin, C 15 H 18 0j — the inner anhydride or lactone of 
santonic acid, obtained from Santonica, occurs in colorless, prismatic crystals, 
turning yellow on exposure to light, odorless, of bitter after-taste, and neutral 
reaction, nearly insoluble in cold water, but soluble in 40 of alcohol, 4 of chloro- 
form, also in solutions of the caustic alkalies. Dose, gr. \-% for a child, gr. \- 
iij [av. gr. j ] for an adult, not repeated soon as the action of the drug is slow. 

Trochisci Santonini, Troches of Santonin, — each troche contains about £ grain of San- 
tonin, with Sugar, Tragacanth, and Stronger Orange Flower Water. Dose, j-v. 

Santonin and its preparation are sensitive to light and should be kept in amber-colored 
bottles tightly corked. 

Physiological Action and Therapeutics. 

Santonin is anthelmintic to the round-worm (ascaris lumbricoides), also 
but in less degree to the thread- worm (oxyuris vermicularis) . It is taken into 
the blood as Sodium Santoninate, and affects the cerebral faculties and the 
vision; objects appearing at first blue, green, or red, then yellow (chromatopsia), 
often succeeded by blindness for a week or more. Toxic doses disturb the con- 
sciousness of the patient, produce a sort of intoxication, tremors, weakness, 
with enfeebled respiration and slowing of the pulse, coldness of the surface, 
vomiting, sweating, mydriasis, convulsions, and death from failure of respira- 
tion. A dose of 2 grains is said to have proved fatal to a feeble child five years 
old. It is excreted by the kidneys, coloring the urine if acid a greenish-yellow, 
if alkaline a reddish-purple, and it produces considerable enuresis. 

As an anthelmintic Santonin is the most certain agent against the round- 
worm, and is best administered in powder with calomel at bedtime after a day 
of fasting, a senna-draught or a dose of castor oil being used the following morn- 
ing. It also acts fairly well in suppository against the thread-worm, but is inope- 
rative against tape-worm. Some observers consider it more promptly efficient 
when given in castor oil, and that the oil lessens the risk of evil after-effects. 
It has also been prescribed with great benefit for nocturnal incontinence of 
urine, and for certain eye affections, particularly amblyopia from atrophic or 



432 SAPO. 

inflammatory changes in the retina and optic nerve. It should never be given 
to children during a fever, nor when the bowels are constipated, for fear of toxic 
results. 



SAPO, Soap, (White Castile Soap), — is Soap prepared from sodium hydrox- 
ide and olive oil; a whitish solid, hard, yet easily cut when fresh, of faint, pe- 
culiar odor free from rancidity, a disagreeable alkaline taste and alkaline re- 
action; readily soluble in water and in alcohol. It is an ingredient of three of 
the official pills, and two plasters. 

Sapo Mollis, Soft Soap, (Green Soap), — is Soap prepared from potassium 
hydroxide and linseed oil; a soft, unctuous mass, of a yellowish-brown color, 
soluble in about 5 of hot water and in 2 of hot alcohol. The name Green Soap 
is a misnomer, as it is not green in color. 

Insoluble Soaps are combinations of the oily acids with earths and metallic 
oxides, as the Soap of Lime, official as Linimentum Calcis, and the Soap of 
Lead Monoxide, the former Lead Plaster. 

Sapo Animalis, Curd Soap, official in the Br. Phar., — is made with Soda and a purified 
animal fat consisting chiefly of Stearin. Used in pills and suppositories. 

Sapo Medicatus, official in the French Codex, — is a Soda soap prepared from expressed 
Almond Oil. 

Saponification is a process of double decomposition between a fat (stearate, palmitate or 
oleate of glyceryl) and an alkali, in which glycerin and the metallic salt of the fatty acid are 
formed. The glycerin, not being saponifiable, is set free, but the fatty acid (stearic, palmitic 
or oleic) unites with the salifiable base to form soaps, which are therefore mixed stearates, 
oleates and palmitates of various bases. Nearly all soaps are oleates or palmitates (or both) 
of sodium or potassium (or both). Hard soaps are sodium soaps, soft soaps are potassium 
soaps. 

Preparations. 

Emplastrum Saponis, Soap Plaster, — has of Soap 10, Lead Plaster 90, Water q. s. 

Linimentum Saponis, Soap Liniment, — has of Soap 6, Camphor 4J, Oil of Rosemary 1, 
Alcohol 724, Water to 100. Opodeldoc is a similar preparation. Soap Liniment is an ingre- 
dient of Chloroform Liniment. 

Linimentum Saponis Mollis, Liniment oj Soft Soap, (Tincture oj Green Soap), — has 
of Soft Soap 65, Oil of Lavender 2, Alcohol to 100. 

Physiological Action and Therapeutics. 

Soap is laxative, antacid and antilithic; externally it is a stimulating dis- 
cutient, and is used for cleansing the skin, removing fatty substances and soft- 
ening the epidermis, but if too long applied it may prove decidedly irritant. 
It is a good antidote in poisoning by acids, and should be administered freely 
in such cases until more energetic alkalies can be obtained. In aqueous solu- 
tion it makes a useful enema for constipation, or a plug of soap may be inserted 
into the rectum. 

Soft Soap is a powerful detergent stimulant and is much employed in skin 
diseases, especially eczema rubrum, in which the tincture is rubbed on, the dis- 
eased skin well washed and then covered with a bland ointment. The tine- 



SARSAPARILLA — SASSAFRAS. 433 

tare is the must elegant form for use, and may be diluted with three parts of 
alcohol for shampooing the scalp. 

The Liniment is used with friction in sprains, bruises and stiff joints, being 
a little more stimulating than camphor-liniment. It makes a good basis for 
extemporaneous liniment prescriptions. 

SARSAPARILLA, — is the dried root of Smilax medica, and other species 
of Smilax, plants of the nat. ord. Liliacea 5 , growing in Mexico, Honduras and 
Brazil. There are six commercial varieties on the market, which are put up 
in differently formed bundles. It contains starch, resin, calcium oxalate, an 
essential oil, and an acrid neutral principle named Parillin or Smilacin, which 
when acted on by dilute sulphuric acid yields another principle Parigenin. 

Preparations. 

Fluidextractum Sarsaparillae, Fluidextract oj Sarsaparilla. — Dose, itjxx- 3j [av. njjxxx]. 

Fluidextractum Sarsaparilla? Compositum, Compound Fluidextract oj Sarsaparilla, — 
has of Sarsaparilla 75, Glycyrrhiza 12, Sassafras 10, Mezereum 3, Glycerin 10, Diluted Alco- 
hol to 100. Dose, itjjxx- oj [av. njxxx]. 

Syrupus Sarsaparilla? Compositus, Compound Syrup of Sarsaparilla, — has of the 
Fluidextract 20, Fl. ext. of Glycyrrhiza ij, Fl. ext. of Senna ij, Sugar 65, Oils of Sassafras, 
Anise and Gaultheria, each 0.02, Water to 100. Dose, oj-5j[av. 3iv]. 

Syrup of Sarsaparilla (Unofficial), — much used to flavor soda-water, is a mixture of the 
oils of sassafras and gaultheria in syrup. 

Incompatibles. 

Incompatible with Sarsaparilla preparations are Galls in infusion, Lead Acetate, Lime- 
water. 'With the Compound Syrup of Sarsaparilla, Mercuric Chloride. 

Physiological Action and Therapeutics. 
Those who believe that Sarsaparilla has any action ascribe to it diuretic, 
diaphoretic, tonic and alterative properties. Careful physiological experiments 
with the drug and its principle have so far given negative results. It has been 
used as a so-called "blood-purifier" in scrofula, chronic abscesses, necrosis, 
old ulcers, and many cutaneous diseases, but is generally combined with other 
agents of undoubted activity. The compound decoction is considered a good 
agent in tertiary syphilis, especially in debilitated subjects; while the other 
preparations are commonly employed as vehicles for potassium iodide and mer- 
curic chloride in syphilis of any form. 



SASSAFRAS, Sassafras, — is the dried bark of the root of Sassafras varii- 
folium, an indigenous tree of the order Lauracea?, collected in early spring or 
autumn, and deprived of the periderm. It contains a volatile oil, the principal 
constituent of which is Safrol (see next page). Dose, 3j-iv [av. gij]. 

Sassafras Medulla, Sassafras Pith, — is the dried pith of the same tree. 
When macerated in water it yields a mucilage which is not precipitated upon 
the addition of alcohol. 
29 



< 



i 



434 SCAMMONIUM. 

Safrolum, Safrol, C 10 H 10 O 2 , — is the methylene ether of allyl pyrocatechol, 
found in oil of sassafras, camphor oil, and other volatile oils. It is largely 
used in the manufacture of soap to disguise the odor of the fatty bases. Dose, 
m,j-x [av. n\,v]. 

Preparations. 

Mucilago Sassafras Medullae, Mucilage of Sassajras Pith, — has of the pith 2, in water 
100. Dose, indefinite [av. 5iv]. 

Oleum Sassafras, Oil of Sassafras, a volatile oil distilled from Sassafras, — a colorless 
or yellowish liquid, having the odor of Sassafras, a warm, aromatic taste and a neutral reac- 
tion, readily soluble in alcohol. Treated with cold nitric acid it becomes of a dark red color, 
and is finally converted into a red resin. Dose, njj-iv [av. njiij]. 

Infusum Sassafras, Infusion of Sassafras (Unofficial), — is a popular "tea" which may 
be taken ad libitum. When made from the bark, and taken internally as well as applied 
locally, it is almost a specific for the rash produced by poison oak (Hinton). 

Sassafras is a constituent of the two compound Sarsaparilla preparations. 
It acts as a stimulant diaphoretic when used in quantity of the hot infusion. 
It enjoys a popular reputation as a "blood-purifier," and has a destructive in- 
fluence on infusoria. It is employed chiefly in combination with Sarsaparilla 
and Guaiacum in cutaneous disorders and rheumatic and syphilitic affections. 
The mucilage of the pith is an excellent demulcent drink in acute gastritis and 
enteritis, or in poisoning by irritant and corrosive agents. It may be used in 
extemporaneous prescriptions to hold insoluble substances in suspension and 
for flavoring purposes. The oil is chiefly used for flavoring in mixtures and 
confectionery. The syrup popularly known as "Sarsaparilla" is composed of 
Oil of Sassafras and Oil of Gaultheria, in syrup. 

Dr. J. Bartlett, of Chicago, in a paper on the toxic properties of Sassafras, 
published in the Pharmaceutical Journal, says that it appears to have some re- 
semblance to three familiar drugs — opium, strychnine, and ergot; for it has 
a narcotic and sudorific action; a property of inducing tetanic and clonic spasms 
followed by paralysis, and a probable stimulant effect on the uterus. 



SCAMMONIUM, Scammony, — is a gum-resin obtained by incising the 
living root of Convolvulus Scammonia, a plant of the nat. ord. Convolvulaceae, 
growing chiefly in Syria and Asia Minor. It contains about 80 per cent, of 
Resin, with gum, sugar, starch, etc. The active principle, Jalapin, is probably 
identical with the Convolvulin of Jalap, and is contained in the root and the 
resin. Dose, gr. j-x [av. gr. ivj. 

Resina Scammonii, Resin of Scammony, — soluble in alcohol and in ether. Dose, 
gr. j-v [av. gr. iij ]. 

Extractum Colocynthidis Compositum, — (see page 246) contains 14 per cent, of 
Resin of Scammony, and is an ingredient of the Compound Cathartic Pill, and the Vegetable 
Cathartic Pill. 

Scammony is an active cathartic, stimulating the liver and the intestinal 
glands, and causing free purgation in a few hours with considerable griping. 
Its solution in the bile is necessarv to its action, and it combines with the soda 



sen i \. 4^5 

in that secretion. Though quite drastic in action it is somewhat uncertain 
as a purgative and is generally employed in combination with similarly acting 
agents. It is anthelmintic against the tapeworm, and in overdoses produces 
a high degree of irritation. It is used as a drastic purgative for children with 
calomel or potassium sulphate, when an active cathartic is indicated. In t In- 
same way it is the appropriate agent on the principle of derivation in dropsies 
and cerebral affections, also in torpid states of the intestines with much slimy 
intestinal mucus; but it is contraindicated in cases attended by irritability of 
the stomach and bowels. 



SCILLA, Squill, — is the sliced dried bulb of Urginea maritima, a peren- 
nial plant of the nat. ord. Liliaceas, growing on the shores of the Mediterranean. 
It contains the glucosides — SciUitoxin, acrid and bitter, the most active prin- 
ciple; Scillipicrin, acting on the heart; and Scillin, causing numbness and 
vomiting; also Sinistrin, a mucilaginous principle. The Scillitin of the older 
writers is a complex substance. Dose of the powdered drug, gr. j-v [av. gr. ij ]■ 

Preparations. 

Fluidextractum Scillae, Fluidextract of Squill. — Dose, ny-v [av. njyss]. 

Tinctura Scillae, Tincture of Squill, — 10 per cent. Dose, ttjjv-xxx [av. ttjxv]. 

Acetum Scillae, Vinegar of Squill, — 10 per cent. Dose, njjv— xxx [av. itRxv]. 

Syrupus Scillae, Syrup of Squill, — has of the Acetum 45, with Sugar 80 and Water to 
100. Dose, iTijx- 3j [av. njjxxx]. 

Syrupus Scillae Compositus, Compound Syrup of Squill, — has of the fluidextracts of 
Squill and Senega, each 8, Tartar Emetic 0.2, Sugar 75, Water to 100. Is known popularly 
as Coxe's Hive Mixture, and contains less than one grain of Tartar Emetic to the fluid ounce 
(15 grains in 17 fl. ozs.). Dose, for children, njv-5j, the latter being an emetic dose; for 
adults, as an expectorant, njjxx-xlv [av. ttjxxx]. 

Incompatibles. 

Incompatibles are: as for glucosides (see page 8), and in addition with the Compound 
Syrup those for Tartar Emetic (see page 139). 

Physiological Action and Therapeutics. 

In small doses Squill is expectorant, in larger doses emetic and diuretic, 
and in overdoses it is a violent irritant poison, producing nausea, vomiting, 
purging, gastro-enteritis, strangury, bloody urine, perhaps suppression of urine, 
paralysis and convulsions, with death by paralysis of the heart in systole. Medi- 
cinal doses slow the heart, making the pulse stronger and slower, raising the 
arterial tension, and increasing the flow of urine (like Digitalis). Its active 
constituents diffuse into the blood, and its systemic effects follow on its appli- 
cation to the skin and seem to be exerted upon the lining of the secretory organs, 
especially affecting the bronchial, gastro-intestinal and genito-urinary mucous 
membranes. 

Squill is employed in medicine for its expectorant and diuretic effects. It 
is especially applicable in cardiac dropsy, combined with digitalis or the saline 



436 SCOPARIUS. 

diuretics, and in chronic bronchitis, in which it may be associated with ipecac, 
ammonia, asafetida, or benzoin. It is used in croup, but is usually combined 
in this affection with some other emetic, as tartar emetic in the compound syrup, 
a mixture which may produce very depressing effects and should be used with 
caution. In whooping-cough and other irritant coughs with tickling sensations 
in the throat the syrup or vinegar is often of great service. 

The action and uses of Squill should be studied in connection with those 
of Digitalis and Ipecacuanha. 

SCOPARIUS, Scoparius (Broom), — is the dried tops of Cytisus Scoparins, 
the Broom plant, a common garden shrub of the nat. ord. Leguminosae, having 
small, downy leaves and numerous large golden-yellow flowers. It contains 
Sparteine, C 15 H 26 N 2 , a volatile, liquid alkaloid, which contains no oxygen, but 
possesses very decided basic qualities; and Scoparin, a neutral principle. There 
are no official preparations. Dose, gr. v-xxx [av. gr. xv]. 

Sparteinae Sulphas, Sparteine Sulphate, — white, prismatic crystals, or a granular powder, 
of slightly saline and bitter taste, very soluble in water and in alcohol. Dose, gr. j R --i [av. gr. \\ 
hypodermically, gr. \— ij by the mouth. Small doses, gr. -fj— 1> every five hours, for cardiac 
action; larger, gr. j-ij, for diuresis (Clarke). Larger doses are necessary, say gr. jss-iij, ter 
die (Prior). 

Incompatibles are as for alkaloids (see page 6). 

Physiological Action and Therapeutics. 

Broom-tops are diuretic and laxative, also emetic and cathartic in large 
doses. Their diuretic power is believed to be due to Scoparin, which acts as 
a stimulant of the renal epithelium. In the form of decoction they have long 
been a favorite diuretic and vehicle for other diuretics in the treatment of dropsies, 
both cardiac and renal, and are considered most reliable in dropsy of renal 
origin, but are contraindicated in acute renal affections, and where pulmonary 
congestion or inflammation exists. 

Sparteine resembles Coniine in action, paralyzing the peripheral termina- 
tions of the motor nerves, though affecting the central nervous system but slightly. 
It depresses the heart, slowing its rate and weakening its contractions. When 
injected intravenously it produces a slight rise of arterial tension for a short 
time, but has no effect on the blood-pressure when given internally. It is much 
less poisonous than coniine or gelsemine, and proves fatal to animals by paralyz- 
ing the end-organs of the phrenic nerves in the diaphragm. It was formerly 
supposed to act similarly to Digitalis on the heart and kidneys, but experimental 
and clinical observations have shown that it possesses no such power comparable 
with that of the latter agent. It has been extravagantly praised as a remedy 
in cardiac affections requiring stimulation of the heart's action with the slight- 
est possible increase of arterial tension, in mitral and aortic regurgitation, mitral 
stenosis, cardiac palpitation and arrythmia, chronic Bright's disease, exoph- 
thalmos, and asthma. In the treatment of the opium habit Jennings found 



SCI in i \ki\ si \i r. \. 437 

it serviceable at the periods of depression, to overcome the plateau shown in 
the sphygmographic trace by stimulating the cardiac force. The claims made 
for it by enthusiastic reporters have not been substantiated generally, and it 
is no longer used to any great extent in practice. 

SCUTELLARIA,— is the dried plant Scutellaria lateriflora, Skull-cap, an indigenous, 
perennial herb of the nat. ord. Labiatse, growing in moist places and along ditches. It con- 
tains a little volatile oil, traces of a bitter principle, besides fat, tannin and sugar. Dose, 
gr. x-xx.x [av. gr. xv]. 

Fluidextractum Scutellariae, Fluidextract of Scutellaria. — Dose, ngx-xxx [av. ttpxv]. 

Scutellaria produces no very obvious effects when taken internally. By some practi- 
tioners it is said to have tonic, nervine and antispasmodic powers, and it has been used in do- 
mestic practice to calm the nervous system in diseases characterized by restlessness, tremors, 
spasms, twitching of the muscles, and hyperesthesia, as chorea, delirium tremens, nervous 
exhaustion from fatigue or over-excitement, hydrophobia, hysteria and epilepsy. The Scu- 
tellarin of the eclectics is not a proximate principle, but an extract precipitated by alum from 
a concentrated aqueous tincture. It is given in dose of gr. j-iv. 

SENEGA, — is the dried root of Poly gala Senega, an indigenous, perennial 
plant of the nat. ord. Polygalaceae, having small, white flowers in a close spike 
at the summit of the stem. Its principal constituent is the glucoside Senegin, 
C 32 H 54 13 , which is identical with Saponin (see page 410), and closely allied 
to Digitonin. It is a white, amorphous powder, readily soluble in alcohol 
and hot water, forming a soapy emulsion when mixed with boiling water, and 
decomposed by HC1 into sugar and Sapogenin. Dose of Senega, gr. x-xxx 
[av. gr. xv]. 

Preparations. 

Fluidextractum Senegas, Fluidextract of Senega. — Dose, ttjjx-xxx [av. njjxv]. 

Syrupus Senegas, Syrup of Senega, has of the fluidextract 20, Syrup 80. Dose, 5j-ij 
[av. 5j]. 

Syrupus Scillae Compositus, Compound Syrup of Squill, — contains 8 per cent, of Sen- 
ega. (See under Scilla, page 435). 

Incompatibles are as for glucosides (see page S). 

Physiological Action and Therapeutics. 

Senega is a stimulating expectorant, a diuretic and a diaphoretic. It causes 
irritation of the throat, with some salivation and gastro-intestinal irritation, 
an inclination to cough, increased bronchial secretion, and perhaps some diu- 
resis and diaphoresis. Inhaled as a snuff it is very irritant to the mucous mem- 
brane of the nose, causing cough, sneezing and nasal catarrh. Senegin is vio- 
lently irritant and a powerful depressant of the heart, and the vascular, ner- 
vous and muscular systems. It is excreted by the bronchial mucous mem- 
brane, the kidneys and the skin, all of which it stimulates and in large quan- 
tity irritates. 

The use of Senega is chiefly that of a stimulating expectorant in chronic 
bronchitis, the second stage of acute bronchitis, typhoid pneumonia, asthma 
and croup, also as a diuretic in dropsy due to renal disease. It removes the 
tightness and oppression experienced in the subacute chest affections, relieves 



438 SENNA. 

cough and rapidly promotes expectoration. When the mucus is tough and 
scanty this remedy is of no value. It has been used with benefit in amenorrhea, 
given in saturated decoction for two weeks before the expected period. In 
chronic rheumatism and in rheumatic paralysis its stimulating and diaphoretic 
powers have been of value. Senegin has been successfully used in 2-grain doses 
as a remedy for uterine hemorrhage. 



SENNA, — the dried leaflets of Cassia acuti folia, Alexandria senna, or of 
Cassia angustifolia, India senna, shrubs of the nat. ord. Leguminosae, grow- 
ing in Egypt and India. They contain an amorphous glucoside, Cathartic 
Acid, which forms salts with bases and may be decomposed into glucose and 
cathartogenic acid. Other constituents are Sennapicrin and Sennacrol, both 
glucosides; Catharto-mannit, a peculiar, unfermentable sugar; also Chryso- 
phanic Acid in small quantity, sugar, and various salts. Dose 3ss-ij [av. 3j]. 

Preparations. 

Fluidextractum Sennas, Fluidextract of Senna. Dose njx-3j [av. njjxxx]. 

Syrupus Sennas, Syrup oj Senna, — has of the fluidextract 25, Oil of Coriander \, Syrup 
to 100. Dose, 3ss-ij [av. 3j]- 

Confectio Sennae, Confection of Senna, — has of Senna 10, Cassia Fistula 16, Tamarind 
10, Prune 7, Fig 12, Sugar 55J, Oil of Coriander h, Water to 100. Is sold under the trade 
names Tamar-Indien, and Tropical Fruit Laxative. Dose, 5 ss— ij [av. 5j]- 

Infusum Sennae Compositum, Compound Infusion of Senna (Black Draught), — has of 
Senna 6, Manna 12, Magnesium Sulphate 12, Fennel 2, Boiling Water 80, Cold Water to 100. 
Dose, S ij— vj [av. Biv]. 

Purvis Glycyrrhizae Compositus, Compound Licorice Powder (See under Glycyr- 
rhiza), — contains 18 per cent, of Senna. Dose, 3ss-3jss [a v. 3j]- 

Syrupus Sarsaparillae Compositus, Compound Syrup of Sarsaparilla (See under Sar- 
SAPaeilla), — contains i\ per cent, of the fluidextract of Senna. Dose, 5j-5j [av. 3iv]. 

Incompatibles. 

Incompatible with Senna are: Mineral Acids, Carbonates, Cinchona infusion, Lead 
Acetate, Lime-water, Mercuric Chloride, Silver Nitrate, Tartar Emetic. 

Physiological Action and Therapeutics. 

Senna is a very efficient and safe cathartic, producing copious yellow stools 
in about 4 hours, with considerable griping and flatulence, which may be less- 
ened by combining it with carminatives. Its action is expended chiefly on 
the small intestine, and it increases both peristalsis and intestinal secretion. 
It has no irritant quality in ordinary doses, and does not produce hypercatharsis, 
or leave constipation as an after-result. Its infusion injected into the veins 
causes both vomiting and purging; and in large doses by the mouth it produces 
nausea, vomiting, flatulence, excited pulse and drastic purgation with severe 
tenesmus, but its effects are never poisonous. It may cause hemorrhoids and 
increase the menstrual flow in women. Given to a nursing mother her milk 
will acquire purgative powers. In some very susceptible persons the odor of 
the leaves or the infusion will cause an evacuation of the bowels. Its odor 



sera. 439 

and taste are particularly disagreeable, especially when administered in in- 
fusion. 

Senna would probably take rank as our best and safest cathartic but for 
the nauseousness of its smell and taste. It is a favorite laxative in England 
for children, and is used with great benefit in habitual constipation or where 
prompt evacuation of the bowels is required. In hemorrhoids and anal fissure 
it is employed to produce soft and easy motions; but if a tendency to hemor- 
rhoids exists, the use of this drug in cathartic doses will cause irritation of the 
part and induce an acute attack. For the same reason it is contraindicated 
in hemorrhage or inflammation of the intestinal mucous membrane, menor- 
rhagia, and abortion. The least disagreeable of its preparations are the con- 
fection and the compound licorice powder. 

SERA, Serums. Serum-therapy proper is the prophylactic and curative 
treatment of certain infectious diseases by the subcutaneous or intravenous 
administration of a blood-serum containing an antibody (antitoxic, bactericidal, 
etc.) which is specific to the particular disease. As generally used however, the 
term includes also the treatment of some of these affections by the toxic prod- 
ucts (toxins) of attenuated cultures of their respective microbes; but these toxins, 
though sometimes grown on blood-serum, may be produced on other media, 
and are never administered in a serum, as the antibodies invariably are. Bergey 
classifies these agents as follows: — 

Toxins, — including tuberculin and other bacterial products employed for 
immunizing purposes. The attenuated virus of rabies, and the toxins of strepto- 
cocci, bacillus prodigiosus, bacillus mallei, bacillus leprse, and the cholera spiril- 
lum have been used for their respective diseases. 

Antitoxic Sera, — including those of diphtheria and tetanus, the only ones 
in general use; though antitoxins for cholera, typhoid, tuberculosis, and other 
diseases, have been used with more or less benefit. 

Bactericidal Immune Sera, — including those for typhoid, dysentery, tuber- 
culosis, and cholera. 

Immune but not Bactericidal, — including the anti-pneumococcus, anti-strepto- 
coccus, and anti-staphylococcus sera. 

This separation of the products of immunity is wholly artificial, and it may 
be that the sera act upon the toxins or upon the micro-organisms, or upon both. 

Toxins are specific poisons produced by bacterial growth in suitable media, 
and when circulating in the organism they are the immediate causes of the 
acute infectious diseases. After the discovery of the bacillus tuberculosis other 
micro-organisms were found constantly associated with certain infectious dis- 
eases, notably tetanus, diphtheria, cholera, pneumonia, erysipelas and typhoid 
fever. The specific microbes of these affections were at first believed to be 
the immediate cause of their respective disorders, but later researches have 
shown that such diseases are due to the action of chemical poisons (toxins) 



44° SERA. 

produced by their specific bacteria growing on suitable soils either within the 
animal organism or outside it. The toxin produced by any particular bacterium 
varies greatly in power through very slight circumstances. It mav be weak- 
ened or increased in virulence by the cultivation of its bacteria on different 
culture media or on the same media with different surroundings as to oxygen, 
temperature, etc.; also by passing successive generations of these organisms 
through a definite series of animals, chosen for. their natural insusceptibility 
or susceptibility thereto. The pathogenic microbes of several diseases may be 
cultivated in test-tubes, forced to acquire an increased or lessened degree of 
virulence or toxin-producing power as required, separated from the poisonous 
products of their metabolic life-work, and by the inoculation of either their 
progeny or their chemical products (toxins) the corresponding diseases may be 
reproduced upon healthy animals in almost any desired degree of intensity. 

The treatment of diseases due to pathogenic microbes by the toxic products 
of their own particular bacteria is based upon the theory that these germs pro- 
duce substances in their culture media which are inimical to their own life- 
The treatment of tuberculosis by Koch's tuberculin and the inoculations of Haff- 
kine against cholera are examples of true toxin treatment. The vaccinations 
of Jenner for variola and of Pasteur for rabies are of the same nature when 
employed as remedial methods, the material being obtained from a morbid 
product of the disease in the one case and from the diseased tissue itself in the 
other, the culture medium in both being the blood and tissues of the infected 
animal organism. It has been frequently observed that patients afflicted with 
malignant disease have been greatly benefited by an intercurrent attack of ery- 
sipelas, in consequence of which the tumors seemed to undergo retrogressive 
changes. This has suggested the employment of the toxins of streptococcus 
erysipelatis and bacillus prodigiosus in inoperable cancer, and may lead to the 
treatment of other diseases by the toxins of bacteria hitherto unassociated with 
them. 

The injection of a toxin, in gradually increasing doses at proper intervals, 
will confer immunity in man)' cases upon the animal so treated against the 
corresponding disease and its particular bacteria. This immunity may be 
transferred to another animal by injecting into its cellular tissue the blood- 
serum of the immunized one, and this serum will also act remedially on a sub- 
ject of the disease if administered early in its course (Behring). The immuniz- 
ing and curative action of the serum is believed to be due to the existence of 
an antibody in the blood of the inoculated animal, elaborated by the living 
cells of its tissues as a defence against the action of the toxin. These facts 
and hypotheses form the basis of the treatment of certain diseases by antitoxic 
and bactericidal sera. 

Antitoxins are suppositious substances, assumed to exist in antitoxic sera, 
and believed to be produced by the cells of the blood or tissues for the defence 
of the organism against foreign bacterial toxins. Alexins are similar substances, 



SERA. 1 1 1 

natural antitoxins, which arc supposed to exist in the Mood of naturally immune 

animals. An Antitoxic- Serum is a blood scrum containing antitoxin, produced 

therein by the cells of the organism as a result of the repeated injection of a 

toxin into the tissues of the animal from which the serum is taken. 

It was shown by Von Fodor in 1 88 7 and subsequently by Nutlall that the 
blood-serum of healthy animals is naturally bactericidal, that it possesses this 
quality in varying degrees of efficiency, and that it may he sufficiently power- 
ful in this respect to prevent certain pathogenic bacteria from gaining lodg- 
ment in the organism, thereby conferring natural immunity against a particular 
disease upon the individual so protected, and in some cases even upon the 
species. Further study and experiment established the fact that temporary 
artificial immunity against certain diseases may be imparted to a susceptible 
animal by repeated inoculations of the specific bacteria or their toxic products 
in gradually increasing degrees of virulence (Behring, Kitasato, Roux). The 
crowning discovery that the blood-serum of such an immunized animal may 
he successfully employed for curative as well as prophylactic purposes against 
its particular disease upon other animals of the same or different species, was 
made by Professor Emil Behring of Berlin, in 1801. This was no chance dis- 
covery, but was the legitimate result of logical reasoning and hard work, and 
is formulated under the title Behring 's Law, as follows: The blood-serum of 
an animal which has been artificially rendered immune against a certain infec- 
tious disease, when injected into the body of another animal, has power to pro- 
tect the latter individual against the same disease and to cure the disease after 
infection has occurred. 

Ehrlich has shown that Behring's law is valid also for the chemical poisons, Ricin and 
Abrin, the respective toxalbumins of the ricinus palm and the jequirity bean. The blood of 
animals slowly immunized by increasing doses of these toxins contains antitoxic substances 
named Aniiricin and Antiabrin, which, if added to their respective poisons, will attenuate 
and even neutralize the latter. These facts are advanced as proof that the slowly increasing 
artificial immunity is not a simple tolerance acquired by the organism, as Sternberg taught, 
but is due to the production of new antagonistic and defensive substances by the living cells 
of the organism. The weight of evidence seems to favor the doctrine that the leucocytes are 
stimulated to the increased secretion of specific antagonistic and bactericidal substances by 
the repeated inoculation of the micro-organisms or their toxins. 

Theories deduced from the observed facts are as follows: As the various 
pathogenic bacteria produce the causative toxins of their respective diseases, 
so the organic cells of the body, reacting under the stimulus of the poisons thus 
introduced, immediately proceed to elaborate defensive bodies, which if pro- 
duced in sufficient quantity will neutralize the effects of the toxins. Residual 
antibodies remaining in the blood after recovery render the animal immune for 
a time against the disease. The immunizing and curative effects obtained 
by the injection of the blood-serum of an immunized animal into the circulation 
of another animal are due — either to direct chemical neutralization of the toxins 
themselves by the antibodies so introduced (Behring, Kitasato), or to a parti- 
cular influence exerted by the antibodies upon the living cells of the organism, 
which, being affected in two opposite directions, remain neutral to the disease 



< 



( 



442 SERA. 

(Buchner). Some authorities hold that these results are due to the conjoint 
action of leucytic and chemical forces. Ehrlich's side-chain theory assumes that 
every toxin contains toxophore molecules having direct toxic action, and hapto- 
phore molecules which combine the toxophores with a similar combining group 
of molecules in the tissue cells of the attacked organism. The tissue-cell mole- 
cules being destroyed by the toxophores, a rapid and profuse regeneration of 
similar molecules occurs in side-chains; and these molecules overgrowing, are 
carried into the circulation, becoming the antitoxin, which acts by combining 
with the haptophores of newly arrived toxin, using up their combining power 
before they can reach the tissue cells. 

Antitoxins are, with perhaps a few exceptions, characterized by possessing 
specific action, which means that the serum from an animal inoculated with 
the toxin of the diphtheria bacillus is effective only against diphtheria, and 
the tetanus antitoxin only against tetanus. A dose of an antitoxin followed 
by a dose of the corresponding toxin produces no effect from either, the action 
of the one being rendered ineffective by that of the other. The corresponding 
toxin and antitoxin may be mixed together outside the body and then injected 
with like result, though of course there must be a certain amount of antitoxin 
present to counteract a given dose of toxin. The immunizing or vaccine property 
of the antitoxins, though transient, is probably destined to be of considerable 
importance. Instances are recorded in which epidemics of diphtheria in schools 
were apparently stopped by vaccinating all the children therein with diphtheria 
antitoxin. 

Serum obtained from human subjects suffering from bacterial diseases has 
been used for therapeutic purposes. In some cases the serum was secured 
by blistering the patient during convalescence, in others by taking blood by 
venesection or by leeches. This has been done in cases of pneumonia, yellow 
fever, scarlet fever, erysipelas, syphilis, and whooping-cough. 

Antitoxic Serum is prepared as follows: A highly virulent culture of the specific micro- 
organism of the particular disease, or still better, a strong toxin of tested strength prepared 
therefrom, is injected into the cellular tissue of a suitable animal, generally a horse, at first in 
very small quantity. The effect is soon shown by the onset of fever and other symptoms of 
acute disease, which are known as the "reaction." After an interval of time sufficient for 
recovery from these symptoms, the injection is repeated with a stronger toxin or with a culture 
of greater virulence, or with a larger quantity of the original toxin. This process is continued 
for several months, or until the animal no longer "reacts" to the poison, and then sufficient 
antitoxin is presumed to exist in its blood to render it immune to the toxin and to the disease. 
After each inoculation the animal's blood serum is tested as to its value by experiment on 
guinea-pigs of definite weights. When the desired degree of immunity is reached the animal 
is bled from the jugular vein under strict aseptic precautions, from 6 to 12 pints being taken 
from a horse, according to his size and general condition. The blood is received in sterilized 
flasks, which are carefully stoppered and stored on ice until the clot has separated from the 
serum. The latter is tested to determine its value in antitoxin, has phenol added to it in the 
proportion of 0.5 per cent., and is bottled in vials which contain in each the dose for one patient. 
The vials are labeled with a statement of the number of normal antitoxin units per Cc. of the 
contents, expressed in multiples of a standard normal serum. 

Proteidin of immunizing and curative powers is produced by cultivating bacteria on 
suitable media, and collecting the specific bacteriolytic enzyme produced, which when com- 
bined with blood albumins, furnishes a specific immunizing and curative substance. The 
culture medium contains asparagin, peptone, bouillon, potassium biphosphate, magnesium 
sulphate, sodium chloride, and distilled water. This product has been used in anthrax and 



SERA. 443 

hog cholera with results which warranl the belief that ii will .supplant the antitoxic sera i Em 
merich). 

Bactericidal Sera are used with the object of reinforcing the natural bac- 
tericidal power of the blood. This is best accomplished by a mixture of nor- 
mal serum with immunized serum, the former furnishing an additional quail 
tity of bactericidal ferment, the so-called complement; while the latter sup- 
plies the binding material or immune body (the amboceptor), which unites the 
complement to the bacteria and enables it to destroy them. Some of the bac- 
tericidal sera have shown marked antitoxic qualities, particularly the antityphoid 
and antidysenteric sera. 

Nonbactericidal Immune Sera include those obtained by inoculation of 
the pneumococcus, the streptococcus, and the staphylococcus toxins. As at 
present produced these sera have no definite antitoxic or bactericidal powers, 
but they possess protective and curative properties as shown by laboratory tests 
and clinical experience. The}' are supposed to exert their influence by stimu- 
lating cell-proliferation in the marrow of the long bones, and by increasing the 
phagocytic power of the leucocytes. 

Diphtheria Antitoxin, though not the first antitoxin discovered, is by 
far the first in practical importance. The bacillus of diphtheria was discovered 
by Loeffler and Klebs in 1884, its toxic products were isolated by Roux, and 
Sidney Martin demonstrated the chemical identity of the toxins produced in 
culture media with those produced by the bacillus in the human organism. 
In 1891 Behring discovered the antitoxin and established its preventive and 
curative properties. The clinical results obtained thereby were announced by 
Roux at the Buda-Pesth Congress of Hygiene in 1894, and attracted universal 
attention. Since then the statistics of diphtheria serum-therapy have grown 
voluminous, have included a large number of reports from official and private 
sources of the highest professional authority, and the weight of evidence has 
steadily grown more and more favorable to this treatment of the disease. It 
is now generally conceded that under antitoxic treatment the mortality in all 
forms of diphtheria has been reduced from 40 per cent, and more to 15 per cent, 
and less, and if laryngeal and operative cases are excluded to less than 5 per 
cent. In laryngeal diphtheria the former mortality of 73 per cent, has been re- 
duced to about 27 per cent., thus almost completely reversing the figures repre- 
senting the deaths and recoveries from this form of the disease. These sta- 
tistics include over 68,000 cases reported on since 1894, by Roux, Welch, Vir- 
chow, the American Pediatric Society, and the Boards of Health of the German 
cities, Massachusetts, New York, London, Chicago, Boston, Baltimore, Wash- 
ington, and Denver. A few writers contend that much of this decrease of mor- 
tality is due to improved hygienic surroundings, and deny the value of antitoxin 
treatment, claiming that under it the deaths from pulmonary and renal com- 
plications are more common than formerly. Dr. Lennox Brown maintains 
that in London the diphtheria mortality without antitoxin treatment rarely 



444 SERA. 

exceeds 20 per cent., and Bayeux states the mortality of this disease through- 
out the world as only 16 per cent. The general professional opinion agrees 
with that of Professor Klein, who stated at a meeting of the British Medical 
Association, in reference to this disease, that "the scientific basis for the ap- 
plication of antitoxic serum is as firmly founded and as thoroughly established 
as the use and application of any known drug." 

The clinical history of the disease under the antitoxin treatment, as recorded 
by its observers, shows an extraordinary decrease in the severity of the symptoms. 
A marked improvement in both the local and general symptoms is usually no- 
ticed within 24 hours after the injection of the serum. The membrane loosens 
and clears off rapidly, high temperature is lowered, and the pulse slows and 
gains in force (Washbourn) . Evident signs of distress vanished within 24 
hours, and apparent strength and good-humor took the place of a previously 
low mental and physical condition (Kossel). In no case did the larynx become 
involved after the use of the serum if not so previously, and many cases show- 
ing laryngeal symptoms recovered without tracheotomy. Even in the fatal 
cases life was prolonged (Caiger). The remedy has decided power to prevent 
the spreading of the false membrane into the larynx and trachea. It is power- 
less to repair damage already done to the tissues by the diphtheria toxin, hence 
the earlier the serum is administered the better are its results. It is decidedly 
more efficient in the fibrinous form of the disease than in the septic form, and 
in cases of simple infection than in those of double or mixed infection. The 
liability to paralysis and albuminuria is not lessened but is perhaps somewhat 
increased by this treatment, though genuine nephritis is less frequently seen 
under its use than in cases treated by other methods. The serum may cause 
certain untoward symptoms, as cutaneous eruptions, swellings, etc., but these 
are not serious and are not attended with danger to life. Its injection is very 
rarely followed by serious local disturbances, as abscess, and probably would 
never be complicated thereby if the serum were always pure and used with 
strict aseptic precautions. Welch states that in over 100,000 injections the 
serious mishaps directly attributable to the serum can be counted on the fingesr. 

Poisonous symptoms are not believed to be caused by the antitoxin, but are 
due to some other constituent of the serum, for they may occur when the simple 
blood-serum of another species of animal is injected into the human subject. 
The most common one is a rash, usually an erythema, but sometimes papular 
or urticarial, which occurs in about 35 per cent, of the cases, generally appear- 
ing about a week after the injection. Pains in and swelling of the joints are 
occasionally experienced, and symptoms of septicemia have occurred, with 
irregular temperature, nephritis, and death. 

Clinically most cases of diphtheria are of mixed infection, and as the anti- 
toxin is effective only against the toxin of the Klebs-Loeffler bacilli, the local 
antiseptic treatment of the throat is still insisted on. If thoroughly carried 
out in the incipiency it may destroy the dangerous streptococci and other mi- 



sera. 445 

crobes, thereby preventing the mixed infection which proves so virulent; if con 

tinucd throughout the ease and during convalescence it will minimize the dan- 
ger of infecting other persons. In some instances bacilli were found as long 
as two months after recovery. 

Diphtheria antitoxin has been employed with good results in the treatment 
of pneumonia, typhoid fever, pertussis and asthma, in which it is supposed to 
act by increasing leucocytosis and hastening the elimination of toxic material. 

The antitoxic unit generally recognized is i Cc. of an antitoxic serum which 
will counteract ten times the minimum fatal dose of toxin in a guinea-pig. The 
prophylactic dose for children is 500 to 1,000 units, to be repeated after two or 
three weeks if the case is still exposed to infection. The immunity so conferred 
is only temporary, its duration depends on the quantity of antitoxin adminis- 
tered, and it gradually decreases as the antitoxin is eliminated, but can be main- 
tained for a long time by the repeated use of smaller doses at short intervals- 
The therapeutic dose recommended by the committee of the American Pediatric 
Society is 1,000 units as the initial dose for children under two years of age and 
for mild cases; 1,500 to 2,000 units for older children, severe cases, and all 
laryngeal cases. Many physicians administer 2,000 to 4,000 units in severe 
pharyngeal cases, or 3,000 to 6,000 units in laryngeal cases, the higher doses 
when the case is not seen until the third or fourth day. In all cases the initial 
dose should be repeated or doubled if favorable results do not follow within 6 
or 8 hours after the first injection. The necessary amount for any case can be 
determined only by estimation of the quantity of toxin present as indicated by 
the symptoms; remembering that this quantity increases rapidly with every 
day after infection. The prognosis is unfavorable if the case is so far advanced 
before treatment that the toxin has had time to accumulate and to exert its par- 
alyzing influence on the nervous apparatus of the heart. 

Diphtheria Antitoxin is now prepared in all European countries and in the labora- 
tories of several boards of health, manufacturing druggists and others in this country. A 
concentrated serum is recommended by the committee of the American Pediatric Society, in 
order that the requisite number of antitoxic units may be administered in small bulk, and 
such sera have been produced, containing as many as 1,750 units in 1 Cc, but they are un- 
stable, and soon lose their power. The sera in general use contain from 200 to 500 units to 
the Cc. In all cases the dose should be regulated by the number of units required, not by the 
quarttitv of serum. Diphtheria Antitoxin is official in the U. S. Pharmacopoeia under the 
title- 
Serum Antidiphthericum, Antidiphtheric Serum, Diphtheria Antitoxin, — a fluid sep- 
arated from the coagulated blood of a horse, immunized through the inoculation of diphtheric 
toxin. It should be kept in sealed glass containers, in a dark place, at temperatures between 
40° and 59 F. Average dose, 3000 units; immunizing dose for well persons, 500 units. 

Double Diphtheria Antitoxin is a serum obtained from a horse which has been im- 
munized against streptococcus virus after having been previously rendered immune against 
the diphtheria toxin. It is supposed to contain both the diphtheria and streptococcus anti- 
toxins, and is intended for the virulent cases due to a mixed infection with these two poisons, 
but it may be used in any case of diphtheria. 

Tetanus Antitoxin. — Tetanus was one of the first diseases to be studied 
successfully by the bacteriologists, and its antitoxin was the first one prepared. 
Breiger in 1880 showed that a crystalline substance of high toxicity could be 



446 SERA. 

obtained from tetanic fluids, and that it would reproduce the symptoms of 
tetanus when injected into healthy animals. Rosenbach found the tetanus 
bacillus in human cases of the disease, and Nicolaier demonstrated its existence 
in soils. Kitasato soon afterwards obtained pure cultures of the bacillus, and 
demonstrated the immunizing power of the serum of animals inoculated with 
its toxin. 

In laboratory experiments tetanus is prevented and cured by its antitoxin 
with almost absolute certainty, but the conditions are in every respect different 
from those which obtain in cases of accidental infection, the amount of toxin 
present in the animal being known, and the antitoxin being administered at 
the same time with the toxin or very soon afterwards. The disease is clinically 
unrecognizable until the nervous system has been sufficiently damaged to pro- 
duce symptoms of nerve lesions, and the toxin is firmly united with the proteids 
of the central nervous tissue before symptoms develop, until which a diagnosis 
is impossible. The case is usually far advanced when professional assistance 
is first sought, and is therefore not so amenable to treatment as diseases which 
manifest their symptoms by progressive stages. 

The study of tetanus statistics shows that its mortality prior to the use of 
antitoxin was from 70 to 90 per cent., in the acute form 80 to 90 per cent., and 
in the chronic type about 40 per cent. The available statistics of cases treated 
by antitoxin give the general mortality under this treatment as between 40 and 
50 per cent., the reduction being chiefly manifested in the subacute and chronic 
cases, acute tetanus showing a mortality of 70 to 80 per cent. There is much 
difference between the results reported from certain countries, indicating a wide 
variance in either the potency of the sera employed or the virulence of the in- 
fecting bacilli. In Italy the disease seems to be amenable to antitoxin as well 
as to other methods of treatment, particularly that by phenol injections, while 
the reports from other countries are much less favorable. 

On account of the natural difficulties in treating this disease by antitoxin 
at the late period when the symptoms are manifested, and from the fact that 
the serum is powerfully immunizing and harmless, the tendency is to adopt a 
prophylactic method in all cases, giving a full immunizing dose as soon as pos- 
sible after the infliction of a wound received under circumstances which indicate 
a possible tetanus infection. For this purpose an injection of 10 Cc. of the serum 
will usually suffice, if repeated at intervals of a week or ten days. Along with 
this treatment the usual preventive measures should be employed, including 
excision of the part or the actual cautery if the wound is recent. The actual 
cautery, or the application of a strong solution of corrosive sublimate with tar- 
taric acid, or the injection of phenol solutions, are the most effectual methods 
of combating the tetanus germs in the wound. For curative purposes the serum 
should be injected as soon as possible, the quantity being determined according 
to its stated strength, the gravity of the symptoms, the patient's age and the 
time since infection. The serum must be fresh to be effective, and the dose 



SERA. 117 

is 10 to 20 Cc, repeated every 4 to 12 hours according to the severity of the 
symptoms. 

Tetanus Antitoxin is manufactured in liquid form, also as a dry powder to be dissolved 
in a specified quantity of distilled water. One severe case, reported by Coffin, received 180 Cc. 

in seven days, with eventual recovery. The serum is usually administered subcutaneouslv, 
but is also injected into the brain tissue, and into the spinal subarachnoid space. Abbe tre- 
phined the skull of a boy 9 years old, and injected 3 Cc. on each side into the brain substam e 
behind the fissure of Rolando two inches from the median line, giving 20 Cc. subcutaneouslv 
at the same time, the patient recovering. Letoux claims that the intracerebral injection is cura- 
tive, while the subcutaneous one is protective, the latter affecting only that toxin which is on its 
way from the site of infection to the nerve centres. 

Tuberculin, or Koch's Lymph, announced in 1890 as a remedy for tuber- 
culosis by Professor R. Koch of Berlin, was subsequently stated by him to be 
an extract of the products of pure cultures of the tubercle bacillus, made with 
glycerin and water. In his preliminary statement to the International Med- 
ical Congress, the chief point made was that guinea-pigs could be rendered 
immune to inoculated tuberculosis by means of this agent, but even this has 
been denied by other observers. In his extended paper it was stated that the 
remedy would not directly kill the bacilli, but that it acted powerfully and 
specifically upon the living tuberculous tissue, caused a necrotic condition thereof 
and hastened its disintegration; also that it might be expected to increase the 
resistant power of healthy tissue and thereby starve the bacilli, check their in- 
crease, and lead in many cases to the cure of the disease. The actual result, 
however, as Virchow and others soon pointed out, was to soften and disintegrate 
quiescent deposits and to disseminate the bacilli throughout the body, forming 
new foci of active infection in other situations. The severe reactions, which 
followed the injections of the lymph in many instances, proved that serious 
risk must attend its general use; and that, like most remedies for phthisis, it 
could do good only in a few carefully selected cases. 

Professor Koch acknowledged that tuberculin is only serviceable in the 
initial stage of phthisis and in cases of simple infection, also that when the 
case is complicated by the presence of other microbes it is of no service and 
often does harm. His statements as to its limitations were ignored in the en- 
thusiasm excited by the discovery, the lymph was administered in advanced 
cases of mixed infection, and in poisonous doses, causing severe reactions, both 
local and general, so that many cases succumbed quickly under its use. A pro- 
found disappointment followed, tuberculin became thoroughly discredited, and 
its use was almost universally abandoned. It has become of interest again 
by reason of the efforts to extract from it a germicidal constituent free from 
toxins, also by the results obtained in tuberculosis with the blood serum of 
animals immunized by its repeated inoculation. 

The violent action of tuberculin, together with its source, prove it to be a 
true bacterial toxin. Taken by the mouth it is inert, being probably digested 
in the stomach. In the dose of one milligramme injected hypodermically upon 
healthy subjects, it gives rise to slight pains in the limbs and a transient sense 



448 SERA. 

of fatigue; but the same quantity injected upon tuberculous subjects produces 
a very powerful reaction both locally and generally, the constitutional effects 
being similar to those accompanying an acute exacerbation of the disease. About 
three hours after the injection a decided rigor occurs, which is followed by a 
rapid rise of temperature and pulse-rate; also pains in the limbs, a sense of 
great fatigue, drowsiness, nausea and loss of appetite, these effects lasting from 
12 to 15 hours. In cases of advanced phthisis with cavities, after the injec- 
tion of tuberculin the temperature has risen to 105. 8° F., and this falling sud- 
denly collapse has occurred and the patients have died. A local tuberculous 
lesion swells and becomes tender to the touch and the skin over it is inflamed. 
In pulmonary cases the reaction is greater than from the same dose in those 
having surgical tuberculous lesions; the cough increases, there are great dis- 
tress and dyspnea, the patient feels decidedly worse and occasionally suffers 
a slight collapse. When the reaction has subsided the patient feels compara- 
tively well and is generally better than before. In cases of lupus the effects 
of the injection are very marked. Within three hours there arises a feeling 
of tightness with heat and burning over the face and nose, and an eczematous 
exudation sets in, which continues about 48 hours and dries into crusts on the 
surface of the lesion. After two days these symptoms began to subside, and 
after nine days the crusts had fallen off and the affected tissue appeared shrunken, 
red and shiny, like the surface of a lupus patch which has been scraped with a 
Volkmann's spoon. 

After tuberculin was discredited as a remedy, its composition became the 
subject of research, with the view of obtaining from it a remedial agent free 
from its toxic constituents. By chemical methods Klebs produced the deriva- 
tives tuberculocidin and antiphthisin; Von Ruck prepared a purified tuberculin, 
also an aqueous extract of the bodies of the bacilli; and Koch announced his 
tuberculin-r and the new tuberculin, which are emulsions of the pulverized bacilli, 
the latter being made with water and glycerin as a menstruum. These prepa- 
rations have been extensively used during the last ten years, and have been the 
subject of a large quantity of literature from reputable physicians, many of 
whom are specialists in tuberculosis and its treatment. The present tendency 
is towards the recognition of Koch's new tuberculin and Von Ruck's aqueous 
extract, the preparations from the bodies of the bacilli, as valuable adjuncts in 
the treatment of this disease, if used in early cases of pure tuberculosis, and 
employed in connection with the recognized dietetic, climatic, hygienic, and 
medicinal measures. 

Denison of Denver, after several years' experience with tuberculin and its derivatives, 
says that Von Ruck's aqueous extract is the most efficient among them, and reports 45 cases 
treated thereby, with 28 cases or 62 per cent, of cures. Von Ruck reports 303 watery extract 
cases, of which 56 per cent, were cured and 34 per cent, improved. Pottenger in 1902 made 
inquiry by letters addressed to 325 physicians, including many of the foremost European 
clinicians, and all known to be especially interested in the subject, and received 143 replies. 

Of these 22 \ per cent, recommended these preparations, 21 per cent, were hostile to them, 
and of 84 who expressed positive opinions on the subject 38 per cent, were favorable, while of 
all who acknowledged having had experience with these remedies 60 per cent, recommended 



SERA. 449 

them. Those favoring them based their opinions upon a total experience of 5,74a 1 ases, those 
sing upon experience in 813 cases. The same writei has collected statistics of 1,795 
cases treated with various culture products, giving 15 per cent, of apparent cures, and 10,771 
treated by other methods, with 14 per rem. of apparent cures. Of 589 first-stage cases 
of pure tuberculosis reported by Goetsch, Von Ruck, Jessen, Trudeau, and Rumbold, as 
treated with tuberculin or similar agents, 496 or 84 per cent, are stated to have been lined; 
while of 611 such cases treated by Bowditch, Clapp, Trudeau and Stubbert, without these 
remedies but in sanitoria, 301 or 64 per cent, were apparently cured. Goetsch alone reports 
356 cases treated by tuberculin in small doses, beginning with ,',, rag. instead of 2 nig. as for- 
merly, and states that 7S per cent, were clinically cured. 

The therapeutic use of tuberculin is a toxin treatment, and when properly 
employed it benefits, either by stimulating the production of an antitoxin by 
the patient's tissue cells, or by the action of an immunizing or healing prin- 
ciple contained in it. It acts upon living tissue, and not upon the dead and 
decaying material existing in advanced cases; though in the latter it may bene- 
fit areas of recent extension which are purely tuberculous, and may produce 
immunity in unaffected tissue, thus preventing the further extension of the 
disease. 

The use of tuberculin as a diagnostic agent is common with veterinarians, 
but has never been popular among physicians, they considering the ordinary 
methods to be sufficiently reliable for diagnosis. A subject is said to "react" 
to the tuberculin test, if he develops, within 12 hours after injection, a rise in 
temperature of i£° to 2° F. or more, above the previous mean course of his tem- 
perature record. A rise of i° F. or less is called a "mild reaction." Other 
symptoms may occur, as headache, malaise, and anorexia, sometimes vomiting 
and diarrhea. Three methods of making the test are in use, — (a) an initial 
dose of £ to 1 mg., followed at intervals of 3 to 7 days_by doses of 2, 4, and 10 
mg. respectively: (b) an initial dose of 5 mg. followed by doses of 10 and 25 
mg. at stated intervals; and (c) a single injection of 5 to 10 mg. By the latter 
method the mild or delayed reactions are avoided, also the possibility of estab- 
lishing a tuberculin toleration, and the occurrence of cumulative effects. 

Preparations (Unofficial). 

Tuberculinum, Tuberculin (Koch), — is a glycerin extract of the culture fluid upon which 
the bacilli have been grown, concentrated to yVth its original volume, and filtered through 
porcelaine to remove the bacilli. Initial dose, y^ to T ' F mg., mixed with distilled water. 

New Tuberculin, Bacilli Emulsion (Koch), — is a suspension of pulverized tubercle bacilli 
in glycerin and water, containing 5 mg. of the bacillar substance in each Cc. Initial dose, T ^ s 
mg., diluted with normal salt solution. 

Antiphthisin (Klebs), — is obtained by treating the original tuberculin with sodic iodide 
of bismuth, rejecting the precipitate, again precipitating with absolute alcohol, and dissolving 
this second precipitate in distilled water. Initial dose, T 'j Cc. 

Tuberculinum Purificatum, Purified Tuberculin (Von Ruck),— is prepared by heating 
the culture fluid and the bacilli together in vacuo at a temperature of 130 F. for 2 or 3 months, 
and contains 1 per cent, of solid material. Initial dose, y 1 ^ Cc. 

Aqueous Extract of Tubercle Bacilli (Von Ruck), — is an extract prepared from the 
bodies of the bacilli freed from their fats, and contains 1 per cent, of solid material. Two 
additional solutions should be freshly prepared from this, one containing J„ of 1 per cent., and 
the other T £ ff of 1 per cent, of solid substance. Initial dose, T l jj Cc. of the weaker solution. 
When doses of 1 Cc. have been reached, this solution is abandoned for the next in strength, in 
order to avoid bulky injections. The dosage is gradually increased at longer intervals, up to 
a maximum of 1 Cc. of the original solution. 

3° 



< 



i 



4SO SERA. 

Tuberculosis Antitoxin superseded tuberculin for several years in the 
treatment of tuberculous disease, but does not seem to maintain its former repu- 
tation. Boinet immunized goats with injections of tuberculin, and used their 
serum in a few cases with decided benefit. Fisch injected horses with Koch's 
new tuberculin, and treated some 20 cases with their serum, reporting gratify- 
ing results. Paquin in 1897 reported on 393 cases, claiming 93 complete cures. 
Holmes in 1899 reported on 50 cases treated with most encouraging results. 
The reports of Ambler in 1899, an d Stubbert in 1900, cover 136 cases, with 
55 apparent cures. Mircoli in 1900 published statistics of 2889 cases, 385 of 
which were cured and 1064 improved. Maragliano of Genoa treated a large 
number of cases with serum obtained from immunized dogs, asses and horses. 
In 1899 he published statistics of 445 cases including his own and others, and 
stated that the local signs of the disease disappeared in 27 per cent, of the cases, 
the weight increased in 57 per cent., and the bacilli disappeared in 43 per cent. 
In 1901 he reported 130 cases treated by himself, of which 36 were cured and 
58 improved. He states that cases of unmixed infection, with circumscribed 
foci of disease, slight surrounding consolidation, and but little fever, are dis- 
tinctly benefited by the treatment and some are even cured thereby, but that 
those with much broncho-pneumonic consolidation or with cavities do not show- 
any great improvement, and that it is impossible to cure without reinforcing 
he strength of the organism. 

A study of the results obtained by the antitoxin treatment of tuberculosis 
shows that this serum is at best an adjunct to other measures; that if so used 
early in cases of unmixed infection it may bring about a cure, and when em- 
ployed later in such cases it will retard the progress of the disease and promote 
healing; but that it is of no value in cases of mixed infection. 

The dose depends on the particular serum employed; that of one manufactured in this 
country being stated attijiv-v daily, gradually increased to a maximum of ttjjxv. Maragliano 
administers in apyretic cases or those with slight fever 1 Cc. of his serum every second day for 
the first ten days, then a similar dose every day for another ten days, then two similar injec- 
tions daily for the next ten days. If there is high fever 10 Cc. should be given at once, and 
after three days a daily injection of 1 to 2 Cc. if the fever does not rise again, but if it persists a 
second dose of 10 Cc. is given eight days after the first one. Improvement is noticeable often 
within two weeks but sometimes not until after two months have elapsed. Even when a cure 
seems complete the injections should be continued for at least a month and even for a year. 
General hygienic measures must not be neglected, and the efficiency of the digestion must be 
especially attended to. 

Streptococcus Toxin. The occasional disappearance of malignant tumors 
after an intercurrent attack of erysipelas suggested to Bruns and others the 
inoculation of cultures of the streptococcus erysipelatis as a remedial measure 
for inoperable cancer. The results, though favorable, were not so complete 
as in the cases acted upon by accidental erysipelas, and the inoculated disease 
often proved fatal to the patient. In 1894 Coley employed the toxin of the 
streptococcus instead of the culture itself, and reported a number of apparent 
cures. When it was found that the bacillus prodigiosus intensifies the virulence 
of the streptococcus, he used the mixed toxins of both germs, and later employed 



SERA. 451 

ttu-ir unfiltered toxins containing the dead bacteria, with better results than 
those obtained with the streptococcus toxin alone. The effects upon carcinoma 
were found to he slight, but were very marked upon sarcoma, especially the 
spindle-celled form. This treatment is employed only in cases which are man! 
festly unfit for operative interference. Virulent cultures of the streptococcus 
pyogenes are grown in the incubator for three weeks, then inoculated with the 
bacillus prodigiosus, and allowed to grow for ten days longer, when they are 
sterilized at a temperature of 140° !•'., and are then ready for use. The initial 
dose is n\,£, diluted with normal salt solution or sterilized water, injected hypo- 
dermically in the vicinity of the tumor or into the tumor itself. The size of the 
dose is gradually increased, and the injections are administered daily over a 
period of several months' duration. In one case they were given for 3 years, 
with occasional intervals of rest. When care is taken to secure asepsis, and 
to avoid excessive dosage, the treatment is said to be practically without danger. 

In 1S08 Coley reported that one-half of the spindle-celled sarcomata thus treated had 
disappeared; and in 1900, after experience in 230 cases, he reaffirmed his previous conclu- 
sions. In iqoi he reported 16 cases of inoperable sarcoma successfully treated by this method, 
and remaining well for periods varying from 3 to Si years. In 1002 Winberg reported a 
desperate case of round-celled sarcoma of the upper jaw with metastases, which was cured in 
live months by daily injections of Coley's toxins administered by injection into the abdominal 
wall. On the other hand, Senn states that in all his cases this treatment failed to effect even 
temporary improvement, and Wood has seen the added burden of septicemia thereby induced, 
and proving disastrous to a system already exhausted by cancer. 

Antistreptococcus Serum has been employed successfully in erysipelas, 
puerperal fever, and several forms of septicemia and pyemia due to streptococcus 
infection. Marmorek, who originated this treatment, maintains that all strep- 
tococci produce the same toxin, and that the serum of animals immunized 
against one form of streptococcus is effective against the toxins of all varieties. 
Other observers generally disagree with him in regard to these contentions, 
and are endeavoring to produce a serum which will be as polyvalent as possible, 
by immunizing with many species of streptococci. It is generally conceded 
that this serum is harmless, and that in cases of pure streptococcus infection 
it will destroy the organisms and control the symptoms caused by their toxin, 
unless used too late for any remedy to be effective. Some authorities consider 
it neither bactericidal nor antitoxic in its action. 

Marmorek treated 411 cases of erysipelas with his serum, and reported a 
mortality of only 3^ per cent. He used it also in 16 cases of puerperal fever, 
of which seven, due to streptococcus infection, recovered; one, due to bacterium 
coli, died; and among eight of mixed infection with streptococcus, bacterium 
coli and staphylococcus, five died. Williams reported 14 cases of severe puer- 
peral septicemia treated with this serum, and 2 deaths. Reports of 70 cases 
so treated by various physicians show only 2 deaths; among them being 29 
of erysipelas, 15 of puerperal septicemia, 11 of infected wounds, and smaller 
numbers of septic cellulitis, cerebro-spinal meningitis, scarlet fever, septic 
m-asles, pyemia, and acute gangrene. Packard and Wilson found records of 



452 SERA. 

117 cases treated with antistreptococcus serum during 1901-2, of which 114 
showed either a marked temporary improvement or a prompt recovery. These 
cases included puerperal septicemia, erysipelas, tuberculosis with pyogenic in- 
fection, general pyemia, local streptococcus infections, and a few cases of simple 
and pernicious anemia which seemed to be decidedly improved by injections 
of this serum. A combination serum, obtained from animals immunized by 
injections of both diphtheria toxins and streptococcus cultures, is used in ad- 
vanced cases of diphtheria with double infection. 

Antistreptococcus Serum is obtained from the horse immunized by inoculations with 
cultures rendered highly virulent by passing them through several rabbits, and then grown on 
a medium which preserves their virulence. After injection for a year with such cultures of 
the living streptococci of gradually increasing toxicity, the animal's serum is considered suffi- 
ciently powerful for use. There is no recognized unit of strength, therefore no general dose 
can be stated, but the manufacturer's directions in this respect may be followed. 

Antipneumococcus Serum has given satisfaction to some physicians in 
the treatment of pneumonia. The reports of De Renzi, Fanoni, Eichberg, 
and Wiesbecker, covering 73 cases, give a mortality under the serum treatment 
of 6.8 per cent. On the other hand, J. C. Wilson has collected 162 cases from 
all sources, with a mortality of 16.6 per cent., and reports 35 cases so treated 
by himself, with 10 deaths, a mortality of over 28 per cent.; while at the same 
time of 20 cases treated without serum only 4 died, a mortality of 20 per cent. 
A later report by the same writer, based upon 36 cases, concludes with the 
statement that the results of this treatment do not encourage its continuance 
in croupous pneumonia. Other observers report disappointment as to the 
curative effects of the serum, but generally find that it improves the bodily 
comfort of the patient, and relieves many of the symptoms. Eichberg states 
that in 5 cases which recovered its administration was followed by almost com- 
plete cessation of cough and expectoration, and that the subsequent resolution 
was apparently accomplished without liquef action. Rochester treated a case 
with a serum obtained by blistering another pneumonic patient, and observed 
marked benefit therefrom. Elfstrom took blood from patients suffering with 
pneumonia by leeching their arms, diluted it with normal salt solution, sterilized 
it by heating to 140 F. for two hours, and treated several patients with injections 
of this preparation, obtaining thereby a more rapid convalescence in the majority 
than is usual in this disease. 

This serum has so far been of low and varying potency, due to the difficulty of 
obtaining sufficiently virulent cultures of pneumococci, but it is believed that when 
more active sera are obtained the results will be more favorable. The usual dose 
is 20 Cc. hypodermically every 4 to 6 hours, while the temperature exceeds 103 F. 

Typhoid Sera, both the toxic and the bactericidal forms, have been used 
for several years, but the results have not been very encouraging. Inoculations 
with sterilized cultures of the bacillus typhosus were employed as a preventive 
measure in the British Army in India and South Africa, and in 1902 Lord Stanley 
announced in parliament that a report had been received, dealing with 4,138 



SERA. 453 

cases, and showing a mortality of 8.2 per cent, in the inoculated, againsl 15.1 
|kt cent, in the uninoculated. Ii is generally acknowledged thai the preventive 
serum produces only a partial and temporary immunity, bu1 thai under its 
influence the disease pursues a milder and less fatal course than is usual. 

In the opinion of those who have studied the question, a curative serum 
for typhoid fever should be both antitoxic and bactericidal, and also polyvalent 
by the use of toxins from many species of the bacillus typhosus. Chantemesse 
cultivates the bacilli on a filtrate of emulsion of splenic tissue digested with 
pepsin, carefully excluding the air, and with the toxin so obtained inoculates 
horses for more than a year. Of 100 cases of typhoid fever treated with his 
scrum, he reports that all recovered in whom treatment was commenced before 
the tenth day of the disease, also all the others except six. In 1903 he com- 
pared 186 cases treated at his hospital by serum, cold baths, and other means, 
in which the mortality was only 3.7 per cent., with 1,478 cases treated at the 
>;irae time in 15 other Paris hospitals, in which the mortality was 19.3 per cent. 
He administers an initial dose of 10 to 12 Cc. to vigorous adults, but a smaller 
dose, 6 to 8 Cc. if the treatment is commenced on or before the fifth day of the 
disease. If after a week the temperature remains high, he gives another in- 
jection of 4 to 10 Cc, according to the height of the fever. 

Jez of Vienna has reported a number of cases treated by him with an extract from the 
spleen, thymus, marrow, brain, and spinal cord, of rabbits immunized against the typhoid 
bacillus. Eichorst reports 12 cases treated with this extract, all of which were of severe type, 
and all recovered. 

Cholera Sera have been employed in epidemics of Asiatic cholera with 
considerable success. Tetrop, who studied the epidemics of 1892-94, claims 
that the benefit of serum was markedly evident in cases in which it was the 
only treatment employed. During an epidemic at Nagasaki in 1902 the Japanese 
physicians used a protective toxin inoculation and an anticholera serum, prepared 
in the imperial laboratory at Tokio under the direction of Dr. Kitasato. All 
persons employed at the quarantine station and in the cholera hospital received 
two immunizing injections, and although constantly in contact with the disease 
no case of cholera occurred among them. In some 700 cases of cholera the 
mortality was only about 35 per cent., but very few cases proved fatal when 
the serum treatment was administered within reasonable time. These state- 
ments were made by the Japanese medical officer in charge of the quarantine hos- 
pital to American army surgeons who were stationed there in attendance on their 
own cholera patients removed from a transport in September, 1902. The epi- 
demic of that year in the Philippine Islands had a mortality of fully 75 per cent, 
with the ordinary treatment carried out under American medical supervision. 

The studies of Lazarus and Pfeiffer showed that the blood-serum of persons 
who have recovered from Asiatic cholera is protective to animals against fatal 
doses of the cholera spirilla, and that this property is bactericidal rather than anti- 
toxic in character; also that the dead spirilla are themselves toxic, and capable 
of acting similarly to the living germs. Haffkine cultivates the spirilla in bouillon 



( 



i 



454 SERA. 

and then kills them by the application of heat, without destroying the toxic- 
material which adheres to their bodies. The inoculation of human subjects 
with this product is followed by severe reaction, both local and general, and 
is believed to cause the production of a protective principle in the blood-serum. 
A preliminary inoculation is made with a weak virus, which produces a mild 
reaction, and after five or six days a more virulent preparation is injected, the 
reaction subsiding in another five days, when the subject is believed to be pro- 
tected. In 42,445 such inoculations no mishap or injury to health resulted, 
and the British medical officers who were assigned to the duty of verifying the 
effects report that these were highly favorable, and that the statistics demonstrate 
for this method a remarkably protective power against Asiatic cholera in a 
country where the disease is endemic. 

Plague Sera have been extensively used in recent epidemics of that disease, 
and although the commissions sent to India from England, Germany and Russia 
reported unfavorably upon the results obtained by them, the experience of 
individual observers indicates a decided, though as yet indefinite value for the 
serum-therapy of bubonic plague. The curative sera seem to have but slight 
influence on the mortality-rate in virulent epidemics, but in mild ones they 
exert a marked beneficial influence. The preventive inoculations have been 
more successful, and in some localities have practically eradicated the disease. 
Haffkine's protective serum is a toxin preparation, obtained by the same method 
as his cholera serum, and employed by a similar manner of administration, 
two injections being given about six days apart. It causes local and general 
reactions, which are more severe after the first inoculation. Yersin's curative 
serum is both antitoxic and bactericidal, and is obtained from horses immunized 
by injections of plague bacilli. After its use Calmette found that phagocytosis 
began at once, and the bacteria disappeared within a few hours. The tem- 
perature dropped in 4 to 5 hours, but often rose again for 8 to 12 hours, and 
finally fell at the beginning of an early convalescence. Lustig's serum is ob- 
tained from animals immunized with a nucleo-proteid extracted ' from dead 
plague bacilli by treatment with acids and alkalies. The use of Haffkine's 
serum in India is said to have reduced the number of cases to -£$ the number 
occurring in the uninoculated. Pinto reports from Brazil that only one person 
contracted the disease out of 1803 inoculated, and that in a certain district the 
only case of plague occurred in a man who had refused inoculation. Statistics 
of 2209 cases treated by various physicians with curative sera show a mortality 
varying between 13 and 59 per cent., against 80 per cent, and more in those 
treated by other methods. Lustig and Galeotti state that in an epidemic in 
India in which the general mortality was about 94 per cent., the mortality under 
the serum treatment was about 47 per cent. 

The dose of the curative sera is large. Calmette gave 20 Cc. of Yersin's serum intra- 
venously, and repeated the injections daily, sometimes giving 320 Cc. in one day. Choksey 
recommends doses of 60 to 100 Cc. of Lustig's serum, up to 300 Cc. ormore, administered hypo- 

dermically. 



SI K \. 



455 



Rabies Toxin. There is abundant proof that the specific virus of rallies 
is produced by a micro-organism, though none such has yet been demonstrated 
by the bacteriologists. Pasteur discovered that the virus is most abundant in 
the spinal cord of the rabid animal and showed that its inoculation upon a 
healthy animal will produce the characteristic symptoms of the disease, also 
that the virus may be attenuated in virulence by drying the spinal cord con- 
taining it. He also found that by the repeated inoculation of viruses of in- 
creasing virulence an animal is rendered immune to rabies, whether the infection 
is introduced by the bite of a rabid animal or by any other method of inoculation. 
Upon these facts he founded his preventive treatment of this disease, which 
consists in the daily inoculation of the bitten person with emulsions of gradually 
increasing virulence, made from the dried spinal cords of rabbits that have 
died from inoculated rabies. By this procedure chemical substances (toxins), 
produced during the life of some specific organism and known to be inhibitory 
of its growth, are introduced into the system of the patient (V. Horsley). The 
period of treatment is usually 15 days, during which from 2 to 6 inoculations 
are administered daily with viruses of gradually increasing intensity; the number 
depending on the time which has elapsed between the infliction of the bite and 
the commencement of the treatment. This method received the unqualified 
endorsement of a special committee appointed by the parliament of Great 
Britain in 1887, the members of which included the most eminent surgeons 
and physicians of England. 

Statistics published by the New York Pasteur Institute state that from 1897 to 1901 in- 
clusive 658 cases were treated at that institution, with a mortality of 0.76 per cent.; and at the 
Paris Institute during the same period there were 7,341 cases treated, with a mortality of 0.3 
per cent. The two sets together give 7,999 cases treated, with a mortality of 0.34 per cent. 

Rabies Antitoxin. Tizzoni and Cantani have published reports on the 
cure of rabies after its actual outbreak. They found that an alcoholic precipitate 
from the serum of highly immunized animals not only gave protection against 
rabies, but also cured the disease even after its first symptoms had manifested 
themselves. 

Antisyphilis Serum. — The blood-serum of lambs and dogs was used by 
Tommasoli and other Italian experimenters in the secondary and tertiary mani- 
festations of syphilis, with encouraging results. It was then suggested that 
the natural insusceptibility shown by certain animals to this disease might 
be increased by injecting into them the blood serum of human subjects in the 
primary or active secondary stages of syphilis. This has been carried out by 
Triboulet and others, without prejudicial effect on the animals injected, and 
their serum was used in the treatment of extensive tertiary ulcerations, with 
the result that these lesions almost completely disappeared, although they had 
resisted a six months' course of the ordinary treatment. Hericourt records a 
striking improvement in a case of syphilitic tabes under the same method, and 
other similar observations have been reported with equally favorable results. 
The doses employed were 2 Cc. of the serum on successive or alternate days. 



< 



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456 SERA. 

The only complications observed were a transitory roseolar eruption, slight 
albuminuria, and a brief elevation of temperature. Moore has used the serum 
of syphilitics as a remedy for the disease in 75 cases. He obtains it by blistering 
syphilitic subjects, injects 10 to 40 Cc. every third day, and reports that it never 
failed to arrest the symptoms. Used locally upon chancroid it had no effect, 
but on chancre it produced a marked change in a day or two, with cicatrization 
in a week, thus acting as a valuable differential measure between the two lesions. 

Antivenene. The active principle of serpent venom is a toxalbumin, 
analogous in character to the bacterial toxins. When taken by the mouth it 
is harmless, but is then antidotal to itself administered hypodermically or intra- 
venously. By forced filtration it may be divided into two principles, one of 
which is toxic, but is digested in the stomach; the other is antidotal to the former, 
and passes from the stomach into the blood. Venomous serpents are almost 
immune to serpent venom, non-venomous ones share this immunity in a less 
degree, and the mongoose and some other animals possess it in marked degree, 
probably by inheritance from many generations of bitten ancestors. Sewall 
in 1887 showed that pigeons can be immunized against crotalus venom by 
successive and increasing inoculations of the poison. Calmette discovered that 
the blood-serum of an animal so immunized is protective against the effects 
of the bite of a venomous serpent, and Fraser found that when immunization 
is performed with cobra venom the resulting serum is protective against the 
virus of several other serpent species. 

Calmette's is the recognized serum remedy for serpent bites, and has been 

used successfully in many cases. While particularly effective against cobra 

venom it is less efficient against that of the crotalus and other vipers, though 

of decided value in all forms. Its action is said to be directed to the nervous 

effects of the venom, rather than to its irritative and tissue-destroying qualities. 

It has been employed in cases of undoubted leprosy with excellent results, having 

brought about cures after other treatment had completely failed. The dose 

is 20 to 40 Cc. repeated frequently, but other recognized measures should not 

be neglected. A ligature should be applied above the wound, which should 

be laid open, well sucked, and surrounded by injections of an aqueous solution 

of calcium chloride. 

The liver of venomous serpents is used by African witches in the preparation of a cure 
for snake-bite, and the Tarahumare cliff-dwellers of Mexico use for the same purpose the bile 
of the biter serpent locally to the wound, at the same time eating the serpent's liver as a rem- 
edy. Fraser states that the bile of a venomous serpent is an effective antidote to its poison. 
Calmette affirms that tetanus antitoxin antagonizes the effects of cobra venom to a certain 
extent, and that intravenous injections of calcium hypochlorite produce a serum which is 
antitoxic to the cobra poison. 

Mallein is a glycerin extract of the culture products of the bacillus mallei, 
the micro-organism of glanders. When this toxin is injected into animals 
affected with that disease, it produces a strongly marked febrile reaction, similar 
to that caused by tuberculin in tuberculous subjects. It is extensively employed 
in veterinary practice for the purpose of testing horses suspected of being infected 



SERA. 157 

with glanders. An antitoxic serum, obtained in the usual manner, has Keen 
used in a few rases of human glanders; one of which, reported by Dupuy, 

recovered under its administration from a severe attack of the disease. 

Other Sera. Shiga prepared an Antidysenteric Scrum which was used 
in 366 cases with a mortality of 8 to 12 per cent., while 1676 cases treated other- 
wise at the same time gave a mortality of 28 to 40 per cent. Rosenthal used 
a serum obtained from immunized dogs, which was bactericidal as well as 
antitoxic, and was used in 157 cases with a mortality of 4^ per cent. Anti- 
anthrax Scrum was employed in 130 cases reported by Dasso, with a mortality 
of less than 7 per cent., also in 3 other cases without a death. Antilepra Serum 
has been used in a few cases with good results; and a toxin named Leprolin, 
obtained from lepra bacilli cultivated in a special medium, has been employed 
by Ross of Calcutta on lepers, with marked improvement in the condition of 
the patients, some cases showing almost complete subsidence of the disease. 
Yellow Fever has been treated with a serum obtained from dogs and rabbits 
immunized against the bacillus icteroides, with "unimportant results, but Agra- 
monte used the blood-serum from convalescent patients in 5 cases, 4 of which 
recovered promptly. Scarlet Fever has been treated with blood-serum from 
scarlatinal patients, with the result of shortening the course of the disease and 
causing marked amelioration of the symptoms. Pertussis was treated by Syl- 
vestri with blood from the arm of a pertussis patient, mixed with an equal amount 
of saline solution, then shaken with chloroform and filtered. This preparation 
was injected into 5 children suffering from the disease, with the effect of im- 
proving the symptoms promptly, the cough and broncho-pneumonia disappearing 
in 8 to 11 days. In Erysipelas Jez employed the serum obtained by blistering 
a subject of the disease in 10 cases, with rapid improvement in all. Vaccinia 
Antitoxin is supposed to exist in the blood of vaccinated heifers, and Beclere 
has treated a few cases of variola with such a serum, in one case using 1,560 Cc, 
the patient recovering rapidly without suffering any serious inconvenience. In 
another case, an infant 21 days old with severe small-pox, the serum was injected 
to the amount of ^th. of the child's weight, with curative result. Hay Fever 
has been the subject of experiment by Dunbar, who isolated from the pollen 
of certain grasses a toxin, which applied to the eyes and nostrils of susceptible 
persons produced the characteristic symptoms of the disease. By injecting the 
pollen into animals he produced a serum, which quelled the symptoms of hay 
fever in subjects on whom they were induced. Thyroid Serum or Antithyroids 
is obtained by Mcebius from animals whose thyroid glands had been extirpated 
six weeks previous to the bleeding. The preparation supplied by Merck is 
taken from thyrodectomized rams, and contains \ per cent, of phenol. It is 
used internally (not hypodermically) in doses of 10 minims, gradually increased 
to a maximum of 80 minims, thrice daily; and has given satisfaction in ex- 
ophthalmic goitre. Morphine Antitoxin is a serum taken from animals immun- 
ized by the injection of morphine for 3 to 5 months. It has proved preventive 



( 



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458 SERPENTAR1A. 

of lethal effects from lethal doses in the lower animals, and has been used suc- 
cessfully in acute opium poisoning in man by Hirschlaff. 

Inorganic Serum, prepared by Trunecek, is an aqueous solution of the alkaline salts 
normally found in the blood, and contains Sodium Chloride 4.92 grammes, Sodium Sulphate 
0.44, Sodium Phosphate 0.15, Sodium Carbonate 0.21, Potassium Sulphate 0.40, Distilled 
Water to make 100.00 grammes. The dose, by subcutaneous injection, is 1 Cc, increased by 
definite increments, up to 5 Cc. every second, fourth, or seventh day. This has been used in 
arterio-sclerosis by Levi of Paris and others, who report favorably upon the effects obtained. 
Trunecek is carrying on investigations with it in the treatment of rheumatism and other con- 
gestive conditions, with some promising results. 

Nutrient Serum. Blood-serum injected subcutaneously in small quantities 
promotes the catabolism of the body, increasing the excretion of nitrogen, and 
causing loss of weight ; but when large quantities are used it more than counter- 
balances the loss due to increased catabolism, is utilized as food, and prolongs 
life without the ingestion of other nutriment (Salter). The blood-serum of one 
animal injected into another of different species frequently causes transitory 
pyrexia, rashes, joint-pains, and other unimportant symptoms; but if heated 
to 150 F. the serum will not produce these effects, while its food-value remains 
unimpaired. A heated serum from the horse or sheep, injected in proper quan- 
tity into the human subject, will act as an efficient nutrient when it is impossible 
or undesirable to introduce food into the stomach or intestinal canal, as after 
abdominal operations and in severe cases of gastro-intestinal disease, such as 
gastric ulcer, typhoid fever and infantile diarrhea, or during the vomiting which 
occurs with post-diphtheritic paralysis. The amount for an infant is 30 to 40 Cc, 
for a child 60 to 80 Cc, and for an adult 100 to 120 Cc, repeated after a few 
days according to the severity of the case. 



SERPENTARIA, Serpentaria {Snake-root), — is the rhizome and roots of 
Aristolochia Serpentaria, or of Aristolochia reticulata, indigenous herbaceous 
plants of the nat. ord. Aristolochiacea?, growing in rich, shady woods, with 
purple flowers arising from joints near the roots. It contain a volatile oil, a 
camphor-resin and a bitter principle named Aristolochine, which is soluble in 
both alcohol and water. All its preparations should be made from the fresh 
root, as it deteriorates by keeping. Dose, gr. x-xxx [av. gr. xv]. 

Preparations. 
Fluidextractum Serpentariee, Fluidextract of Serpentaria. — Dose, ngx-xxx [av. njjxv]. 
Tinctura Serpentariae, Tincture of Serpentaria, — 20 per cent. Dose, 3 ss— ij [av. 5j]- 
Tinctura Cinchona? Composita, Compound Tincture of Cinchona, — has two parts of 
Serpentaria in 100. (See under Cinchona.) 

Physiological Action and Therapeutics. 
Serpentaria is a stimulating expectorant and tonic, a cardiac stimulant, a 
diaphoretic, diuretic, emmenagogue, aphrodisiac, and somewhat of an anti- 
periodic Its taste is warm and pungent, its odor is characteristic. Small 



silicon. 459 

doses promote appetite and digestion, increase the bronchial and intestinal 
secretions, the action of the heart, the cutaneous circulation and the surface 
temperature, and produce mental exhilaration. Large doses are irritant, causing 
nausea and vomiting, vertigo and headache, colic, borborygmi, rectal tenesmus, 
flatulent distention and frequent but not watery stools. The irritant action 
seems to produce gas rather than fluid. Pruritus ani and hemorrhoids are 
occasionally caused by its use. 

Serpentaria is chiefly employed as a vehicle for other stimulant drugs, but 
has many uses of its own. In bronchial affections it is extremely valuable 
as a stimulating expectorant. In typhoid pneumonia it is a good vehicle for 
ammonium carbonate, and in the exanthemata it is useful when much depression 
exists. It is indicated in typhoid conditions generally, and in the amenorrhea 
of anemia and chlorosis it is an efficient emmenagogue in many cases. It will 
often restore the waning sexual power in functional impotence, while in bilious 
vomiting it frequently checks the nausea and settles the stomach. It is used 
as a vehicle for cinchona in remittent fever. In diphtheria and scarlatina an 
infusion forms an excellent gargle. Its diaphoretic and diuretic properties, 
though slight, are sometimes of avail in chronic rheumatism. 

SILICON, Si. — is next to oxygen the most abundant element in nature, 
its combinations forming about a fourth of the earth's crust. The oxide, Silica, 
Si0 2 , is familiar in the form of sea-sand, flint, quartz, etc., also as silicates of 
aluminum etc. in clay, granite, glass, felspar and sandstone. It is present in 
the stems of grasses and the teeth and bones of animals. Silicates of Aluminum 
Magnesium, Potassium, and Sodium are used in medicine and surgery. 

Official Silicates. 

Kaolinum, Kaolin, — a native aluminum silicate. (See under Aluminum, page 115). 

Talcum, Talc, — a native hydrous magnesium silicate, a white or grayish-white powder, 
inodorous and tasteless, insoluble in water. 

Talcum Purificatum, Purified Talc, — is prepared by boiling Talc with water and hy- 
drochloric acid, washing and drying the coarser residue. 

Unofficial Silicates. 

Magnesii Silicas Hydratus, Hydrated Magnesium Silicate, Meerschaum, 2MgO,- 
3Si0 2 + 2H 2 0, — a mineral used for the manufacture of smoking-pipes, and employed in 
France as a substitute for Bismuth Subnitrate in obstinate choleraic diarrhea, to protect the 
intestinal mucous membrane or as an absorbent. It is given in fine powder and in doses of 
5j— iv per diem. 

Sodii Silicas, Sodium Silicate, Na 2 S0 3 + H z O, — occurs in white lumps or as a white 
powder, partly soluble in water, more freely in a dilute solution of soda. Dose, gr. x-5j- 

Liquor Sodii Silicatis, Solution of Sodium Silicate, Soluble Glass Solution, — is a semi- 
transparent viscid liquid, of sharp saline taste and alkaline reaction. It usually contains about 
20 per cent, of Silica and 10 per cent, of Soda, and is used on bandages to make immovable 
dressings, being lighter than plaster and stronger than starch. Its I ncom patibles are Acacia, 
Acids, and Alcohol. 

Liquor Potassii Silicatis, Solution of Potassium Silicate, — also known as Soluble Glass 
Solution, — is used for immovable dressings in the same manner as the preceding. A mixture 
of 2 parts of this solution with one of the soda salt solution is said to set more quickly and 



460 SINAPIS. 

firmly than either solution separately. Diluted (1 to 4) the solution of Potassium Silicate has 
been applied locally in erysipelas, gonorrhea, cystitis, and vaginitis, as an antiseptic with good 
results. 

Talc is used as a dusting powder in various skin affections, and for infants; 
in insufflating powders, and as a remedy for diarrhea, also in the preparation 
of the official waters and other pharmaceutical preparations. 

Sodium Silicate may be administered internally to animals in comparatively 
large doses without detriment to their general condition. It has been employed 
with benefit in gout, hyperacidity, acid diabetes and pulmonary tuberculosis, 
in the latter disease inhibiting progress by inducing the formation of firm scars 
and coarse capsules, and by changing the process of disintegration into a fibrous 
condition of the pulmonary tissue (Kobert). 



SINAPIS, Mustard, — is official under the two following titles, but the phar- 
macopceial preparations are directed to be made from Black Mustard only. 

Sinapis Alba, White Mustard, — the seed of Sinapis alba, an annual plant of 
the nat. ord. Cruciferae, cultivated in gardens. It has yellow flowers in racemes, 
and ribbed pods with a long, ensiform beak. Dose, as emetic, 3j-iij [av. gij]. 

White Mustard contains Myrosin, a ferment, and Sinalbin, a crystalline substance, which 
reacting on each other in the presence of water produce Sulpho-cyanate of Acrinyl, a rube- 
facient principle allied to the volatile oil of black mustard. It also contains Sinapine, an 
alkaloid, Erucic or Brassic Acid, and a bland, fixed oil, all three of which are contained also 
in black mustard. 

Sinapis Nigra, Black Mustard, — is the seed of Brassica nigra, an annual 
plant of the nat. ord. Cruciferae, native of Europe, but naturalized in the United 
States. It has small, yellow flowers on peduncles at the end of the branches, 
also smooth, erect pods with a short beak. Dose, as emetic, gj-iij [av. gij]. 

Black Mustard contains Myrosin, a ferment, and Sinigrin (potassium myronate), which 
reacting on each other in the presence of water produce the Sulpho-cyanide of Allyl, or Volatile 
Oil of Mustard. It also contains Sinapine, an alkaloid, Erucic or Brassic Acid, and a bland, 
fixed oil; all three of which are contained also in white mustard. 

Commercial Flour 0} Mustard (Unofficial), — is a mixture of white and black 
mustard seeds ground to a fine powder. It may be employed in lieu of either 
variety. Dose, as an emetic, 3 j— ii j . 

Preparations. 

Oleum Sinapis Volatile, Volatile Oil oj Mustard, {Sulpho-cyanide oj Allyl) C 4 H 5 NS, — 
a colorless or pale yellow liquid, of pungent, acrid odor and taste and neutral reaction, almost 
insoluble in water but freely soluble in alcohol and in ether. Dose, rnj| — J [av. nj$.] 

Charta Sinapis, Mustard Paper, — Consists of Black Mustard, the fixed oil removed by 
percolation with Benzin, mixed w^ith Solution of Rubber and spread on paper. Each square 
inch should contain about gr. vj of Mustard. For local use. 

Linimentum Sinapis Compositum, Compound Liniment of Mustard (Unofficial), — has 
of the Volatile Oil 3, Fluidextract of Mezereum 20, Camphor 6, Castor Oil 15, Alcohol to 100. 

Thiosinamin, Allyl Sulpho-carbamide (Unofficial), — is prepared by heating together Oil 
of Mustard 3, Alcohol 3, and Ammonia 6. It occurs as colorless crystals, which are very soluble 
in water, in alcohol, and in ether. A 15 to 20 per cent, alcoholic solution is used hypodermi- 



SODIUM. 461 

rally in lupus; or a to per cent, solution in glycerin and water hypodermically for cicatricial 
stenosis of the esophagus, corneal opacities, and to promote the absorption of fibrous deposits 

in joints. 

Physiological Action and Therapeutics. 

Mustard is not irritant until its oil is developed by the action of water, and 
then it requires time to produce its local effects, which are rubefacient and 
counterirritant, also vesicant after its prolonged application. It stimulates 
the nervous system and produces heat, redness, severe burning pain and finally 
local inflammation, leaving sores which heal with difficulty and often become 
gangrenous. The Oil is highly irritant, and powerfully germicidal even in the 
dilution of 1 to 33,000 (Koch). Taken internally in full dose it may excite 
severe gastro-enteritis. Mustard taken internally in small doses is a condiment 
and carminative, in full dose it acts promptly as an emetic when mixed with 
warm water. 

Mustard paste is used for disinfecting the surgeon's hands, after washing 
with sterilized corn meal as a' mechanical cleanser (Park). Mixed with water 
it is commonly employed as a local application to redden the skin, cause counter- 
irritation, relieve pain, and stimulate the heart, the vascular system, and the 
respiratory apparatus, as in muscular rheumatism, neuralgia, colic, gastralgia, 
inflammation of the throat, larynx, bronchi, lungs, pleurae and pericardium; 
also as a derivative in headache, cerebral congestion, and suppressed menstrua- 
tion. When action of a mild character is desired it may be diluted with flaxseed 
or flour. Internally it may be employed as an emetic in indigestion or narcotic 
poisoning. Its use as a condiment is familiar, acting by stimulation of the 
gastric mucous membrane. In overdoses it may excite severe gastritis. White 
Mustard seed, unground, has been used as a laxative, as it produces no irritation. 
The Oil is used chiefly as an ingredient of stimulating liniments, but may be 
employed internally in doses of £ to J drop as a gastric stimulant. 



SODIUM, Natrium, Na. — This metal is represented in medicine by a 
number of official salts, which are generally colorless or white, and with very 
few exceptions are readily soluble in water. Some of them are found native, 
as the Chloride, in sea-water, salt lakes, salt mines; the Nitrate, in Peruvian 
deserts; and the Borate, in dry lakes of Persia, California, etc. The Carbonate 
occurs in the ashes of marine plants. From the Chloride is prepared the Sul- 
phate, from this the Carbonate, and from the latter most of the other salts are 
prepared. All sodium salts impart a yellow color to flame, which should not 
appear more than transiently red when observed through a blue glass. The 
latter cuts off the yellow rays but allows the violet ones of potassium to be seen. 

Sodium Salts and their Preparations. 

Sodii Hydroxidum, Sodium Hydroxide, Soda, NaOH, — is a white, hard, opaque solid, 
deliquescent in moist air, efflorescent in dry air, odorless, of intensely acrid and caustic taste 
and strongly alkaline reaction, soluble in 1.7 of water at 50° F., and in 0.8 of boiling water, 



462 SODIUM. 

very soluble in alcohol. Is a powerful caustic, but milder than Potassa, and should be kept 
in well-stoppered bottles made of hard glass. 

Liquor Sodii Hydroxidi, Solution oj Sodium Hydroxide, Solution of Soda, — contains about 
5 per cent, of the hydroxide, and is prepared by dissolving 56 of Soda in 944 of Distilled 
Water. It is a clear, colorless liquid, odorless, of acrid and caustic taste and strongly alkaline. 
Dose, trgv- 5 ss [av. npxv], well diluted with water. 

Sodii Acetas, Sodium Acetate, NaC 2 H 3 2 +3H 2 0, — large, transparent prisms, efflo- 
rescent in dry air, odorless, of saline, bitter taste and a neutral or faintly alkaline reaction, 
soluble in 1.4 of water and in 30 of alcohol at 59 F., in i of boiling water and in 2 of boiling 
alcohol. Dose, gr. v-xxx [av. gr. xv]. 

Sodii Carbonas Monohydratus, Monohydrated Sodium Carbonate, N 2 C0 3 + H 2 0, — a 
white, crystalline, granular powder, soluble in water and in glycerin, insoluble in alcohol and 
in ether. Dose, gr. j-vij [av. gr. iv]. 

Sodii Bicarbonas, Sodium Bicarbonate, NaHC0 3 , — an opaque, white powder, per- 
manent in the air, odorless, of cooling, saline taste, and a slightly alkaline reaction; soluble 
in 1 2 of water, insoluble in alcohol, decomposed by hot water and converted into normal Car- 
bonate. Of it 20 grains neutralize 16.7 grains of Citric Acid, or 17.8 grains of Tartaric Acid. 
It is a constituent of Mistura Rhei et Sodas and of Pulvis Effervescens Compositus. Dose, 
gr. x-xxx [av. gr. xv]. 

Trochisci Sodii Bicarbonatis, Troches of Sodium Bicarbonate, — each troche contains 
of the Bicarbonate about 3 grains, with Sugar, Nutmeg, and Mucilage of Tragacanth. 

Sodii Citras, Sodium Citrate, — a white, granular powder, of cooling and saline taste, 
very soluble in water, slightly soluble in alcohol. Dose, gr. v-xxx [av. gr. xv]. 

Sodii Chloras, Sodium Chlorate, NaC10 3 , — colorless, transparent tetrahedrons, per- 
manent in dry air, odorless, of cooling, saline taste and neutral reaction; soluble in 1.1 of 
water and in about 100 of alcohol, also in 0.5 of boiling water and in about 40 of boiling alcohol. 
Should be kept in well-stoppered bottles, and should be not mixed or heated or triturated with 
readily oxidizable or combustible substances. Dose, gr. j-x [av. gr. iv]. 

Sodii Chloridum, Sodium Chloride, {Common Salt), NaCl, — white, hard, cubical crystals 
or a crystalline powder, permanent in the airv odorless, of a purely saline taste and neutral 
reaction; soluble in 2.8 of water at 59 F., and in 2.5 of boiling water. Almost insoluble in 
alcohol. Dose, gr. x- 3 j [av. as emetic oiv]. 

Sodii Ethylas, Sodium Ethylate, Caustic Alcohol, C 2 H 5 NaO (Unofficial), — is a white 
powder, often having a brownish tinge, dissolving in water with a hissing sound. Upon 
contact with the smallest quantity of water or moist living tissue it splits into alcohol and 
caustic soda. An alcoholic solution is made by dissolving sodium in absolute alcohol, and is 
used as a caustic. Chloroform decomposes it at once into ether and sodium chloride. It 
should be kept in a cool place, as it is liable to explode. 

Sodii Nitras, Sodium Nitrate, {Chili Nitre, Chili Saltpetre) NaN0 3 , — colorless, trans- 
parent crystals, slightly deliquescent, odorless, of cooling, saline and bitter taste, and neutral 
reaction; soluble in 1.3 of water at 59 F., in 0.6 of boiling water, scarcely soluble in cold 
alcohol. Dose, gr. v-xxx [av. gr. xv]. 

Sodii Sulphas, Sodium Sulphate, {Glauber's Salt) Na 2 S0 4 + ioH 2 0, — large, colorless, 
transparent, monoclinic prisms, rapidly efflorescent in air; of cooling, saline taste and neutral 
reaction; soluble in 2.8 of water at 59 F., in 0.25 of water at 93. 2 F., and in 0.47 of boiling 
water, insoluble in alcohol. Dose, gr. v-xx; as a purgative oss-j [a v. oss]. 

Uricedin (Unofficial), — is the trade name of a preparation which contains Sodium Citrate 
67 per cent., Sodium Sulphate 27^ per cent., Sodium Chloride 1.6 per cent., and smaller quan- 
tities of the citrates and phosphates of potassium and calcium. It is used in lithemia and 
gout. Dose, gr. x— xxx. 

The Arsenate is described under Arsenum; — the Benzoate under Benzoinum; — the 
Borate under Acidum Boricum; — the Bromide under Bromum; — the Solution of Chlori- 
nated Soda under Chlortjh; — the Iodide under Iodum; — the Hypophosphite, Phosphate 
and Pyrophosphate under Phosphorus ; — the Nitrite under Amyl Nitris — the Salicylate 
under Salicin ; — the Sulphite, Bisulphite and Thiosulphate, under Acidum Sulphurosum ; 
and the Phenolsulphonate under Phenol. 

Incompatibles. 

Incompatibles with Sodium Compounds are as for Potassium compounds (see page 401), 
those with Sodium Salts are given under their respective acid constituents, as the Carbonate 
under the title Carboneum, the Sulphate under Acidum Sulphuricum. 



SODIUM. 463 

Physiologic \ 1 Action. 

The action of the Sodium salts is similar to that of the Potassium salts, 
except that the former are feebler as alkalies, arc not so depressant, and are 
not so poisonous to the cardiac muscle or the nerves. They are diffused more 
slowly, are neither absorbed nor excreted so readily, and have not so marked 
diuretic action. Locally applied in large doses to muscular and nervous tissues 
they are paralyzant, but not so powerfully as potassium salts. Sodium urate 
is not soluble like the urates of lithium and potassium, and is therefore much 
less readily excreted, forming the masses called chalk-stones in gouty subjects. 
Soda is a less active escharotic than potash, having less affinity for water. Liquor 
Sodii Hydoxidi renders the blood and secretions more alkaline, but does not 
alter nutrition to the extent that the potassium solution does. The Acetate is 
converted into the carbonate in the blood, and is a less active diuretic than the 
corresponding potassium salt. The Carbonate is irritant to the stomach, and 
is chiefly used in the preparation of the other salts. The Nitrate is mildly 
purgative and diuretic, and in solution is solvent to false membranes. The 
Ethylate is antiseptic, and a powerful but almost painless escharotic. 

Sodium Bicarbonate has the same action as the corresponding potassium 
salt, except that it is more slowly absorbed and is less depressant. It is antacid, 
antipruritic, and analgesic, the latter being probably due to the increased alka- 
linity imparted by it to the blood. Internally in small doses it is neutralized 
by the hydrochloric acid of the gastric juice; in medium doses it is solvent to 
the gastric mucus, slightly irritant to the stomach, and sedative to the gastric 
nerves; in large doses it renders the stomach contents neutral or alkaline and 
stops the gastric digestion. 

Sodium Chloride, common salt, is one of the most important and abundant 
of the saline constituents of the animal organism, existing normally in the blood, 
where it keeps the fibrin and albumin in solution. In inflammation, being thus 
needed, it accumulates at the seat of the morbid action, disappearing temporarilv 
from the urine, its reappearance therein being considered one of the surest 
signs of the patient's improvement. In very dilute solution it enables water 
to dissolve both albumins and globulins, and renders water non-irritant to the 
animal tissues and harmless to the red blood-corpuscles. For these purposes 
the solution employed is one of 0.65 per cent., known in experimental physiology 
as the normal salt solution. In substance or in concentrated solution, this salt 
is very irritant to cut surfaces, mucous membranes, muscle and nerve tissues. 
Taken into the stomach in quantity it irritates that organ and induces vomiting. 
When absorbed in excess of the normal requirements of the body it causes the 
peculiar nervous irritation expressed by the sense of thirst; which is relieved 
only by the ingestion of water in sufficient quantity to enable the excess to be 
dissolved and excreted by the kidneys. It is rapidly absorbed, and rapidly 
excreted; and acts as a hemostatic, decreases the secretion of mucus, is a vermi- 
fuge against thread-worms, promotes the absorption of pleuritic exudations 



< 



( 



I 



464 SODIUM. 

and dropsies, and has considerable power as an antiperiodic and an antiseptic. 
In excess it neither increases nor decreases the elimination of urea or other 
products of tissue-waste. The excessive ingestion of potassium salts (as in the 
cases of herbivorous animals and vegetarian cranks) increases the excretion of 
sodium chloride by a double decomposition between these salts in the blood, 
forming potassium chloride and sodium phosphate, which being foreign to the 
blood are constantly excreted. In this way, by a continuous vegetable diet 
the normal amount of sodium chloride in the organism may be greatly reduced, 
and the animal will feel the want of it and will often travel hundreds of miles 
to visit a salt-lick. 

Sodium Sulphate, administered by the mouth in dilute solution, excites active 
secretion in the intestines, especially in the small intestine, partly by its bitter- 
ness but also by its irritant quality and its specific power of stimulating the ac- 
tivity of the intestinal glands. The action is not an osmotic one, as was formerly 
taught. The stimulation caused by this salt extends to the liver and the pan- 
creas, especially the former. The absorption of the secretions is impeded by 
the low diffusibility of the salt, the result being a large accumulation of fluid 
in the intestinal canal, which finds its way to the rectum and produces purgation. 
The more dilute the solution employed the more prompt will be the effect, and 
this salt will not produce catharsis if administered in concentrated solution. 
When injected into the blood it excites no intestinal secretion, does not act as 
a purgative, and produces no toxic effect. [Magnesium Sulphate is toxic when 
so administered.] The quantity of Sodium Sulphate to the pint of Carlsbad 
water (Sprudel) is 20 grains, in Friedrichshall 46^ grains, and in Hunyadi Janos 
from 122 to 173 grains; the last being the most active hepatic stimulant of 
the three. A mixture of the Sulphate and the Bicarbonate is sold as the natural 
salt obtained by evaporation of Carlsbad water. 

The action of the other Sodium salts is described under the titles of the 
respective constituents to which their effects are mainly referable. 

Therapeutics. 
The Sodium salts mentioned in the first paragraph treating of their action 
are not much used internally, the corresponding Potassium salts being preferred, 
especially when it is desired to alkalinize the urine or to promote oxidation. 
In the alkaline treatment of stomach affections the Sodium salts are the most 
efficient, especially the Bicarbonate, which is in common use as a gastric sedative 
and antacid. This salt in powder or saturated solution on compresses is an 
efficient analgesic application for burns and scalds, also to relieve the pain at- 
tending large boils and rheumatism of the joints. It is an efficient application to 
painful dental cavities, and to the gums in many cases of toothache. Dilute solu- 
tions are employed locally in eczema and itching skin affections. Internally it is 
used with benefit in frontal headache with constipation, to reduce the excretion 
of sugar in diabetes, and in doses of 3ij-iv to neutralize the acid toxins in diabetic 



SOLANUM CAROLINENSE SPIGEL1A. 4O5 

coma. The Carbonate may be used in dilute solution locally as an antipruritic, 
also as an alkaline bath, to remove cutaneous scabs and scaly incrustations. 
Added to the boiling water in which surgical instruments arc sterilized, in the 

proportion of I per cent, it will prevent their rusting. The Sulphate is an 
efficient purgative and somewhat of an hepatic stimulant, and may l>c admin- 
istered alone or with the bicarbonate in imitation of Carlsbad salts, for bilious 
disorders, gouty affections, chronic constipation, obesity and diabetes mellitus. 
The Chlorate has uses similar to those of potassium chlorate, and being more 
soluble can be used in stronger solutions, but this is of doubtful benefit for 
internal administration, as it possesses all the irritating power on the kidneys 
and destructive action on the blood possessed by the other salt. The Nit rate- 
is employed as a mild cathartic, and in solution by atomization to destroy the 
false membrane in diphtheria. The Ethylate has been of service as a caustic 
in cancer, lupus and nevus, for the latter affection being painted over the growth 
with a glass rod. Caustic Soda is a better escharotic than caustic potassa, as 
it has less affinity for water, and hence does not destroy the tissues so deeply, 
nor has it the same tendency to run over adjacent parts. 

Sodium Chloride is employed in baths as a mild general stimulant and a 
cutaneous tonic, and in concentrated hot baths for chronic rheumatism and 
sciatica. As an anthelmintic for threadworms it is used by enema in the strength 
of two tablespoonsful to the pint of water. As the normal salt solution, 0.65 
per cent., or 50 grains to the pint of sterilized water, it is employed to wash out 
wounds and to irrigate the nasal and abdominal cavities; also subcutaneously 
or by intravenous or rectal injection to supply fluid lost in cholera and severe 
hemorrhages, and to dilute toxins in the blood and promote their elimination 
in uremia and other intoxications. A better solution would be one of 0.9 per 
cent., containing also a small quantity of the chlorides of calcium and potassium 
(Ringer). Internally it is used as an emetic and a hemostatic, as an antidote 
in poisoning by silver nitrate, and as a remedy in bilious diarrhea and migraine. 

The therapeutics of the other sodium salts are described under the titles 
of the constituents to which their uses are chiefly referable. 



SOLANUM CAROLINENSE, Horse-nettle, Sand-brier (Unofficial),— is a weed be- 
longing to the nat. ord. Solanaceae, a native of Florida and Carolina. In epilepsy a 20 per 
cent, tincture of the berries is highly recommended, in doses of 5ss-j thrice daily. It has 
been used with benefit in convulsions due to the albuminuria of pregnancy and in other con- 
vulsive affections. 



SPIGELIA, (Pink-root) — is the dried rhizome and roots of Spigelia ma- 
rilandica, the Carolina Pink, an herbaceous perennial of the nat. ord. Logan- 
iaceae, native of the Southern States; having large, showy flowers, scarlet or 
crimson externally, yellow within. It contains a bitter principle and a volatile 
oil, also tannin, wax, resin, lignin and salts. Dose, 3ss-ij [av. 3j] for an adult; 
gr. x-xx for a child of 3 years. 



( 



i 



( 



466 STAPHISAGRIA — STILLINGIA. 

Fluidextractum Spigeliae, Fluidextrad of Spigelia. — Dose for an adult, 3 ss-ij [av. 5j]; 
for a child of 3 years, njjx— xx. 

Infusum Spigelian Compositum, Compound Infusion of Spigelia, Worm Tea (Un- 
official), — has Spigelia 15, Senna 10, Fennel 10, Manna 30, Water 500. Dose, §jss-v. 

Spigelia is anthelmintic against the round-worm (ascaris lumbricoides) , 
and is in popular use as a vermifuge, administered with senna. In large doses 
it is an uncertain cathartic, and may produce serious symptoms, as vertigo, 
dimness of vision, dilated pupils, spasms and convulsions. These effects are 
most apt to occur when the drug fails to produce purgation, hence it is usuallv 
administered with an active cathartic. 

Spigelia Anthelmia, Demarara Pink-root, Worm-grass (Unofficial), — produces vomiting, 
dilated pupils, dyspnea, convulsions and death. If eaten by cattle they perish in great agony. 
It has been used with real benefit in cardiac affections of rheumatic origin, also in rheumatic 
fever and in cardiac palpitation with dyspnea, due to mitral and aortic disease. A tincture 
( 1 in 8) may be used in doses of tijv-xx. 



STAPHISAGRIA, (Stavesacre), — is the ripe seed of Delphinium Staphisagria, an annual 
or biennial plant of the nat. ord. Ranunculaceas, a native of Europe, having bluish or purple 
flowers in terminal racemes, and seeds in straight, oblong capsules. The seeds contain an 
alkaloid Delphinine, probably three other alkaloids, a bitter principle, a volatile oil and a 
fixed oil, etc. Dose, gr. ss-ij [av. gr. j ]. 

Fluidextractum Staphisagriae, Fluidextrad of Staphisagria, — Dose, irgss-ij [av. njj]. 

Unguentum Staphisagriae, Ointment of Staphisagria (Unofficial), — contains of the 
powdered seeds 1 part with 2 each of olive oil and lard. 

Delphinina, Delphinine, C^H^NO^ (Unofficial), — is the active alkaloid, and exists in 
the fatty oil which is extracted by ether. Dose, gr. T V" J. 

Stavesacre is a violent emetic and cathartic, also parasiticide. The alkaloid is irritant 
to the skin if locally used, producing tingling, burning and inflammation. Internally, it 
lowers the activity of the heart and respiration, produces a most profound adynamia, and 
may prove fatal from paralysis of the spinal cord and asphyxia. In many respects its alkaloid 
resembles Aconitine and Veratrine. The ointment is often employed as a parasiticide against 
pediculi and the acarus scabiei. The fixed oil is probably equally effective. Delphinine 
has been used internally in asthma, rheumatism and neuralgia, and in the latter affection is 
well employed as an ointment (gr. xx to 5j), applied over the course of painful superficial 
nerves. It has been suggested as an antipyretic and for dropsy. A tincture or fluidextract 
is a very efficient application against pediculi. 



STILLINGIA, Stillingia, — is the root of Stillingia sylvatica, the queen's 
delight, an indigenous, perennial plant of the nat. ord. Euphorbiaceae. It con- 
tains a resin and a volatile oil, but its active principle has not yet been isolated. 
The fresh root should be used in making the preparations, as those from the 
dried root are almost inactive. Dose of the powdered root, gr. x-5] [av. gr. xxx]. 

Preparations. 

Fluidextractum Stillingiae, Fluidextrad of Stillingia, — Dose, tijx-SJ [av. njxxx]. 

Syrupus Stillingiae Compositus, Compound Syrup of Stillingia (Unofficial), — is com- 
posed of Stillingia, Corydalis, Iris, Chimaphila, Coriander, Xanthoxylum, Sambucus, Sugar, 
Water and Alcohol. For the formula, see U. S. Dispensatory, 17th edition. Dose, 5j-' v 
thrice daily. 

Succus Alterans (McDade), — is a proprietary preparation much used by southern 
practitioners in syphilis. It is said to contain Stillingia, Lappa, Phytolacca, Sarsaparilla and 
Xanthoxylum. Dose, oj-iv, thrice daily. 



stramonium. 467 

Physiological Action and Therapeutic s. 

Stillingia in large doses is emetic and cathartic, in smaller doses is expec- 
torant, diaphoretic, diuretic, sialagogue and cholagogue, possessing the various 
properties which are considered alterative. Its taste is acrid and pungent, it 
increases the action of the heart, skin, kidneys, and bronchial mucous mem- 
brane, also the gastric, hepatic, intestinal and salivary secretions. Full doses 
excite epigastric pain, nausea and vomiting. 

Stillingia is much employed with Sarsaparilla and similarly acting drugs as 
an alterative in syphilitic affections, particularly in chronic cases of the tertiary 
form, in which the system is greatly reduced by the abuse of mercurials and 
iodides. In these cases it possesses considerable power and frequently cures. 
It is highly esteemed in strumous affections, in ascites due to hepatic changes, 
in portal changes with jaundice following malaria, in intermittent fever, habitual 
constipation, and hemorrhoids from hepatic obstruction. In ague the fluid 
extract with quinine or arsenic is a useful combination, and a strong decoction 
has been employed to ward off an impending paroxysm. The compound syrup, 
a model of polypharmacy, is largely used by physicians in the western and 
southern states. 

STRAMONIUM, Stramonium, — is the dried leaves of Datura Stramo- 
nium, the Jamestown weed or Thornapple, nat. ord. Solanaceae, yielding on assay 
not less than 0.35 per cent, of mydriatic alkaloids. The plant is an annual, 
of rank and vigorous growth, has a green stem with large, white flowers, and 
grows wild in Russia and the middle United States. It contains the alkaloids 
Atropine and Hyoscyamine, also some Hyoscine (see pages 171 and 310), and 
a volatile oil containing Daturic Acid. Daturine is the name of the mixed alka- 
loids. Dose, gr. ss-iij [av. gr. j]. 

Datura Tatula (Unofficial), — is an indigenous plant of the nat. ord. Solanaceae, re- 
sembling Stramonium very closely, with which it generally agrees in its alkaloids, physio- 
logical action and therapeutics. It is distinguished by its purple stem, purple flowers and 
anthers, and the darker green of its leaves. It has been smoked in asthma, in a few cases giving 
continued relief when Stramonium had failed to render any service. 

Mandragora, — the plant Mandragora autumnalis, contains Mandragorine, which is 
probably a mixture of Atropine and Hyoscyamine. 

Preparations. 
Extractum Stramonii, Extract 0} Stramonium. — Dose, gr. J-J [av. gr. £]• 
Fluidextractum Stramonii, Flicidextract of Stramonium. — Dose, njss-iij [av. rrpj ]. 
Tinctura Stramonii, Tincture oj Stramonium, — 10 per cent. Dose, ttjjv-xv [av. njviij ]. 
Unguentum Stramonii, Stramonium Ointment, — has of the Extract 10, Diluted Alcohol 
5, Benzoinated Lard 65, Hydrous Wool Fat 20. 

Daturina, Daturine, (Unofficial), — -is a mixture of the alkaloids. Dose, gr. jJj-gV- 

Incompatible!. 

Incompatibles are as for Belladonna (see page 171); with the addition of Mineral Acids 
and the salts of Iron, Lead, Mercury and Silver. 



468 strontium. 

Physiological Action and Therapeutics. 

The action of Stramonium is similar to that of Belladonna in almost every 
particular, except that Stramonium is more powerful and chiefly influences the 
sympathetic nervous system, not affecting the motor or sensory nerves. It 
excites a greater degree of cardiac irregularity and a more furious delirium, 
and seems to have a special affinity for the generative apparatus, being decidedly 
aphrodisiac in full doses. It relaxes the muscular coat of the bronchial tubes 
more powerfully than belladonna. Poisoning by Daturine is not to be distin- 
guished from that by Atropine. 

Stramonium is chiefly used as an antispasmodic and to relieve local pain. 
In asthma the leaves are smoked with advantage at the commencement of a 
paroxysm, the smoke being drawn into the lungs. In other spasmodic affections, 
as hepatic colic, laryngeal cough, chorea and stammering, it is very beneficial. 
In dysmenorrhea and neuralgia it is used in combination with opium and hyos- 
cyamus, and in tic douloureux and sciatica it is often efficient. In nympho- 
mania with great mental depression it is frequently effective, and in mania of 
furious character, particularly the puerperal form with suicidal tendency, it 
is highly serviceable in 10 to 20 minim doses of the tincture every 3 or 4 hours. 
The ointment is much used in irritable ulcers, and as an anodyne application 
in painful hemorrhoids and certain cutaneous diseases. 

STRONTIUM, Sr. This metal is represented in medicine by four salts, 
the Bromide, Iodide, and Salicylate, which are respectively described under 
Bromum, Iodum, and Salicinum, also the unofficial salt — 

Strontii Lactas, Strontium Lactate, (Unofficial), — a white, granular powder, or crystalline, 
nodules, of slightly bitter and saline taste; soluble in 4 of water, in less than \ of boiling water 
also in alcohol. Dose, gr. v-xxx. 

Incompatible with Strontium Salts are: Alkalies, Carbonates, Chromates, Oxalates, Phos- 
phates, and Sulphates. 

The Strontium salts are among the recent additions to the materia medica. 
Their marked anti-putrescent and antiseptic properties were first noticed in 
1891 by Germain See, on patients suffering from gastric dilatation. He found 
that in such cases the Bromide prevented the acetic and lactic fermentations 
and the formation of the gases of decomposition. The toxic action, hitherto 
attributed to the salts of strontium, has been ascertained to be due to barium, 
which was present in the commercial products used. When pure, they may 
be safely employed in the same doses, and in the same cases, as the corresponding 
preparations of potassium and sodium; while they are much less liable to cause 
eruptions and are more rapidly and completely eliminated by the kidneys. 

The Lactate has been successfully employed in diabetes and in albuminuria. 
It diminishes the amount of albumin in Bright's disease, in the parenchymatous 
nephritis of rheumatic and scrofulous subjects, and in the albuminuria of preg- 
nancy; for which purpose it should be given in full doses (gr. xxx) thrice daily. 



STROPH \\ iin s 469 

Ii is contraindicated when there is scanty urine or symptoms of uremia. Da 
Costa held that while the strontium salts are admirable as diuretics in renal 
affections, they accomplish more in the acute than in the chronic forms of 
nephritis. 

The actions and uses of the Bromide, Iodide and Salicylate are given under 
the titles Bromum, Iodum and Salicinum respectively. 

STROPHANTHUS,— is the ripe seed, deprived of its long awn, of Strophan- 
tus Kotnbi, an African climbing plant of the nat. ord/Apocynacese, from which 
the natives extract a toxic preparation known as the Kombe arrow-poison. It 
contains a crystalline glucoside, named Strophanthin, the active principle, which 
is an agent of great energy, the frog being killed by a solution of 1 part in 
10,000,000. Dose of Strophanthus, gr. ss-ij [av. gr. j]. 

Preparations. 

Extractum Strophanthi, Extract 0} Strophanthus (B. P.), — is prepared by percolation 
with ether and alcohol. Dose, gr. J-j. 

Tinctura Strophanthi, Tincture 0} Strophanthus, (10 per cent.). — Dose iijv-x, [av. 
HRviij], or TTji-ij frequently repeated. A stronger tincture (1 in 8) is on the market. 

Strophanthinum, Strophanthin, C 3 iH <s 12 , — constitutes 8 to 10 per cent, of the seeds, 
and is very soluble in water and in alcohol. It varies in composition and power, and its 
solutions are prone to decomposition. Dose is generally given at gr. 3$o ~ iOO [ av - g r - 2rol> but 
gr. 7 -' f has often seemed inert, and gr. -$$■$ of some samples has been found to be a sufficient 
dose. 

Analogue. 

Ouabain, C 30 H 46 O 12 (Unofficial), — is a glucoside obtained from the root and wood of 
Acocanthera Ouabaio, an apocynaceous tree of the Somali coast; also from the seeds of 
Strophanthus glabrus, a climbing plant from Gaboon. The former furnishes an arrow poison 
used by the African natives. Ouabain occurs in white, odorless crystals, of feebly bitter 
taste; soluble in hot water and in spirit, slightly in cold water, insoluble in absolute alcohol, 
chloroform and ether. Dose, gr. TToTy~3iny- ^ n tne blood gr. -^ 5 is sufficient to kill a man. 

Incompatibles. 
Incompatibles with Strophanthus are those for glucosides (see page 8). 

Physiological Action. 

Strophanthus is primarily a muscle poison of great energy. It increases 
the contractile power of muscular tissue, and a poisonous dose fixes the muscles 
in permanent tetanic rigidity, the fibres being unable to resume their normal 
condition of partial flexibility. As the heart receives much more blood in a 
given time than any other muscle in the body, it is quickly and markedly affected 
by the strophanthus-charged fluid, and by regulating the dosage the cardiac 
muscle may be affected by a quantity which will not influence the other muscles. 

Small doses of Strophanthus act exactly like Digitalis on the heart, stimulating 
the contractions, increasing the force of the ventricular systole, and lowering 
the cardiac rate. At the same time the general blood-pressure is raised and 
diuresis is produced, both being due to the vis a lergo — the direct stimulation 
of the circulation from behind. Large doses paralyze the heart in systole and 



I 



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47° STY RAX. 

leave the cardiac muscle in a state of contraction resembling cadaveric rigidity. 
It does not act through the nervous system, but paralyzes the muscular tissue, 
striated and non-striated, by direct contact; and when contractility has been 
once destroyed thereby no stimulus will re-excite it. It does not affect the vas- 
cular system directly. The influence of one injection of gr. -£$ of Strophanthin 
on the circulation is said to have lasted eight days. Strophanthus differs from 
Digitalis in being less irritant to the stomach, more rapid in its cardiac action, 
more quickly eliminated and therefore not cumulative, more powerfully diuretic, 
and having no direct contractile influence on the vessels. It has little or no 
action upon the general nervous system, but its active principle Strophanthin 
is a powerful local anesthetic and a myotic when applied to the conjunctiva. 

Therapeutics. 

Strophanthus is undoubtedly a valuable cardiac stimulant, from the rapidity 
and permanence of its action, as well as its non-interference with the calibre 
of the peripheral vessels. It promptly relieves cardiac dyspnea, often modifies 
the pulse-rate in less than an hour, while the influence of a single dose upon 
the circulation persists for a long time. It may well replace digitalis in the 
treatment of chronic Bright's disease and valvular lesions of the heart, when 
it is important that the work of the heart should not be increased by any addi- 
tional resistance in the arterial system. It has been reported as exceedingly 
useful in the treatment of Bright's disease for the dyspnea, orthopnea, dropsy 
and uremia; also in mitral insufficiency with great anasarca and dyspnea, in 
palpitation, exaggerated cardiac action, in weak heart, and for exophthalmos 
with tumultuous action of the heart; also in pulmonary edema due to valvular 
lesions or to pneumonia. It is useful in endocarditis, also in atheroma of the 
arteries, in reflex palpitation of neurasthenia, hysteria and chlorosis, and for 
rigors due to catheterization or operations on the urethra. Notwithstanding 
its undoubted value, it has not become popular with the medical profession, by 
reason of the uncertainty of the pharmaceutical preparations on the market. 

Ouabain is an extremely active poison, paralyzing the cardiac muscle by 
direct action. It is a powerful emetic, especially when given hypodermically; 
also a potent local anesthetic, being considered by many observers as superior 
to Cocaine in this respect. In therapeutic doses it does not seem to affect the 
body-temperature, but increases urination, either by stimulating the blood- 
pressure or by paralyzing the sphincter vesicae. It also promotes defecation, 
probably by stimulating peristalsis. Very small doses give some evidence of 
action similar to that of Digitalis. It has been used with striking benefit in all 
stages of pertussis; and to some extent as a local anesthetic for the eye. 



STYRAX, Storax, — is a balsam prepared from the wood and inner bark of Liquidambar 
orientalis, the Oriental Sweet-gum, a tree of the nat. ord. Hamamelidacea?, growing in Asia 
Minor. It is semi-liquid, sticky, opaque and gray-colored, of agreeable odor and balsamic 
taste, completely soluble (except accidental impurities) in an equal weight of warm alcohol. 



SUCC1NUM — SULPH0NMET1I \\l M. 47 I 

It consists of a volatile oil named Styrol, C\ll s ; a crystalline solid Stynn in, whii l> is .1 1 inna- 
mate of cinnamic ether; two peculiar resins, one hard, the other softj and Ciiuuimit Add, 
CV1 9 : , a colorless, odorless, crystalline body, closely allied to Benzoic Acid, excreted in the 
urine partly as Hippuric Acid, and occurring also in the Balsams of Peru and Tolu. Dose of 
Storax, gr. v-xx [av. gr. xv], 

Tinctura Benzoini Composita, Compound Tincture of Benzoin, (Friar's Balsam), — 
contains 8 per cent, of Stora\. Dose, itjjx-3j [av. njjxxx]. 

Storax is a stimulant expectorant, an antiseptic and a disinfectant, acting both locally 
and remotely, like benzoin and the balsams. It is used with benefit in chronic bronchitis and 
other affections of the respiratory organs, also in chronic catarrhs of the genito-urinary pas- 
sages, in gonorrhea and in amenorrhea. Externally it is employed in ointment as a detergent 
for foul ulcers, and as a parasiticide for scabies and phthiriasis. 



SUCCINUM, Amber (Unofficial) — the source of Oil of Amber, is a fossil resin, occurring, 
in alluvial deposits, chiefly in Prussia, Bohemia, and Courland. It is usually associated 
with lignite, sometimes encloses insects and parts of vegetables, and consists of a volatile oil, a 
yellow resin, another resin, succinic acid, and a bituminous principle. Its source is thought to be 
an extinct coniferous tree, the Pinites succinifer, of which amber represents the exudation. 
The Kauri Gum from New Zealand is a similar substance. 

Oleum Succini, Oil of Amber (Unofficial), — is a volatile oil obtained by the destructive 
distillation of Amber, and purified by subsequent rectification; a pale yellow, thin liquid, 
of sp. gr. about 0.920, of empyreumatic and balsamic odor, warm, acrid taste, and neutral 
or faintly acid reaction, readily soluble in alcohol. Dose, gtt. v-x. 

Oil of Amber is stimulant, antispasmodic and diuretic, when used internally. Exter- 
nally it is irritant and rubefacient. It has been employed with benefit in epilepsy, hysteria, 
convulsions, amenorrhea and whooping-cough. As a liniment it is often used in chronic 
rheumatism, and has been applied along the spine in infantile convulsions, mixed with an 
equal part of laudanum and diluted with olive oil or brandy. 



SULPHONMETHANUM, Sulphonme thane, (Sulphonal), C 7 H 16 S 2 4 — 
is diethylsulphone-dimethylmethane, the product of the oxidation of the mer- 
captol obtained by the condensation of acetone with ethylmercaptan. It occurs 
in colorless, prismatic crystals, soluble in 15 of boiling water, in about 450 of 
cold water, and in about 50 of cold alcohol; very soluble in boiling alcohol. 
Sulphonal is a very stable body, being unaffected by concentrated acids, alkalies 
or oxidizing agents, cold or warm. Dose, gr. x-xxx [av. gr. xv], in hot aqueous 
solution. 

Official Analogues. 

Sulphonethylmethanum, Sulphonethylmethane, (Trional), C s H I8 S 2 4 , — is diethyl- 
sulphone-methylethylmethane, a product of the oxidation of the mercaptol obtained by the 
condensation of methvlethylketone with ethyl mercaptan. It occurs in lustrous, bitter crystals, 
soluble in 320 of cold water, readily soluble in hot water, in alcohol and in ether. It is an 
efficient hypnotic, prompter in action and less liable to produce ill effects than Sulphonal, but 
must be given in doses fully as large, gr. x-xxx [av. gr. xv]. 

-flJthylis Carbamas, Ethyl Carbamate, (Urethane), C 3 H 7 N0 2 , — is an ester of carbamic 
acid, obtained by the reaction of ethyl alcohol upon carbamide (urea) or one of its salts. It 
occurs in colorless crystals, readily soluble in water, alcohol, ether, or glycerin. Dose, gr. x-xxx 
[av. gr. xv]; but is best given in doses of 5 grains frequently repeated, up to 20 grains or more, 
as a full dose may cause vomiting. It is incompatible with many substances, and is best ad- 
ministered by itself. 

Unofficial Analogues. 

Tetronal, Diethyl sulphon-diethyl-methane, — contains 4 ethyl groups to 3 in Trional and 
but 2 in Sulphonal. Dr. Lauder Brunton holds of the physiological action of the disulphones, 
to which group these three substances belong, that only those containing ethyl groups are 
active, and that the hypnotic activity is increased with the number of such groups. This, 



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472 SULPHONMETHANUM. 

if substantiated in practice, would make Tetronal the most powerful hypnotic of the three, 
but it is scarcely heard of in practice. It is patented in this country, though produced by a 
foreign manufacturer. Dose, gr. x-xxx. 

Veronal, Diclliyl-malonyl-urea, C s H 12 N 2 3 , — is a white, crystalline powder, of faintly 
bitter taste, soluble in 145 of water, and in 12 of boiling water. Dose, gr. v-xv, an average 
dose being gr. vijss, in some hot liquid, or in cachet, or as a powder. 

Physiological Action and Therapeutics. 

Sulphonal was introduced several years ago as a harmless hypnotic which 
would produce sound and quiet sleep without unpleasant after-effects, without 
intoxicant or narcotic action, and having no unfavorable effects on the heart 
or circulation even in full doses. It rapidly came into general use as a hypnotic 
in mental diseases, in nervous insomnia and in sleeplessness from various causes. 
Many competent observers have recorded instances of toxic action following 
its use, and opinions are now greatly divided as to its therapeutical value. If 
it were not for the very evident advantage of the drug when used with care 
and under medical supervision, it would stand a very fair chance of being either 
excluded from practice or restricted by law (Squibb). Its prolonged use has 
caused noises in the ears, headache, vertigo, weakness and incapacity for mental 
or physical exertion. The subject may pass into a condition of drowsiness 
or 1 stupor, or may suffer from difficulty of speech; and ptosis, edema of the 
eyelids and cyanosis may be experienced. In one case a single dose of 20 grains 
caused edema of the lower limbs after a very restless night. In another a dose 
of 20 grains taken nightly for 15 months was accompanied by complete cessation 
of menstruation. It has produced persistent skin eruptions in some cases and 
severe functional disturbances in others. The chief characteristics of chronic 
poisoning by this drug are as follows: — disturbances of digestion, shown by 
vomiting and diarrhea or constipation; disturbances of the nervous system, as 
ataxy and feebleness of the limbs, ptosis and ascending paralysis; also ischuria 
and oliguria, sometimes albuminuria or hematoporphyrinuria. In order to 
secure elimination and to guard against cumulative action and consequent 
toxicity, its administration should be interrupted from time to time, and the 
patient taking it should be frequently purged. 

As a hypnotic Sulphonal acts admirably in many instances, if administered 
in hot fluids and about two hours before its action is required; but its efficacy 
decreases with use, and it is of no value whatever against insomnia due to pain. 
The average hypnotic dose is about 20 grains for a woman and 30 grains for 
a man. The dose is to be administered only once daily, and should be discon- 
tinued at the first sign of toxic action. In no case should its administration 
be continued over any great length of time. In cases of insomnia due to neu- 
ralgia and nervous excitement, the dose of sulphonal may be advantageously 
combined with a small dose of morphine, in proportion to suit individual cases, 
the mixture forming a safe and efficient hypnotic. An excellent hypnotic com- 
bination is made by mixing together 10 or 15 grains each of sulphonal and 
trional, to be taken in some hot liquid at bed-time. The trional producing 



SULPHUR. 473 

early sleep and the sulphonal effects being manifested later, the patienl will 

usually obtain a more prolonged result from the small dose of each agent ad- 
ministered together than from a larger dose of either alone. 

Trional is an efficient hypnotic, acting more rapidly than sulphonal, and 
usually without cumulative action or unpleasant after effects. Several eases of 
poisoning, including three deaths, have been reported as caused by it, and in 
one case its prolonged administration gave rise to multiple neuritis and hemato- 
porphyrinuria (Hart). It has been used with satisfaction as a hypnotic and seda- 
tive for the insane and in the treatment of narcomania. It acts well in chorea, 
and as an alternating substitute for the bromides in epilepsy. It is said to be 
particularly efficient in cases of slight psychical excitement accompanied by 
obstinate insomnia, also in many forms of delirium. When pain is present it 
may be administered in conjunction with phenacetin or acetanilide. When used 
for any long period the daily action of the bowels should be obtained, an alkaline 
water should be freely administered, and the drug be intermitted every week 
for one or two days. 

Ethyl Carbamate (Urethane) is a mild hypnotic for adults, but a safe and 
efficient one for children. It stimulates the respiration, and in medicinal doses 
does not affect the circulation; but in very large quantity it slows the heart, 
depresses the body temperature, and induces muscular relaxation and some 
degree of general anesthesia. 

Tetronal is theoretically more hypnotic than trional, but has not proved so efficient in 
practice and often causes vomiting. It is rarely used in this country. 

Veronal is a very efficient hypnotic in dose of 8 to 10 grains, given in some hot liquid 
when ;i rapid action is required. It induces a practically normal sleep, does not affect the 
heart, circulation or kidneys, and is free from after-effects. It is particularly efficient when 
mixed with Sulphonethylmethane (Trional) in the proportion of two parts of the former to one 
of the latter, (gr. viij with gr. iv, or gr. x with gr. v). It sometimes causes some motor inco- 
ordination, especially of the lower extremities, also an erythematous eruption and neuralgia, 
and is said to diminish the solid and urinary excretions. 



SULPHUR, and SULPHIDES.— The non-metallic element Sulphur, S, 
is a brittle solid of a pale yellow color, permanent in the air, of crystalline texture 
and susceptible of several allotropic states, which are for the most part induced 
by heat. It is obtained native in several volcanic districts, or from the native 
Sulphides of Iron and Copper (iron and copper pyrites) by roasting, as it sub- 
limes at about 238 F. It is official in three forms, viz. — 

Sulphur Sublimatum, Sublimed Sulphur, S, — is prepared from crude 
Sulphur by sublimation and condensation. It is a fine citron-yellow powder, 
of faintly acid taste and acid reaction, insoluble in water or alcohol. Ignited 
it burns with a blue flame, forming sulphurous acid gas, and leaving no residue 
or only a trace. Dose, gr. x-5ij [av. 5j]- 

Sulphur Lotum, Washed Sulphur, S, — prepared by digesting sublimed 
sulphur with dilute water of ammonia, thoroughly washing with water and 
passing through a sieve. In this process the ammonia dissolves out any sulphide 



( 



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474 SULPHUR. 

of arsenic which may be present and neutralizes any sulphurous or sulphuric 
acid. For its solubility and dose see Sulphur Pr^cipitatum below. 

Sulphur Praecipitatum, Precipitated Sulphur, {Lac Sulphuris, Milk of 
Sulphur), S, — is prepared by boiling sublimed Sulphur with slaked lime and 
water, forming the sulphide and hyposulphite of calcium, which are then de- 
composed by HC1, and Sulphur is precipitated as a very fine powder which 
is next washed until the washings are tasteless, and dried with a gentle heat. 
The result is a very fine, yellowish-white, amorphous powder, odorless and 
almost tasteless, insoluble in water or alcohol, but completely soluble in carbon 
disulphide or in a boiling solution of soda. By heat it is completely volatilized. 
Dose, gr. x-3ij [av. 5j]. 

Preparations of Sulphur. 

TJnguentum Sulphuris, Sulphur Ointment, — has of Washed Sulphur 15, Benzoinated 
Lard 85, rubbed together until thoroughly mixed. 

Purvis Glycyrrhizae Compositus, Compound Licorice Powder (see under Giacyr- 
RHIZa), — contains 8 per cent, of Washed Sulphur. Dose, 3ss-jss [av. oj]- 

Sulphurous Acid and the Sulphites are described under Acidum Sulphurosum ; the 
Sulphates under the titles of their respective bases. For Sulphuric Acid see Acidum Sul- 

PHURICUM. 

Sulphides. 

Calx Sulphurata, Sulphurated Lime, {Crude Calcium Sulphide), — is a mixture of CaS, 
CaSO,, and Carbon, in varying proportions, containing at least 60 per cent, of the first. A 
pale, gray powder, of offensive taste and smell, and alkaline reaction, insoluble in alcohol, very 
slightly soluble in water. Dose, gr. 1 2 5 - ij [av. gr. j]. 

Calcii Sulphidum, Calcium Sulphide, CaS (Unofficial), — a constituent of the preceding, 
is named Hepar Sulphuris, Liver oj Sulphur, by the homeopathists, who prepare it by mixing 
equal parts of powdered oyster-shell and sublimed sulphur, and heating at a white heat in a 
crucible hermetically sealed. Dose, gr. T \p- !• 

Sulphuris Iodidum, Sulphur Iodide, {Iodine Disulphide), — is prepared by fusing to- 
gether Washed Sulphur 1 part and Iodine 4. It is a grayish-black crystalline solid, having 
the odor of iodine, an acrid taste and a faintly acid reaction, insoluble in water, but very sol- 
uble in disulphide of carbon and in about 60 of glycerin. Alcohol and ether dissolve out the 
iodine, leaving the sulphur. Used only as ointment, gr. xxx to the o- 

Hydrogenii Sulphidum, Hydrogen Sulphide, Sulphuretted Hydrogen, H 2 S, — is used 
only for test purposes; a saturated, aqueous solution being one of the official reagents. It is 
a colorless gas, having the odor of rotten eggs, prepared by the action of dilute sulphuric acid 
on iron sulphide. It precipitates most of the metals from acid solutions as sulphides; that with 
Arsenic being yellow; with Antimony, orange; with Cadmium, yellow; with Copper, Lead, 
Mercury and Silver, black; with Bismuth, brown; with Gold and Platinum, brownish-black. 

Carbon Disulphide is described under Carboneum. 

Unofficial Allied Compounds. 

Ichthyolum, Ichthyol, Ammonium Sulpho-ichthyolate, C 28 H 3B S 3 6 (NH 4 ) 2 , — is prepared 
from the product of the distillation of bituminous rocks from the Tyrol which contain fossil 
fishes. It occurs as a viscous, reddish-brown mass, of tarry odor and appearance and feebly 
alkaline reaction; soluble in water and in a mixture of alcohol and ether; mixes in all propor- 
tions with glycerin, fats and oils. It contains a large proportion of Sulphur, about 10 per 
cent. Dose, gr. j-x, up to 5jss daily, in pills or capsules, or dissolved in peppermint water. 
Sulpho-ichthyolates of Lithium, Sodium, and Zinc are on the market. 

Ichthalbin, Ichthyol Albuminate, — occurs as a greenish-brown powder, odorless and 
almost tasteless, insoluble in water but soluble in alkaline solutions. It contains 75 per cent, 
of Ichthyol, and is used in syphilis, also in scrofula with a lowered condition of nutrition. 
Dose, gr. xv-xxx, thrice daily. 

Ichthargan, — is the trade name of a compound of Ichthyol and Silver, described under 
the title Argentum. 



sulphur. 475 

Ichthoform, — is a chemical compound of Ichthyol and Formaldehyde, and occurs as a 
dark-brown, practically odorless powder, insoluble in the usual solvents. Dose, gr. x-xxx 

thrice daily. 

Sulphaminol, Thioxy-diphenyl-amine, obtained by the action of sulphur on salts of 
metaoxy-diphenyl-amine, is an inodorous, yellowish powder, insoluble in water, but soluble in 
alkaline solutions, alcohol, and glacial acetic acid. It readily breaks up, yielding sulphur 
and phenol. Dose, gr. ij-v. 

Thigenol, — is the trade name of a solution of sodium sulphite in a synthetic sulphuretted 
oil containing ro per cent, of sulphur in organic combination. It occurs as a dark-brown, 
syrupy Quid, soluble in distilled water, alcohol, or glycerin. It is odorless and almost taste- 
less, and is used locally in eczema, seborrhea, acne rosacea, and other skin diseases. Dose, 
gr. iij-x. 

Thiolum, Thiol, — is prepared by the sulphuration of certain non-saturated hydro- 
carbons, and is a product very similar to Ichthyol. It occurs in both dry and liquid form, the 
former, Thiolum siccum, as dark-brown lamella; or powder, of bituminous odor and bitter, 
astringent taste; soluble in water and in chloroform, sparingly in alcohol, insoluble in ether 
and in benzin. The liquid form, Thiolum liquidum, is a dark-colored, syrupy fluid, miscible 
in all proportions with water. Dose, internally, gr. v-xxx. 

Tumenolum, Tumeiwl, — is obtained by treating the unsaturated hydrocarbons of mineral 
oils with concentrated sulphuric acid. It occurs in several forms, solid and fluid, that 
known as Commercial Tumenol being considered the most generally useful. It is a dark- 
brown fluid, which can be employed in ointment and in tincture, externally. 

Incompatibles. 

Incompatible with Sulphur are Potassium Chlorate, Potassium Permanganate, Calcium 
Chloride, and all oxidizers. With the Sulphides in solution are Mineral Acids, Metallic Salts. 
With Ichthyol are Acids, Alkaloids, Alkaline Carbonates and Hydrates, Iodine, Resorcinol. 



Physiological Action. 

Sulphur used externally is a mild vascular stimulant, causing slight dilatation 
of the vessels, and in some persons producing eczema. Applied to raw surfaces 
it is converted into sulphurous and sulphuric acids, and is powerfully irritant. 
It is parasiticide, especially to the itch-mite. Taken into the stomach it has 
no effect on that viscus, and most of it passes out in the feces unaltered; but 
a portion is converted in the intestinal canal by the alkaline bile into hydrogen 
sulphide and other sulphides, which are mildly laxative and diaphoretic. The 
former is excreted by the lungs, giving to the breath the smell of rotten eggs, 
also by the skin, discoloring silver articles carried about the person by forming 
a sulphide of silver. The Sulphides are partly absorbed into the blood and 
are excreted in the urine, chiefly as sulphates, and in the feces, which they 
blacken and render soft. Given in full doses they are irritant to the stomach 
and intestines, extremely nauseous to the taste and smell, increase the secretions 
of the intestinal glands, promote peristaltic action, and if used for any length 
of time they impair the blood, causing anemia, emaciation, tremor and great 
debility. 

Hydrogen Sulphide is very destructive to plant life. In animals it destroys 
the tissue functions, decomposing the blood and paralyzing the nervous and 
muscular systems. The symptoms of poisoning are those of asphyxia; mus- 
cular tremors occur and are followed by convulsions and death. This gas is 
often found in cesspools in large quantities, but in one case poisoning occurred 



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476 SULPHUR. 

from its excessive formation in the intestines and subsequent absorption into 
the blood. 

Calx Sulphurata and Potassa Sulphurata are parasiticides and act like the 
sulphides as local irritants and in large doses as irritant poisons, producing 
narcotic symptoms and convulsions. In small doses they act like sulphur, 
and are supposed by many observers to have a special influence on suppuration, 
limiting or preventing it if given in small doses frequently repeated. 

The Iodide is believed to possess some of the properties of both its elements. 
It is doubtful whether it is a distinct chemical compound or merely a physical 
mixture. As a parasiticide it is very efficient, and has been found remarkably 
alterative in many local affections of chronic character, but may prove very 
irritant to the skin if improperly prepared. 

The actions of Sulphuric Acid, of Sulphurous Acid and of the Sulphites are respectively 
described under the titles Acidum Stjlphuricum and Acidum Sulphurosum; those of the 
Sulphates under the titles of their respective bases. 

Therapeutics. 

Sulphur is chiefly used as a laxative when pultaceous rather than liquid 
stools are required, as in hemorrhoids and anal fissure, also in constipation. 
Scabies has long been treated by its local and internal use, but sulphur alone 
does not kill the itch insect. The older sulphur ointments were made with 
sublimed sulphur, and probably contained a considerable amount of sulphurous 
acid, on which their parasiticide property depended. The later ointments, made 
with purified sulphur, all contain an alkaline ingredient and develop sulphides, 
which are powerful insect poisons. Sulphur fumigations are practically appli- 
cations of volatile sulphurous acid, while most of the sulphur baths and sul- 
phurous mineral waters are solutions of sulphuretted hydrogen or of the alkaline 
sulphides. They are of value in lead poisoning to favor the elimination of that 
metal, in chronic constipation, chronic rheumatism and sciatica and many skin 
diseases, especially chronic psoriasis, eczema, pityriasis and prurigo. The Oint- 
ment and the alkaline ointment are both used in scabies. 

The Iodide has been used internally in scrofula, glanders and cutaneous 
disorders, but it is chiefly employed as an ointment in lupus and parasitic skin 
diseases, especially herpes circinatus. Calx Sulphurata is an efficient depilatory, 
and is used as a paste to remove hair from fields of operation where the razor 
cannot be employed. It is painless, non-irritant, leaves no trace behind, and 
does not prevent the subsequent growth of the hair. Internally, in doses of 
gr. yq- frequently repeated, it has been considered an efficient remedy to prevent 
or limit suppuration, and is used in crops of boils, scrofulous sores, carbuncles, 
and tuberculous glands. 

Ichthyol was introduced twenty years ago, by Dr. Unna, the celebrated 
dermatologist, as an efficient remedy in certain chronic skin diseases, particu- 
larly eczema and psoriasis. It causes slight irritation and a burning sensation 
if applied undiluted to the skin, but in a 50 per cent, ointment it is not irritant, 



si i nu r. 477 

oven if covered with oiled silk. As a local application its value is due to its 
large proportion of sulphur, which is in a similar condition to that in organic 
sulphides and mercaptans, and in any pharmaceutical combination would excite 
a dermatitis. Its application in medicine depends chiefly upon its reducing 
property, its antiseptic power and its contractile action upon the vascular system. 
Most of the affections for which it has been recommended are caused by anoma- 
lous circulation, especially capillary dilatation. Used internally, it retards 
the disintegration of albumins and favors their formation and accumulation, 
checking waste and promoting assimilation without irritating the gastro-intestinal 
mucous membrane or interfering with digestion. It has little apparent toxic 
action on the general system, though instances of poisoning are reported as 
caused by its free use in eczema infantile, and in the curetted uterus. It is an 
intestinal antiseptic, is analgesic and antiphlogistic, and has remarkable power 
over exudations, promoting their absorption and alleviating the pain due to 
them, when given internally and applied externally at the same time. For these 
purposes it has been highly praised in gynecology and even in pleurisy. For 
chronic rheumatism a 50 per cent, ointment is used locally and the remedy is 
also given internally. It has done excellent service in erysipelas and in ulcers 
of the leg, locally applied in ointment form with Lanolin or pure; and internally 
in various affections of the digestive and intestinal tract, also in phthisis, syphilis 
and leprosy. In gynecology it is combined with glycerin (1 in 10); it is used 
with turpentine as a liniment for rheumatism, or with an equal weight of a 
mixture of lanolin and olive oil and 30 per cent, of chloroform; and against 
erysipelas as a 10 to 20 per cent, collodion, with or without castor oil. Applied 
as a thick ointment it is very serviceable in many skin diseases, especially furun- 
culosis, impetigo contagiosa, folliculitis of the scalp, impetiginous eczema, acne, 
herpes genitalis and sycosis barbae. In variola, a 20 per cent, ointment is suc- 
cessfully used, giving prompt relief to the local symptoms, shortening the course 
of the disease, and preventing pitting; and in other eruptive fevers it alleviates 
itching and controls the dermatitis. It is an efficient application in chronic joint 
affections, acute sprains, acute articular rheumatism, fissures of the nipples and 
anus, and in almost every form of subacute and chronic gout, in lymphatic 
enlargements, and in all diseases depending on hyperemia and capillary dilata- 
tion. For internal administration it should be prescribed in neutral aqueous 
solutions or in capsules, as it is decomposed in acid or alkaline solutions. 

Ichthoform is a harmless intestinal antiseptic and has been used internally 
with much satisfaction in acute gastro-enteritis, chronic gastric catarrh, dysen- 
tery, the diarrhea of tuberculosis and typhoid fever, chronic intestinal catarrh, 
and intestinal fermentation. Locally it is applied with benefit in endometritis, 
ozena, wounds, ulcers, and other lesions for which iodoform is considered ap- 
plicable. 

Thigenol has been employed with excellent results in various types of eczema, 
in seborrhea, and in acne rosacea. Sulphaminol by insufflation has given satis- 



i 



i 



I 



478 SUMBUL — TABACUM. 

faction in tuberculous laryngitis and diseases of the antrum and frontal sinuses, 
also in doses of gr. iv internally in cystitis. 

Thiol causes neither pain, burning, nor other symptoms of irritation, nor 
any bleeding from eroded surfaces. The dry form is used as a dusting powder 
in erysipelas, eczema, erythema, intertrigo, impetigo, pemphigus, periphlebitis, 
subcutaneous hemorrhages, and syphilitic ulcers. It is an efficient application 
in pelvic exudations and endometritis. 

Tumenol is said to owe its therapeutic value to its reducing power rather 
than to the sulphur in its composition. It is of no service in erysipelas, and 
is not a parasiticide; but has rendered good service in moist eczema, erosions, 
excoriations, and superficial ulceration. The tincture is an efficient application 
in all forms of pruritus. 



SUMBUL, — is the dried rhizome and root of an undetermined plant, probably of the nat. 
ord. Umbellifera?, growing in northern Asia. It contains Angelic and Valerianic Acids, 
also a volatile oil, balsamic resins, and a bitter principle. Dose, gr. x- oj [av. gr. xxx]. 

Fluidextractum Sumbul, Fluidextract of Sumbul, — Dose, njx- oj [av. itjjxxx]. 

Extractum Sumbul, Extract of Sumbul, — Dose, gr. j-x [av. gr. iv]. 

Sumbul is an efficient nerve tonic, having qualities closely resembling musk and valerian. 
It is used by the Russian physicians in very many morbid conditions and seems to be a favorite 
remedy in that country for almost any disease. It is probably of some value in hysteria and 
other nervous derangements of delicate females, and may be used as a substitute for musk in 
typhoid conditions and fevers, asthma, delirium tremens and perhaps in epilepsy. 



TABACUM, Tobacco (Unofficial) — is the commercial dried leaf of Nicotiana 
Tabacum, an annual plant of the nat. ord. Solanaceae, native of tropical America, 
but cultivated in several parts of the world, especially in Cuba and Virginia. 
The leaves contain a very poisonous, oily fluid alkaloid named Nicotine, C 10 H 14 Nj, 
which consists of Pyridine, C 5 H 5 N, and a hydrated pyrrhol ring, occurs in the 
plant as a malate, and varies in quantity from -i to 10 per cent, in different 
specimens. Tobacco contains also a volatilizable, camphoraceous principle 
named Nicotianin, the existence of which is denied by some analysts, besides 
potassium and calcium salts (nitrates and phosphates), silica, gum, resin, and 
other substances. 

The proportion of Nicotine in tobacco is stated at 6 in 10,000 parts (0.06 per cent.) by 
Posselt and Reimann, but other analysts have found 2 per cent, in Havana tobacco and more 
than 8 per cent, in French tobacco. Turkish tobacco is said to contain little or none. The 
effect of curing undoubtedly produces chemical changes but chemists differ as to whether the 
proportion of nicotine is greater or less after that process. 

According to Zeise (1843) an< ^ Vohl and Eulenberg (1872), tobacco-smoke contains no 
nicotine, but does contain a series of empyreumatic products, the result probably of its decom- 
position, viz. — pyridine, collidine, picoline, parvoline, etc. Of these, Pyridine C 5 H 6 N, pre- 
dominates when tobacco is smoked in a pipe, but Collidine C 8 H U N, which is far less active, 
predominates when there is free access of air as in smoking cigars. Tobacco-smoke also 
contains Carbon Dioxide, C0 2 , of which Krause determines the average proportion to be 0.3 
per cent., and to which he credits much of the injurious effects of smoking in young subjects. 
It also contains creosote, hydrogen cyanide and sulphide gases, also several acids, including 
acetic and valerianic. 



i \r. \> i \i. 

Unofficial Preparations and D 

Enema Tabaci, Enema of Tobacco (H. V. 1867), gr. w of the leal infused in Jviij of 
boiling water foi an hour, strained, and the whole administered as one enema. 

Oleum Tabaci, Oil of Tobacco, — is an empyreumatic producl and a most virulent poison, 
obtained by distillation at a temperature above that of boiling water. 

Vinum Tabaci, II 'ine of Tobacco, — 3 j to the pint. Dose, ni'v 5j. 

Nicotina, Nicotine, C 10 II U N,, — the alkaloid and active principle; a colorless, oily fluid, 
having the odor of tobacco and an acrid taste; readily soluble in water, and forming soluble 
salts with acids. Dose, its j'o— r'o> U P t0 UUi.i in two hours, in tetanus and in strychnine poi- 
soning. 

Nicotinae Bitartras, Nicotina Bitortrate, — occurs in line, white crystals, having ,1 ten- 
dency to aggregate, readily soluble in water. This salt is stable and keeps well, even in solu- 
tion. It is recommended as the most suitable form of administering nicotine in tetanus and 
strychnine poisoning. Dose, gr. jV" rVi U P to a maximum of gr. ij in 2 hours. 

Pyridina, Pyridine, C S H B N, — is a colorless, liquid, alkaloidal base, formed during the 
dry distillation of nitrogenated organic substances. It has a powerful odor, evaporates in the 
air, and mixes with water in all proportions. Dose, internally ttjv-xv; by inhalation 5j 
allowed to evaporate in an open dish in a small room, in which the patient is exposed for 20 
or 30 minutes thrice daily for the relief of asthma (See). 

Incompatibles. 

Incompatibles are as for Alkaloids (see page 6). Physiologically incompatible are 
Strychnine, Atropine, Digitalis, Ergot, Alcohol, Ammonia. 

Physiological Action. 

Tobacco is a very depressant nauseant, an emetic by irritant as well as by 
systemic action, and an antispasmodic; also sternutatory, diuretic, diaphoretic, 
cathartic, sedative and narcotic. It first stimulates and afterwards paralyzes 
the motor nerves and the secreting nerves of the glands, also the spinal cord 
and the vagus; at first stimulating both the vagus-roots and its ends in the 
heart, slowing the pulse-rate, but afterwards paralyzing the latter and causing 
high pulse-rate. It increases the salivary and intestinal secretions, and pro- 
duces diuresis, tremor, clonic spasms, and a tetanic stage followed by paresis. 
It contracts the pupils, slows and depresses the heart, lowers arterial tension 
at first and afterwards raises it, reduces the body-temperature and causes profuse 
sweating, cold and clammy skin, collapse and death usually by paralysis of 
respiration, sometimes by paralysis of the heart. It does not impair the mus- 
cular irritability, nor does it act upon the cerebrum directly. Its empyreumatic 
products act similarly but less powerfully. Fatal results have followed the 
inhalation of its vapor into the lungs. 

The continued use of Tobacco, by smoking or chewing it to excess, produces 
granular inflammation of the fauces and pharynx, atrophy of the retina, dys- 
pepsia, lowered sexual power, sudden faints, nervous depression, cardiac irri- 
tability and occasionally angina pectoris. Used by the young it hinders the 
development of the higher nerve centres and impairs the nutrition of the body 
by interfering with the processes of digestion and assimilation. It has been 
credited with causing cancer of the lips and tongue, blunting of the moral sense, 
mental aberration and even insanity. The so-called "tobacco heart" includes 
many forms of nervous, painful or oppressed cardiac action, depending on the 



480 TAMARINDUS. 

age of the subject, the quantity consumed and other circumstances. In mild 
cases an occasional palpitation or flutter is complained of; in more severe ones 
there are considerable cardiac irregularity and rapidity, and more or less distress 
experienced; in some there are actual cardiac pain, decided irregularity and 
occasional intermittence of action, and the symptoms may simulate those of 
a case of angina pectoris. There are no physical signs as a rule, so that the 
diagnosis is made by exclusion. The pathology is unknown, but probably 
involves some lesion of the vagus. In the young, excessive indulgence in to- 
bacco may lead to cardiac hypertrophy, dilatation and even valvular lesions 
(Osier). A synergistic action has been observed by the author between opium 
and tobacco in many cases, in which persons accustomed to tobacco began to 
use opium or morphine, when the slightest use of tobacco made them very sick, 
as though they were novices in this respect. 

Nicotine, in even minute doses causes symptoms of intense gastric irritation 
with an extreme degree of collapse. It abolishes the function of the motor 
nerves and paralyzes respiration. Its general action is that of tobacco, but 
it is one of the most powerful and rapidly-acting poisons known, death having 
occurred within three minutes after its ingestion, the patient dropping instantly 
to the floor insensible, with no symptoms except a wild stare and a deep sigh. 
The jj of a grain has caused death in a human being, and ^ is Iata l to cats 
and dogs. 

Therapeutics. 

Tobacco is now but little used in medicine, the dangers attending its employ- 
ment either internally or externally having caused it to be superseded by less 
violently acting agents. The principal objects for which it is employed are to 
relax spasm of the intestines and to relieve local pain therein. Intestinal af- 
fections, like impaction of the cecum, intussusception and strangulated hernia, 
may be overcome by a tobacco-enema to relax spasm, but it is a dangerous 
expedient. In dropsy, especially the renal form, it makes a very efficient diuretic. 
In tetanus there is no more effective remedy than minim doses of the alkaloid 
every two hours by the stomach, or n\_ij by the rectum, or better still the wine in 
10 minim doses repeated for effect. Strychnine-poisoning may be treated by 
minute doses of Nicotine, gr. -£% hypodermically, as a physiological antagonist. 
It may be employed with advantage in habitual constipation, for the dyspnea 
of spasmodic asthma and emphysema, also in nymphomania and chordee. In 
all forms of asthma the inhalation of the fumes of Pyridine is beneficial, as it 
has a powerfully sedative action on the respiratory centre. The use of Tobacco 
in moderation, when under excessive exertion, aids in supporting the system 
and lessening the sense of fatigue. Smokers rarely suffer from constipation, 
but generally experience an immediate laxative result from their morning cigar. 

TAMARINDUS, Tamarind, — is the preserved pulp of the fruit of Tamarindus indica, 
a large tree of the nat. ord. Leguminosa?, native in the East and West Indies. It contains, 
citric, tartaric and malic acids, sugar, gum, potassium bitartrate. Dose, 5j _ oj[av. 3ivj. 



TANACETUM — TKK IU1 \ I 1 1 1 \ \. |M 

Confectio Sennas, Confection of Senna, contains Tamarind bo the amount of 10 per 

rent. Dose, ,~ Hj lav. oj]. (See under Senna.) 

Tamarind is a laxative and refrigerant fruit. In infusion it may I"- used by convales- 
cents as a pleasant acidulous drink, or the pulp may In- boiled with milk as a whey for the 
same purpose. As a laxative it is usually prescribed in connei non with other agents having 
the same aetion. 

TANACETUM, Tansy (Unofficial), — the leaves and tops of Tanacetum vulgare,a. per- 
ennial, herbaceous plant of the nat. ord. Composite, indigenous in Europe but cultivated in 
gardens and growing wild in old fields. It contains a volatile oil, a bitter principle Tanacelin, 
a tannic acid, etc. A Buidextract may be prepared according to the general rule and admin- 
istered in doses of injx— 3 j - The dose of the volatile oil (Oleum Tanaccti) is i to 3 drops. An 
infusion (Tansy Tea) may be made in the proportion of oj to the pint, and used in doses of 
Sj-ij- 

Tansy is emmenagogue, diuretic and anthelmintic, an aromatic bitter and an irritant nar- 
cotic poison. Fatal results have followed upon overdoses of the oil ( oss-j) or strong decoc- 
tions, preceded by clonic spasms, disturbed respiration and cessation of the heart's action. 
It is a useful remedy in amenorrhea, but is in popular repute as an abortifacient, a virtue 
which it does not possess except in quantity dangerous to life. 

TARAXACUM, (Dandelion), — is the dried root of Taraxacum officinale, a pant of the 
nat. ord. Composite. All parts of the plant contain a bitter, milky juice, exuding from any 
break or wound. Its constituents are a bitter amorphous principle named Taraxacin, a 
crystalline principle Taraxacerin, with potassium and calcium salts, Inulin, and resinoid 
bodies, etc. The French name for the plant is Pissenlit. Dose, 3j _ 5j [av. 3ij]- 

Extractum Taraxaci, Extract of Taraxacum. — Dose, gr. v-xxx [av. gr. xv]. 

Fluidextractum Taraxaci, Fluidextract of Taraxacum. — Dose, 5j- oj [av. oij ]• 

Taraxacum is a bitter tonic, a diuretic and an aperient. It has been supposed to act 
especially on the liver and is chiefly used in dyspepsia with hepatic torpor. As found in the 
shops it is usually inert. The extract is used as an excipient for pills. 

TEREBINTHINA, Turpentine. — A Turpentine means a vegetable exuda- 
tion, liquid or concrete, consisting of resin combined with a peculiar essential 
oil named Oil of Turpentine, C 10 H 16 , and generally procured from various species 
of the nat. ord. Pinaceae. Of the many turpentines two only are official, viz. — 

Terebinthina, Turpentine, — a concrete oleoresin from Pinus palustris the 
Yellow Pine, and other species of Pinus, nat. ord. Pinaceae. It occurs in tough, 
yellowish masses, brittle when cold, crummy-crystalline interiorly, of terebin- 
thinate odor and taste. Dose, gr. v-xxx as a stimulant, antispasmodic or diu- 
retic; oij-iv as an anthelmintic. 

Terebinthina Canadensis, Canada Turpentine, (Balsam of Fir), — a liquid 
oleoresin obtained from Abies balsamea, the Silver Fir or Balm of Gilead, 
nat. ord. Coniferae. A yellowish, transparent, viscid liquid, of agreeable, tere- 
binthinate odor and a bitterish and slightly acrid taste, slowly drying on expo- 
sure, forming a transparent mass; completely soluble in ether, chloroform or 
benzol. Dose, gr. x-xxx. 

Pitch and its preparations are described under the title Pix. 



I 



( 



Unofficial Turpentines. 
Chian Turpentine, — from the Pistacea Terebinthus, a small larch tree 
growing in the islands of Chio and Cyprus; a thick, tenacious, greenish-yellow 
32 



482 TEREBINTHINA. 

liquid, concreting on exposure to the air into a translucent solid. Dose, gr. 
iij-v in emulsion. 

Venice Turpentine, — procured in Switzerland from Larix Europcea the 
European Larch; a viscid liquid of the consistence of honey, does not concrete 
on exposure, and is entirely soluble in alcohol. The Venice Turpentine of com- 
merce is usually prepared by dissolving resin in oil of turpentine. 

Thus Americanum, Common Frankincense (B. P.), — the concrete turpen- 
tine scraped off the trunks of Pinus australis and Pinus Tceda. An ingredient 
of the Emplastrum Picis of the Br. Phar. 

Official Preparations oj Turpentine. 

Oleum Terebinthinae, Oil oj Turpentine, C I0 H„, commonly called Spirit or Spirits of 
Turpentine, — is a. volatile oil distilled from Turpentine. A thin, colorless liquid, of character- 
istic odor and taste; soluble in 3 times its volume of alcohol, mixes with other volatile and fixed 
oils, and dissolves resins, wax, sulphur, phosphorus and iodine. Bromine and powdered 
Iodine act violently on it, and when brought into contact with a mixture of Nitric and Sul- 
phuric Acids it takes fire. It is isomeric with a number of volatile oils, and constantly absorbs 
oxygen from the air when exposed, becoming thicker and less active from formation of resin. 
It is a mixture of several hydrocarbons iter penes), each having the same formula as itself. 

Oleum Terebinthinae Rectificatum, Rectified Oil of Turpentine, — prepared by shaking 
Oil of Turpentine with an equal volume of solution of Sodium Hydroxide, distilling three- 
fourths, and separating. This preparation should always be dispensed when Oil of Turpen- 
tine is required for internal use. Dose, as a stimulant or diuretic, irgv-xxv [av. njjxv], in emul- 
sion 3 to 6 times daily; — as a cathartic or anthelmintic §ss or more, combined with other 
cathartics. A little glycerin and oil of gaultheria will disguise the taste. 

Emulsum Olei Terebinthinae, Emulsion 0} Oil of Turpentine, — has of the rectified Oil 
15, Expressed Oil of Almond 5, Syrup 25, Acacia 15, Water to 100. Dose, 5ss-ij [av. oj]- 

Linimentum Terebinthinae, Turpentine Liniment, — has 35 parts of the Oil of Turpen- 
tine with 65 of Resin Cerate. 

Linimentum Terebinthinas Aceticum, Liniment oj Turpentine and Acetic Acid (B. P.), 
— has of the Oil of Turpentine 4, Glacial Acetic Acid 1, Liniment of Camphor 4. An imita- 
tion of St. John Long's celebrated liniment. 

Official Derivatives. 

Resina, Rosin, — is the residue left after distilling off the volatile oil from Turpentine. It 
is a transparent, amber-colored substance, hard and brittle, with a glossy arid shallow con- 
choidal fracture and a faintly terebinthinate odor and taste; soluble in alcohol, ether, fixed 
or volatile oils, and in its own weight of oil of turpentine. Chemically it is considered the 
anhydride of Abietic Acid, C M H e4 5 , into which acid it is converted by agitation with warm 
diluted alcohol. Silvic, Pinic, and Palmaric Acids are decomposition products, not con- 
stituents of rosin as was formerly taught. Dose, gr. j-vj [av. gr. iv]. 

For the definition of a Resin see page 9, also the title Resin^e in Part II. Other official 
resins are, Resina Jalapae, Resina Podophylli and Resina Scammonii, which are severally de- 
scribed under the titles of the plants forming their respective sources. 

Ceratum Resinae, Rosin Cerate, — has of Rosin 35, Yellow Wax 15, Lard 50. It forms 
65 per cent, of Turpentine Liniment. 

Ceratum Resinae Compositum, Compound Rosin Cerate, — has of Rosin 22 i, Yellow 
Wax 22^, Suet 30, Turpentine nj, Linseed Oil 13J per cent. 

Terebenum, Terebene, — is a liquid consisting of dipentene and other hydrocarbons, 
obtained by the action of concentrated sulphuric acid on oil of turpentine, and subsequent 
rectification with steam. It is soluble in 3 of alcohol, slightly soluble in water. Dose, njv-xv 
[av. Ttjviij], on sugar, or suspended in water oss, by the aid of light magnesium carbonate 
gr. xx. 

Terpini Hydras, Terpin Hydrate, C 10 H 18 (OH) 2 .H,O, — is the hydrate of the diatomic 
alcohol Terpin (Terebinthene), obtained by distilling oil of Turpentine with an alkali. Col- 
orless, lustrous, rhombic prisms, nearly odorless, of slightly aromatic and somewhat bitter 



TEREBINTHINA. 483 

taste; soluble in 10 of alcohol and in about 250 of water .11 |9° 1 . in 3 • of boiling water and 
in 2 of boiling alcohol. Dose, gr. j-v [av. gr. ij ]. 

Unofficial Derivativ* 

Terpinol, —an oily body obtained from the preceding by the action of an acid thereon. 
Dose, gr. ij— v. 

Sanitas Disinfecting Fluid, — is an aqueous solution of turpentine which has been oxi- 
dized by exposure to the air. It contains Hydrogen Dioxide, Thymol, Camphor and Cam- 
phoric Acid, the latter in such small proportion, however, that its action cannot be expected. 
This proprietary preparation has many advantages. It is a good oxidizing agent and anti- 
septic, is not poisonous and does not stain the linen; qualities which recommend it as a disin- 
fectant and for use in surgical operations. 

Retinol, Resinol, Codol, — is obtained as a product of the destructive distillation of resin, 
and occurs as a yellowish, fluorescent, oily liquid. It is used as a solvent for aristol, iodol, 

phor, creosote, phenol, phosphorus, cocaine, codeine, and other alkaloids. The term 
Resinol is used as a trade name for a secret proprietary preparation, which is advertised as a 
remedy for all varieties of skin disease. Heidingsfeld states that it is irritant, causes derma- 
titis, and has dangerous narcotic properties. 

Official Analogues oj Turpentine. 

These include Juniperus Juniper, Sabina Savin, and Pix Liquida Tar, which arc 
described under their respective titles. 

Unofficial Analogues of Turpentine. 

Oleum Succini, Oil of Amber, — a volatile oil obtained from the destructive distillation of 
Amber (Succinum\ a fossil resin thought to be the exudation of Pinites succinifer, an extinct 
coniferous tree. Dose, gtt. v-x. See under Succinum. 

Oleum Thujae, Oil of Thuja, — a volatile oil which is given in doses of njjj-v. A satu- 
rated tincture may be used in drachm doses. Obtained from Thuja occidentalis, the Arbor 
Vitse, a coniferous tree. See under Thuja. 

Oleum Pini Sylvestris, Oil of Scotch Fir (B. P.), — a colorless liquid, obtained by dis- 
tilling the fresh leaves of Pinus sylvestris, used externally and by inhalation (see page 395). 

Incompatibles. 

Incompatible with Oil of Turpentine are: Bromine, Chlorine, Iodine, Water. With 
Rosin are: Caustic Alkalies, Menthol, Phenol, Salol, Thymol, Urethane. With Terebene are: 
Chlorine, Bromine, Iodine, Water. 

Physiological Action. 

Turpentines are stimulant, diuretic, anthelmintic, and hemostatic; in large 
doses laxative and irritant, and externally used are rubefacient and antiseptic. 
Their virtues depend entirely on the volatile oil. 

Oil of Turpentine in small doses causes a sense of heat at the epigastrium, 
burning in the mouth and salivation by reflex action. In moderate doses it at 
first stimulates the vaso-motor nervous system, afterwards paralyzing it, and 
thus causing a rise and then a fall of the arterial tension. It lowers the functions 
of the brain, spinal cord and medulla in the order stated, causing diminution 
of voluntary movement and reflex action, dilatation of the vessels, lowered 
blood-pressure and slowed respiration, the latter often becoming spasmodic. 
The pulse is sometimes slowed, sometimes quickened. Large doses produce 
gastro-enteritis, with vomiting and diarrhea, suppression of urine, pain in the 
lumbar regions, burning in the urethra, hematuria and strangury. The mus- 
cular power is diminished, coordination impaired and a state of intoxication 






( 



484 TEREBINTHIXA. 

induced. In toxic dose it acts as a narcotic poison and causes complete mus- 
cular relaxation, profound insensibility with abolished reflexes, dilated pupils, 
cyanosed face, labored and stertorous breathing and death by paralysis of respira- 
tion. It is excreted by the various organs of excretion, all of which are highly 
irritated, the kidneys suffering particularly. Its vapor inhaled produces nasal 
and renal irritation, frontal headache, also frequently strangury and hematuria. 
Locally to the skin it is rubefacient and even vesicant if applied for any length 
of time or if evaporation be prevented. 

The Oil, when exposed to the air, readily absorbs oxygen in the form of 
ozone, which it retains tenaciously. This ozonized oil of turpentine is an anti- 
dote to phosphorus, preventing the formation of phosphoric acid and converting 
the phosphorus into an insoluble substance resembling spermaceti. Worn 
about the neck in an open vial it is believed to prevent necrosis of the jaw and 
steatosis of the organs in workmen exposed to phosphorus-fumes. It is sup- 
posed to dissolve gall-stones. 

Therapeutics. 

Oil of Turpentine is employed externally as a rubefacient and counter- 
irritant in many conditions producing pain and inflammation. Cloths wrung 
out of hot water and then sprinkled with the oil (turpentine stupes) are useful 
applications in sciatica and other neuralgias, lumbago, chronic rheumatism, 
chronic bronchitis, peritonitis with tympanites, pleurisy, and renal colic. It 
is one of the most efficient agents in hospital gangrene, applied in full strength 
to the part affected. The liniment is in constant use for sprains, neuralgia 
and other slight local affections. 

Internally it is best employed in ulceration and hemorrhage of the intestines 
and in passive hemorrhages from other organs. Active bleeding with a plethoric 
condition and hematuria are states in which it is contraindicated. It is often 
used with ether (1 to 3) in biliary and flatulent colic as an anodyne and anti- 
spasmodic. As a vermifuge against tape-worm it must be employed in large 
doses (gss-ij) with castor oil to promote its rapid passage through the intestinal 
canal. It is well employed as a stimulant to the heart and vaso-motor system 
in puerperal fever, yellow fever, traumatic erysipelas, pneumonia, and capillary 
bronchitis. It is useful in chronic bronchial catarrh, chronic cystitis, subacute 
gonorrhea, and similar affections of the mucous surfaces generally. Inhalations 
of the vapor or atomized oil are beneficial in chronic affections of the larynx 
and bronchi. The pure vapor is a good irritant inhalation to provoke coughing 
and thereby cause the expulsion of morbid products in cases of bronchitis and 
pneumonia when expectoration is arrested by exhaustion and remedies by the 
mouth have no effect. It is too irritant for ordinary inhalation but may be 
diluted with steam from an atomizer. Chian Turpentine is one of the remedies 
which have been used for cancer. 

Terebene has been extensively used by Murrell, with excellent results, as 
a remedy for obstinate winter-cough and emphysema of the lungs, in flatulence 



rHEOBROMATIS OLEUM — THUJA. 485 

and flatulent dyspepsia, in cystitis and gleet, and as a spray in phthisis and 
post-nasal catarrh, also with cocaine in solution as a spray for corv/.a and hav- 
fever, Other observers, of several years' experience with this remedy, praise 

it highly as an inhalant remedy in phthisis, bronchiectasis, chronic bronchitis 

and other pulmonary affections characterized by profuse, purulent expectoration. 
Rieu employs it in bronchitis and bronchorrhea, in doses internally of gr. xv-xxx 
per diem, but says that it does not affect the muco-purulent expectoration of 
phthisis. It probably has no superior efficacy to creosote or Venice turpentine, 
except that it is without much odor and has no taste. 

Terpin Hydrate is praised in chronic and recurrent bronchitis, night-cough 
from habit, catarrhs and kindred affections. In fact, all acute and many chronic 
affections of the respiratory passages form the proper field for the therapeutical 
action of this preparation. 

Rosin is used to give consistence and adhesiveness to plasters and cerates, 
and generally acts as a mild local stimulant, but the writer has seen persons 
with so susceptible a skin that the ordinary adhesive plaster would produce on 
them a high degree of cutaneous irritation. It is never employed internally, 
but in chronic bronchial catarrh the fumes from boiling rosin are inhaled with 
considerable advantage. Rosin Cerate is one of the most commonly used appli- 
cations to promote the healing of indolent ulcers, also to blistered surfaces, 
burns, scalds and chilblains. 



THEOBROMATIS OLEUM, Oil of Theobroma, {Cacao-butter),— is a fixed oil ex- 
pressed from the roasted seeds of Theobroma Cacao, the Chocolate-tree, nat. ord. Stercu- 
liaceE, growing in Mexico, the West Indies and South America. The oil is a yellowish- 
white solid, of faint odor, bland taste and neutral reaction. The seeds are oval, about the 
size of almonds, and consist of shells and kernels, in both of which is found the alkaloid 
Theobromine, C,H 8 N 4 2 , which closely resembles Caffeine, the latter being its methyl deriv- 
ative. Chocolate is prepared by roasting the seeds, removing the shells, then crushing or 
grinding the kernels to a smooth paste, which is cast in molds. 

Oil of Theobroma consists chiefly of Stearin with a little Olein. Its action is demulcent, 
and it does not become rancid on exposure to the air. Its chief use is as a basis for making 
suppositories. A Cerate is prepared by melting together Cacao-butter 35, White Wax 35, 
Oil of Almond 30, adding a drop of Oil of Rose and coloring with a minute quantity of Car- 
mine previously triturated with a drop of Water of Ammonia. This is known as Red Lip- 
salve. 

Theobromine has the same action and uses as Caffeine. See under Caffeina, page 186, 
for this principle and for Diuretin. 



THUJA, Arbor Vitae (Unofficial), — the fresh tops of Thuja occidentalis, 
a tree of the nat. ord. Coniferae, incorrectly called White Cedar, growing in 
swampy ground in Canada and in the northern United States. They contain 
a volatile oil, tannin, wax, resin, etc.; also Pinipicrin, a bitter principle, and 
Thujin, a yellow, astringent and crystallizable coloring principle, separable into 
glucose and Thujetin. 

The dose of a saturated, fresh tincture or fluidextract is oj> 3 to 6 times daily. The 
Volatile Oil may be given in doses of ttjj-v. 



486 thymi oleum. 

Physiological Action and Therapeutics. 

Thuja resembles Savin in action very closely. It is stimulant, irritant and 
astringent, also aromatic, diuretic and emmenagogue. The oil is a gastro- 
intestinal irritant and produces epileptiform convulsions in warm-blooded ani- 
mals but paralysis in cold-blooded ones. It causes rhythmical contraction and 
dilatation of the vessels, lowers the temperature and is anthelmintic. Thuja 
is indirectly an abortifacient when given in doses sufficient to cause violent 
gastro-enteritis. It is reported to have produced an acute urethritis resembling 
gonorrhea. 

Thuja in decoction has been usefully employed in coughs, rheumatic and 
arthritic pains, dropsy and amenorrhea. It has been given with benefit in 
intermittent fever and as an alterative blennorrhetic in chronic catarrh and 
bronchorrhea. It is highly praised by Phillips for the cure of warts with narrow 
base and pendulous body, a strong tincture being applied locally and given 
internally at the same time in 5-minim doses twice daily. Piffard speaks strongly 
in its favor as a valuable agent for non-syphilitic warts (condylomata acuminata) 
of the penis and vulva, for papillomatous growths in general and for gleet de- 
pendent on granular urethritis. It has been used in chronic gonorrhea and 
prostatitis with asserted success, and is said to have cured epithelioma. The 
oil has been employed as a vermifuge. 

THYMI OLEUM, Oil of Thyme,— is a volatile oil distilled from the 
leaves and flowering tops of Thymus vulgaris, the Garden Thyme, a common 
shrub of the nat. ord. Labiatae, indigenous to France but cultivated in our gar- 
dens. This oil is a pale yellow or colorless, thin liquid, having a strong odor 
of thyme, a warm, pungent and afterwards cooling taste and a neutral reaction; 
readily soluble in alcohol. It consists of two portions, the more volatile being 
a mixture of the hydrocarbons Cymene and Thymene, the less volatile being 
chiefly Thymol, which is official. Dose, "lj-v [av. ^iij]. 

Thymol, C 10 H 14 O, — is a phenol contained in Oil of Thyme and in the vola- 
tile oils of several other plants. It occurs in large, colorless, hexagonal crystals, 
of aromatic odor, pungent taste and neutral reaction; soluble in 1200 of water, 
in 900 of boiling water, in 1 of alcohol, freely in fats and oils, solutions of chloral 
and alkalies, ether or chloroform. It liquefies when triturated with an equal 
quantity of camphor, menthol, or chloral. Dose, gr. ss-iij [av. gr. ij]; for un- 
cinariasis, gr. xv-3j. 

Thymolis Iodidum, Thymol Iodide, (AristoP), — is official, and is described under 
Iodum, page 314. 

Unofficial Preparations. 

Thymol Solution, — for antiseptic spray, 1 part in 1000. 

Thymol Ointments, — vary in strength from 5 to 30 grains to the 5- 

Thymol Inhalation, — Thymol gr. xx, Alcohol oiij, Magnesium Carbonate gr. x 
Water to oiij- A teaspoonful to a pint of water at 150 F. for each inhalation. 



TIOI.II OLEUM. 4X7 

Volkmann's Antiseptic Fluid, — has of Thymol i, Alcohol 10, Glycerin 20 and Watei 
100 pans. 

Thymotal, Thymol Carbonate — is an efficient vermicide, and is particularly useful in 
ankylostomiasis. Dose, gr. ij-x. 

Incompatible*. 

Incompatible with Thymol are Acetamide, Acetanilide, Antipyrine, Bomeol, Butyl- 
chloral Hydrate, Camphor, Chloral Hydrate, Euphorin, Kxalgin, (loid sails, Menthol, Phe- 
nol, Pyrocatechin, Quinine Sulphate, Rosin, Salol, Spirit of Nitrous Ether, Urethane. 

Physiological Action and Therapeutics. 

Oil of Thyme has the same properties as the oils of other mints, and contain- 
ing a large quantity of Thymol it is similar to the latter in action. 

Thymol in its action stands between phenol and oil of turpentine. Like 
the former it is a powerful antiseptic and disinfectant, also a local irritant and 
anesthetic to the skin and mucous membranes, paralyzing the end-organs of 
the sensory nerves. When absorbed it paralyzes the nerve-centres in the spinal 
cord and in the medulla, lessening reflex action, slowing respiration, lowering 
the temperature and the arterial tension, and in poisonous doses causing weak- 
ness, coma and death. Internally administered in doses of 20 to 30 grains per 
diem it produces a sensation of epigastric heat, sweating, singing in the ears, 
deafness, a sense of constriction in the forehead and increase of the urinary 
discharge, which assumes a dark greenish hue. It is eliminated by the respira- 
tory and urinary organs, which it irritates considerably during the process of 
its excretion. As an antiseptic it is much more powerful and permanent than 
phenol, and much less poisonous, but its insolubility in water prevents its general 
use for this purpose. 

Thymol is chiefly employed as a gargle, spray or inhalation in laryngitis 
and diphtheria; as an ointment in ringworm, eczema and psoriasis, and as an 
injection in ozena. A solution of 1 part in 1000 is the strength usually pre- 
scribed. Internally it has been used with success in diphtheria, typhoid fever 
and other intestinal affections, diabetes, phthisis and vesical catarrh. Its fra- 
grant odor renders it a very agreeable antiseptic application for ulcerated con- 
ditions of the mouth and fauces, but makes it very attractive to flies, which 
fact together with its high price will prevent it becoming a favorite in hospital 
practice. A solution, used as a mouth-wash, is very efficient in removing the 
odor of tobacco from the breath. Thymol is almost specific against the intestinal 
parasite ankylostomum duodenale (uncinaria Americana) for which it is given 
in three or four doses of 10 to 30 grains, well triturated, in capsules; care being 
taken that no alcoholic drink is ingested afterwards, in order to avoid the ab- 
sorption of thymol and consequent poisoning thereby. 



TIGLII OLEUM, Croton Oil, — is a fixed oil expressed from the seeds 
of Croton Tiglium, a small tree of the nat. ord. Euphorbiaceas, a native of India. 
The oil is of a pale or brownish-yellow color, somewhat viscid and slightly 



488 TRAGACANTHA. 

fluorescent, of fatty odor, acrid taste and slightly acid reaction; soluble in 60 
of alcohol, freely in ether, chloroform, or carbon disulphide. Its composition 
is very complex and has not been thoroughly made out, but it is known to contain 
the glycerides of several fatty acids, also a peculiar acid named Tiglinic Acid, 
C 5 H 8 2 , which is isomeric with Angelic Acid. Dose, "lj-ij [av. ny], in pill, 
emulsion or tincture. 

Corson's Paint (Unofficial), — has of Croton Oil 3ij, Ether oiv, Compound Tincture 
of Iodine to make oij; and is used as a counterirritant by painting over the part once daily. 

Linimentum Crotonis, Liniment of Croton Oil (B. P.), — contains 1 part of the oil in 3$ 
each of Alcohol (90 per cent.) and Oil of Cajuput. It is a useful pustulant application, being 
more manageable than the oil itself. 



Physiological Action and Therapeutics. 

Externally Croton Oil is highly irritant, producing a pustular eruption 
which heals by scabbing and may leave unsightly cicatrices. Internally it is 
a powerful drastic cathartic, producing in one or two hours copious watery 
stools, in overdoses causing great congestion of the intestinal canal and perhaps 
death from gastro-enteritis. Vomiting usually occurs after large doses, so that 
the irritant hyper-catharsis is not always observed. It is absorbed into the 
blood, and produces glandular hyperemia as well as direct inflammation of the 
intestinal mucous membrane, together with increased peristaltic action. Its 
cathartic power is increased by the addition of an alkali, and is manifested, 
though in less degree, when applied to the integument. 

Croton Oil is used as a hydragogue cathartic when a speedy and complete 
evacuation of the bowels, diminution of arterial pressure and prompt derivative 
action are desired, as in apoplexy, impaction of the intestines, dropsy, lead 
constipation, and paralysis. It is contraindicated when either debility, organic 
obstruction or an inflammatory condition of the stomach and bowels exists. The 
smallness of the dose makes it a very easily administered and manageable purga- 
tive. An inconsiderable fraction of a drop, absorbed by a pellet of sugar or 
bread, may be given in repeated doses until the desired effect is obtained. It has 
been used as a vermifuge against tapeworm. Externally it is employed as a 
counter-irritant in ovaritis, bronchitis, pleurisy, rheumatism, neuralgia, glandular 
swellings and in laryngeal and pulmonary diseases. 



TRAGACANTHA, Tragacanth, — is a gummy exudation from Astragalus gummijer and 
from other species of Astragalus, shrubs of the nat. ord. Leguminosae, growing chiefly in Asia 
Minor and Persia. It occurs in shell-like, curved or contorted bands, swelling with water to a 
gelatinous mass, which is tinged blue by test-solution of iodine, and consists of a mixture of 
Arabin, or gum-arabic, which is soluble in water, and Bassorin, a gum which is insoluble in 
water but swells up in it, also a little starch. 

Mucilago Tragacanthge, Mucilage 0} Tragacanth, — Tragacanth 6, Glycerin iS, Water 
to 100. Dose, oss or more [av. oiv]. 

Incompatibles are Alcohol, Copper Sulphate, Ferrous Sulphate, Lead Acetate both basic 
and neutral. 



iKinci m OVA 1 RSI. 4S9 

Tragacanth is demulcent, but in large quantities may cause indigestion. It is 1 
employed to suspend resins and heavy powders in emulsion. The mucilage may be usi d 
vehicle for active agents in gargles for pharyngitis, and to cause cohesion in the prepararj 
of pills and troches. It is a constituent of 1-' of the 16 official troches, and is a better agent 
than acacia for making emulsions of cod-liver oil. 

TRITICUM, Couch-grass, — is the dried rhizome, gathered in the spring and deprived 
of its roots, of Agropyron repens, the Couch-grass, a perennial plant of the nat. ord. Graminee, 
abounding in meadows and cultivated grounds, where it ranks as a weed though of the same 
genus as wheat. It contains much sugar and a gum-like principle, Trilicin. Dose, 5j~5j 
[av. 5ij] in infusion or decoction. 

Fluidextractum Tritici, Fluidextract oj Triticum. — Dose, oj-oj [av. oij], well diluted. 

Couch-grass is demulcent, emollient and a feeble diuretic. It is chiefly used in cystitis 
and irritable bladder. The infusion is a popular fever-drink in Europe, and has had a con- 
siderable reputation in dysuria. 

ULMUS, Elm, (Slippery Elm), — is the dried inner bark of Ulmus julva, an indigenous 
tree of the nat. ord. Ulmaceae. It contains a large quantity of mucilage which it readily parts 
with to water. 

Mucilago Ulmi, Mucilage oj Elm, — Elm 6, Water to 100, digested for an hour and 
strained. Dose, ad libitum [av. 5iv]. Should be freshly made when wanted. 

Slippery-elm Bark is demulcent, slightly astringent and somewhat tonic. It is used inter- 
nally in diarrhea, dysentery and affections of the urinary passages, and externally in the form 
of poultice as an emollient application in cases of inflammation. It is employed for the dilata- 
tion of fistula?, strictures, and the os uteri. 



UVA URSI, — the dried leaves of Arctostaphylos Uva-ursi, the Bearberry, 
a low, evergreen shrub of the nat. ord. Ericaceae, inhabiting the northern latitudes 
and high mountains of Europe, Asia and America. They contain tannic and 
gallic acids and 3 principles, Arbutin, a bitter glucoside, neutral, crystalline, 
resolvable into glucose and hydroquinone; Ericolin, bitter and amorphous; 
Ursone, resinous, neutral, crystalline and tasteless. The Californian Manzanita 
(Arctostapiiylos glauca) is an allied plant and contains arbutin and tannin. Dose 
of the powdered leaves, gr. x-gj [av. gr. xxx], in infusion or decoction. 

Preparations. 
Fluidextractum Uvae Ursi, Fluidextract oj Uva Ursi. — Dose, itj>x-5j [av. ttjjxxx]. 
Infusum Uvae Ursi, Infusion oj Uva Ursi (Unofficial), — o j in Oj. Dose, 3 j-ij. 
Arbutinum, Arbutin, C 12 H la 7 (Unofficial), — occurs in colorless, odorless, bitter crystals, 
soluble in 8 of water and in 16 of alcohol. Dose, gr. v-xv. 

Incompatibles are as for Glucosides and Tannic Acid (see pages 8 and 70). 

Uva Ursi is astringent, tonic and feebly diuretic. Used in large quantity 
it produces vomiting and purging and is alleged to have oxytocic power. Arbutin 
is an efficient diuretic, and is decomposed in the body yielding hydroquinone, 
(see page 410), which is a powerful poison, and must be formed in the kidneys, 
as though appearing in the urine after arbutin is taken, it does not cause toxic 
effects under such circumstances, but powerfully disinfects the urine and the 
mucous membrane of the urinary passages. It imparts a greenish-brown color 
to the urine. 

Uva Ursi was formerlv used in calculous affections and chronic disorders 



49° VALERIANA. 

of the urinary passages. It has some reputation as an antilithic, and is useful 
in gravel, chronic nephritis, cystitis and urethritis. It relieves incontinence 
of urine, dysuria and strangury, and has proved serviceable even in uterine 
hemorrhages. The fluidextract is an excellent remedy for correcting the ardor 
urinae of acute gonorrhea. Arbutin has been successfully employed in cardiac- 
dropsy as a diuretic, also in urethritis. 

VALERIANA, Valerian, — is the dried rhizome and roots of Valeriana 
officinalis, a large, herbaceous plant of the nat. ord. Valerianaceae, having small, 
white, or rose-colored flowers, a native of Europe, but cultivated in Vermont 
and New York. It contains a Volatile Oil, from which are developed by oxida- 
tion Valerene, C 10 H 16 , a terpene; Valerol or Baldrian Camphor, C 12 H 20 O; and 
Valeric Acid, C 5 H 10 O 2 , which occurs also in many other plants and in cod-liver 
oil. The valeric acid of pharmacy is obtained as a product of the oxidation 
of amylic alcohol, and from it are formed the various valerates. It is not thera- 
peutically identical with the natural acid. Dose of the powdered root, gr. 
x-xlv [av. gr. xxx]. 

Preparations of Valerian. 

Fluidextractum Valerianae, Fluidextract of Valerian. — Dose, n£x-xlv [av. njxxx]. 

Tinctura Valerianae, Tincture of Valerian,— strength 20 per cent. Dose, 3 ss— ij 
[av. 3j]. 

Tinctura Valerianae Ammoniata, Ammoniated Tincture of Valerian, — has of Valerian 
20, Aromatic Spirit of Ammonia to 100. Dose, irjjv-xlv [av. iijfxxx]. 

Oleum Valerianae, Oil of Valerian (Unofficial), — the volatile oil, a greenish or yellowish, 
thin liquid, having the odor of Valerian, an aromatic taste and a slightly acid reaction, readily 
soluble in alcohol. Dose, tijj-v. 

The Oil is by far the best preparation for use, as the tinctures are extremely nauseous 
and the fluidextract is too bulky. The taste is best covered by Cinnamon. 

Preparations of Valerianic Acid. 

Valerates of Ammonium and Zinc are official and are described under the titles of their 
respective bases. They are made with the artificial valeric acid and do not represent the 
action of the plant but rather that of the bases from which they are prepared. 

Incompatibles. 
Incompatible with Valerian preparations are: Cinchona infusion, Iron and Silver salts. 

Physiological Action and Therapeutics. 
Valerian is antispasmodic and a gentle stimulant to the nervous and circu- 
latory systems. It is sedative to reflex excitability, antagonizing the action of 
strychnine, brucine, and thebaine, and is laxative, diaphoretic and anthelmintic. 
Its taste and odor are very disagreeable but cats are extravagantly fond of it. 
In these animals it excites the sexual appetite, probably from a resemblance 
between its odor and theirs when under venereal excitement; and after a time 
it produces in them violent spasms and convulsions. In full doses it increases 
the action of the heart and raises the temperature, in most persons producing 
exhilaration, in some a slight mental disturbance, with formication of the hands 



VANILLA — VERATRl \l. 49 1 

and feet. Long used it induces a condition of melancholia. Large doses cause 
hiccough, diarrhea, nausea and vomiting, frequent micturition with tenesmus 
of the bladder and lithates in the urine, mental disturbance even to delirium, 
reduced motility and sensibility and lessened retlex excitability. The Oil in 
large doses is paralyzant to the brain and the spinal cord, lowers the blood- 
pressure and slows the pulse. 

The Valerates follow their bases in general action but are supposed to possess 
some of the sedative qualities of their acid constituent. 

Valerian was formerly employed in epilepsy but was probably useful only 
in the hysterical form of that disease. It is a valuable remedy in all forms of 
hysteria, especially in young and delicate women. It is useful in the flatulence 
of infants and in that of hypochondriacal and hysterical subjects, also for coughs 
of nervous type, whooping-cough, diabetes insipidus, convulsions due to worms 
and in delirium with vital depression. In the coma of typhus fever the oil 
proved remarkably efficient in 135 out of 172 cases treated by it. Ammonium 
Valerate is used in the same class of disorders as is valerian. It is often a good 
remedy for nervous headache, administered in 10-grain doses in an elixir. Zinc 
Valerate has been supposed to combine the antispasmodic power of valerian 
with the nerve-tonic effect of a zinc salt. It has been used in cholera, epilepsy 
and neuralgia, frequently with considerable success. 



VANILLA, — is the fruit of Vanilla planijolia, a perennial climbing plant of the nat. ord. 
Orchidaceoe, native of the West Indies and tropical America, but cultivated in Java, etc. Its 
characteristic odorous principle is Vanillin, the methyl-ether of protocatechuic aldehyde, 
which oxidizes slowly in damp air to Vanillic Acid, and may be resolved into methyl chloride 
and protocatechuic acid. Vanillin may be made synthetically from Coniferin or from Eugenol. 
Dose, indefinite [av. gr. xv]. 

Tinctura Vanillas, Tincture of Vanilla, — 10 per cent. Dose, a few drops, according to 
the strength of flavor desired. 

Vanillinum, Vanillin, C s H 8 O a , — may be made artificially; occurs in fine, white needles> 
soluble in about 100 of water, easily soluble in alcohol. Dose, gr. J-j [av. gr. ss]. 

Vanilla is an aromatic stimulant, with considerable influence on the nervous system. It 
is chiefly employed as a perfume and for flavoring purposes but has been used with benefit in 
hysteria and low fevers. 



VERATRUM, Veratrum, — is the dried rhizome and roots of Veratrum 
viride, American Hellebore, or Veratrum album, White Hellebore, plants of the 
nat. ord. Liliacese, the latter growing in the mountains of Europe. They contain 
the alkaloids Jervine, Pseudo-jeruine, and Rubijervine; but Veratrum viride 
contains also Veratrine (Cevadine), and Veratrum album contains also Proto- 
veratrine, Protoveratridine and other alkaloids. Dose, gr. j-iij [av. gr. ij]. 

Asagrcea officinalis, Veratrum Sabadilla, Cevadilla, — the source of the official 
Veratrine, a mixture of alkaloids, is a bulbous plant of the nat. ord. Liliaceae, 
indigenous to Mexico and Central America. It contains the alkaloids Veratrine 
{Cevadine), Cevadilline, Sabadine, Sabadinine, and another base known as 
Wright's Veratrine. 



i 



492 VERATRUM. 

The nomenclature of the various veratriae alkaloids is confusing, having undergone con- 
siderable modification. That given above is the most recent, but many authors follow Bul- 
lock, who gave the names Jervine and V eratroidine to the chief constituents of veratrum viride 
and Veratralbine to the principal alkaloid of veratrum album. The substance officially termed 
Veratrine is not the alkaloid so named but is a mixture of alkaloids. 

Veratrine can be decomposed into Angelic Acid and Cevine, a base allied to aconine; ' 
Protoveratrine is probably a combination of Isobutyric Acid and a similar base. Veratrine 
and Protoveratrine are powerful alkaloids, the latter almost rivalling aconitine in toxicity. 
Jervine, Sabadine, and Sabadinine possess some action on the organism. Cevadilline has not 
been examined; the others are said to be inert. 

Preparations. 

Fluidextractum Veratri, Fluidextract of Veratrum, — Dose, njj-iv [av. njjss]. 

Tinctura Veratri, Tincture of Veratrum, — 10 per cent. Dose, njjx-xxx [av. itjxv]. 

Norwood's Tincture of Veratrum Viride (Unofficial), — has a very high reputation for 
efficiency. Dose, itjv, increased by ttjtj every 3 hours, until pulse is down to 65, when the 
original dose will hold it there. Larger doses in puerperal convulsions. 

Veratrina, Veratrine, — is a mixture of alkaloids obtained from the seeds of Asagrcea 
officinalis (see p. 491). A white, or grayish-white, amorphous powder, highly irritant to the 
nostrils, of very acrid taste, producing tingling and numbness of the tongue and constriction 
of the fauces; slightly soluble in cold water, soluble in 3 of alcohol, in 6 of ether, in 2 of chloro- 
form, in 96 of glycerin and in 56 of olive oil. Dose, gr. 3V- tV [av. gr. ■£$]. 

Unguentum Veratrinae, Veratrine Ointment, — Veratrine 4, Expressed Oil of Almond 
6, Benzoinated Lard 90. For local use. 

Oleatum Veratrinae, Oleate of Veratrine, — Veratrine 2, Oleic Acid 50, Olive Oil to 100. 
For local use. 

Incompatibles are as for alkaloids (see page 6). 

Physiological Action. 

Veratrum Viride is closely allied to Aconite in action, being a powerful 
cardiac depressant and spinal paralyzant. It differs from aconite in affecting 
the respiration to a much less degree, in being a systemic emeto-cathartic, in 
paralyzing the motor system centrally, impairing the reflexes but leaving sensa- 
tion unimpaired, and in having little or no diaphoretic or diuretic action in 
ordinary medicinal doses. It causes great muscular depression but is seldom 
fatal; when death does result from its use it occurs by paralysis of respiration. 
In small doses Veratrum reduces the force of the pulse, but does not at first 
affect its rate. If continued for some time, the pulse becomes slow, soft and 
compressible; rising on the least exertion to be very rapid and feeble. At the 
same time there is great muscular weakness, and frequently nausea and vomiting. 
Large doses increase these symptoms, the pulse becoming very rapid and so 
small as to be almost imperceptible; the skin is cold and clammy, and constant 
vomiting, extreme debility, giddiness, impaired vision, and partial unconscious- 
ness ensue. 

Veratrum Album contains the powerful alkaloid Protoveratrine. Its general 
action is similar to that of its congener, but it is much more irritant to the gastro- 
intestinal mucous membrane, causing violent vomiting and purging, intense 
abdominal and esophageal pain, greatly reduced temperature and pulse, collapse 
and death from cardiac and respiratory paralysis. 

The action of the alkaloid Veratrine on the central nervous system and 



VFK \ I'Kl M. 

sensory nerve terminations resembles that of Aconitine very closely. Locall] 
applied it causes the same prickling, warm sensation, followed after a time by 
a feeling of numbness and cold in the part. In contact with the mucous mem 
brane of the nose and throat it gives rise to violenl sneezing and coughing. 

Internally administered the characteristic prickling, burning sensation is soon 
felt in the mouth and throat, followed by a sense of heat in the stomach, saliva- 
tion, nausea and vomiting. The prickling sensation spreads to the skin all 
over the body and profuse perspiration often occurs. The pulse becomes slow 
and irregular, the respiration slow and labored. In veratrine poisoning the 
bowels are more affected than with aconitine, severe colic and violent catharsis 
being usually experienced. Fibrillary contractions of the muscles and con- 
vulsions are commonly observed, and collapse occurs, followed by coma and 
finally by failure of the respiration. 

Veratrine stimulates the central nervous system and the sensory nerve ter- 
minations, but by large doses this stimulation gives way to paralysis. Applied 
directly in solution to the peripheral nerves it abolishes their irritability. At 
first it slows the heart by stimulating the cardiac inhibitory centre, and contracts 
the bloodvessels by stimulation of the vaso-motor centre, but later it depresses 
both, the blood pressure and body temperature are lowered, and finally the 
respiratory centres are paralyzed. It stimulates the cerebral motor centres, 
causing convulsions, but does not effect consciousness or the pupils. In the 
frog it has a peculiar and characteristic action on the muscles, producing a 
prolonged period of contraction and causing an increase in the height and abso- 
lute strength of the contractions. The result is that the muscles remain short- 
ened for a time after contraction and resist the action of their opposing muscles, 
so that the animal cannot extend a limb immediately after flexing it and its 
locomotion is greatly impaired. 

H. C. Wood describes two principal alkaloids as responsible for the action of vcratrum 
viride, viz. — Jervine, the cardiac, vaso-motor and spinal depressant; and Rubijervine (the 
Veratroidine of Bullock), a gastro-intestinal irritant, a stimulant and paralyzant of the pneu- 
mogastric, and a powerful respiratory poison. 

Protoveratrine is much more poisonous than veratrine but acts on the same 
general lines as aconitine. It does not paralyze the motor nerve terminations 
even when applied to them in quantity. It shortens the contraction period of 
muscular tissue instead of prolonging it as veratrine does, and it increases the 
muscular force temporarily but induces its early exhaustion. Jervine, Sabadil- 
line and Sabadinine have the same action as veratrine but are much less poi- 
sonous. 

The official Veratrine is an acrid and intensely irritant powder, consisting 
of a mixture of alkaloids. It causes violent sneezing, a burning sensation, and 
free salivation. It affects the heart and circulation similarly to the other Vera- 
triac and in addition seems to be a direct poison to muscular tissue and to cause 
violent convulsions before the muscular paralysis sets in. 



i 



( 



494 verbascum — viburnum prunifolium. 

Therapeutics. 

Veratrum is inferior to Aconite in most of the fevers and inflammations, by 
reason of its lacking power over excretion. It renders good service in the earlv 
stages of many parenchymatous and serous inflammations when occurring in 
sthenic subjects, especially pneumonia. It is highly esteemed in puerperal fever 
and in simple hypertrophy, irritable heart and other cardiac disorders. It has 
been used with remarkably good results in acute mania and puerperal convul- 
sions, and is of service in aneurism to depress the circulation to the lowest point, 
but in this case the recumbent position must be strictly observed in order to 
secure safety. It should always be administered in small doses and its effects 
carefully watched. In puerperal eclampsia large doses have been administered 
without danger and with decided benefit, as much as 20 drops of Norwood's 
tincture every hour for 5 consecutive days and nights in one case, the patient 
making a good recovery. The same preparation may be given hypodermicallv, 
in doses of ttl ij— iv. 

Veratrine is chiefly used externally. The ointment or oleate is applied with 
benefit in many cases of superficial neuralgia, myalgia and headaches, a small 
quantity being rubbed in over the seat of the pain. It may be absorbed through 
an abrasion of the cuticle and give rise to dangerous symptoms. Internally it 
has been employed as a cardiac sedative in fevers and inflammation, also in 
acute articular rheumatism, dropsies, dysmenorrhea and various nervous affec- 
tions, but its uncertainty of action and the dangerous depression which it may 
produce have caused it to lose favor as an internal remedy. 

VERBASCUM, Mullein (Unofficial),— the leaves of Verbascum Thaspus, the Mullein- 
weed, a plant of the nat. ord. Scrophulariacese, having large woolly leaves and yellow flowers 
in dense spikes. Its chief constituent is mucilage, but the flowers contain an oil in very small 
quantity. An infusion of §iv of fresh leaves to the pint of milk is the form in which it has 
generally been given ; a pint to be taken thrice daily. 

Mullein is emollient and demulcent, perhaps also slightly anodyne. It has long been a 
popular Irish remedy in pulmonary affections. Under its use the weight steadily increases 
in phthisis and other wasting disorders, while expectoration is rendered more easy, cough is 
palliated and the general condition improved. It is recommended in cystitis, irritable blad- 
der, and diarrhea, and is employed as an enema in dysentery and as a poultice for hemorrhoids. 
The dried leaves may be smoked with benefit in aphonia from laryngeal irritation. 

VIBURNUM OPULUS, (Cramp Bark),— is the dried bark of Viburnum Opulus, a shrub 
of the nat. ord. Caprifoliaceae. Dose, gr. x-xlv [av. gr. xxx]. 

Fluidextractum Viburni Opuli, Fluidextract oj Viburnum Opulus. Dose, nj x-xlv 
[av. ttjjxxx]. 

Viburnum Opulus is highly valued by many practitioners as a remedy for uterine and 
abdominal pains. The so-called Viburnum Compound oj Dr. Haydcn is stated by its manu- 
facturers to consist of "the active principles of the Viburnum Opulus, Dioscorea Villosa, 
Scutellaria Lateriflora, and a combination of aromatics, prepared by a process peculiar to 
ourselves." This they call publishing the formula of the preparation. 

VIBURNUM PRUNIFOLIUM {Black Haw),— is the dried bark of the root of Vibur- 
num Prunijolium, or of Viburnum Lentago, indigenous shrubs of the nat. ord. Caprifoliaceae. 
It contains tannic, oxalic, citric and malic acids, sulphates and chlorides; also two resins, one 



VIOLA TRICOLOR — XANTHOXYLUM. 495 

named Vibumin, and Viburnic Acid which is identical with Valeric Arid. Dose, gr. \ riv 
[av. gr. xxx]. 

Fluidextractum Viburni Prunifolii, Fluidextract 0) Vib. Prun. Dose, m>\ xlv [av. 

up xxx). 

Viburnum Prunifolium is considered to possess nervine, antispasmodic, astringent, diu- 
retic and tonic properties, and to be especially useful in preventing abortion, in the nervous 

diseases of pregnancy, aiul in spasmodic dysmenorrhea, li may be administered with can- 
nabis indica, morphine, nerve-sedatives or simple aromatics. No exacl observations havi 
been made regarding its action, and its therapeutical claims are denied by many who have 
used it. It often excites nausea and vomiting. 

VIOLA TRICOLOR, Pansy (Unofficial),— is the wild-grown, flowering herb of Viola 
tricolor, the Heart's-ease Pansy, a plant of the nat. ord. Violacete, native in Europe, but nat- 
uralized in the southern United States. It contains an active alkaloid, Violme, allied in 
many respects to Emetine, and poisonous. Doss, gr. x- 5j, in decoction. 

Viola is mucilaginous, emollient, expectorant and slightly laxative. Its active principle 
is emeto-cathartic, but exists in very small quantity. A decoction of the fresh herb in milk, 
with a poultice of the same, was formerly recommended highly in crusta lactea and impetigo. 
It is used with benefit in some forms of eczema, especially in that of the head and face, and 
has had some reputation in bronchitis and constitutional syphilis. An infusion and a poul- 
tice of the leaves have been used locally in cancer, with some reported success. 

Viola Cucullata, the common Violet, is used in Pennsylvania with success as an internal 
antidote against rattlesnake venom. The leaves are eaten, and a poultice of salt and indigo 
is applied to the wound. 

VISCUM, Mistletoe (Unofficial), — occurs in two species, Visciim album, the European 
Mistletoe, a small, parasitic, evergreen shrub, of the nat. ord. Loranthacea, growing chiefly 
on deciduous-leaved trees, and Viscum flavescens, the American species, growing on oaks, 
elms, etc. They contain mucilage, starch, fixed oil, resin, salts, and Viscin, or Bird-lime, 
which occurs also in Ilex aquifolium, Gentiana lutea and other plants. Dose, gr. x- 5j in 
decoction, or njv-xxx of a ten per cent, tincture. 

The berries of the mistletoes have produced emeto-catharsis, with great thirst, tenesmus, 
bloody stools, convulsions and even death in young children. The leaves and twigs have been 
used in epilepsy, hysteria, chorea, asthma and other nervous affections. The American 
plant is asserted to possess qualities similar to those of Digitalis and to incite uterine contrac- 
tions. It has been used in cardiac affections, dropsies, uterine hemorrhages and amenorrhea, 
also as an abortifacient. 



XANTHOXYLUM, Xanthoxylum, {Prickly Ash),— is the dried bark of 
Xanthoxylum americamtm the northern species, or of Fagara Clava-H erculis 
the southern species, of an indigenous shrub of the nat. ord. Rutaceae. It con- 
tains an acrid, green oil, tannic acid in small quantity, two resins, and the alkaloid 
Xanthoxyline, which is probably identical with Berberine. Dose of the pow- 
dered bark, gr. x-xlv [av. gr. xxx]. 

Preparations. 
Fluidextractum Xanthoxyli, Fluidextract oj Xanthoxylum. — Dose, njx-xlv [av. irgxxx]. 
Decoctum Xanthoxyli, Decoction oj Xanthoxylum (Unofficial), — oj to the quart. 
Dose, a pint during 24 hours in divided doses. 

Physiological Action and Therapeutics. 

Xanthoxyiumjs a stimulant and aromatic bitter, a local and systemic sialo- 

gogue, also diaphoretic, diuretic and emmenagogue. Its taste is aromatic, soon 

becoming acrid and bitter, causing profuse salivation, tingling in the tongue 

and increased secretion from the stomach, intestines, liver and pancreas. It 



496 YOHIMBINE — ZINCUM. 

increases the cardiac action and raises the arterial tension, and is classed among; 
the vegetable alteratives with mezereum, guaiac and stillingia. 

Xanthoxylum is highly valued in chronic rheumatism, myalgia, lumbago 
and similar disorders, also in jaundice from catarrh of the bile-ducts, in dropsies 
and chronic pharyngitis. It is one of the constituents of McDade's Succus 
Alterans (see page 466), a preparation which has considerable reputation among 
southern physicians in cases of chronic syphilis. In old cases of pharyngitis, 
the mucous membrane being glazed and dry, the decoction may be used as a 
gargle and n^x-xxx of the fluidextract taken internally thrice daily. The bark, 
used as a masticatory, is a popular remedy for toothache and has been frequently 
successful in paralysis of the tongue. 



YOHIMBINE (Unofficial), — is an alkaloid obtained from the bark of the Cameroon 
tree, indigenous to East Africa. It is highly aphrodisiac and a powerful local anesthetic. It 
is efficient in pure forms of sexual impotence, but not in those due to constitutional or organic 
disease, and has slight influence in persons of advanced years. It is contraindicated in all 
acute and chronic inflammations and hyperemia of the abdominal and pelvic viscera. As 
an anesthetic it acts efficiently when applied directly to a nerve or to the mucous membrane, 
but produces local hyperemia instead of the anemia caused by cocaine. It is readily decom- 
posed by light, hence its solutions should be kept in amber-colored bottles and in a dark place. 
Dose, gr. j—J, or njjv-viij of a 2 per cent, solution, gradually increased to tijjxvj. 



ZEA, Zea, (Corn Silk), — is the fresh styles and stigmas of Zea Mays, the 
Maize or Indian Corn, nat. ord. Gramineae. It contains Maizenic Acid, a fixed 
oil, resins and salts. Dose of a fluidextract, 3J-ij; of an infusion (1 to 8), 
§iv-viij, almost ad libitum. There are no official preparations. 

Zea is a certain but mild diuretic when given in full doses at short intervals. 
It is by some observers considered demulcent and anodyne, and is generally 
believed to have a specific or alterative influence over many disorders of the 
genito-urinary passages and the urinary bladder. It has been used with success 
for incontinence of urine, uric and phosphatic gravel, gout, rheumatism, ure- 
thritis, pyelitis, acute and chronic cystitis, cardiac dropsy and obstructive val- 
vular disease of the heart. 

ZINCUM, Zinc, Zn, — is metallic Zinc, in the form of thin sheets or irregular, 
granulated pieces, a bluish-white metal, having the sp. gr. 6.9. It occurs native 
as Blende a sulphide, Calamine a carbonate, Zincite a red oxide, Franklinite 
a mixture of the oxide with that of iron and manganese; also as a silicate. The 
metal is soluble in the weakest acids and therefore should never be used for 
culinary vessels. Its salts are all more or less actively poisonous. Metallic 
Zinc is official but is not employed as a medicine. 

Zinc Salts and tlieir . Preparations. 

Zinci Acetas, Zinc Acetate, Zn^HjC^+zH^O, — soft, white, micaceous or pearly, 
six-sided tablets or scales, somewhat efflorescent in dry air, of faintly acetous odor, sharp 
metallic taste and a slightly acid reaction; soluble in 3 of water and in 36 of alcohol at 59 F. 



ZINCI \i. 



497 



in it of boiling water and in 3 of boiling alcohol. Used locally as an astringent ill solution of 
gr. j or ij to the ,">. or internally in doses of gr. A -iij [av. gr. ijj. 

Zinci Carbonas Praecipitatus, Precipitated Zinc Carbonate, a white, impalpable 

powder, permanent in the air, odorless and tasteless, insoluble in water or ale ohol, but soluble 

m aeids with copious effervescence. Used locally as a protective, 

Zinci Chloridum, Zinc Chloride, ZnCl a , a white, granular powder, or porcelain like 
masses, odorless, of intensely caustic properties; win soluble in water and in alcohol; very 
deliquescent. Is tonic and escharotic. For internal use a solution in Spirit of hither is the 
most convenient form, strength ~t\ to the ,', , of which four to eight minims may be given 
twice daily in water. Strength of injections and collyria, gr. j ij to the 5> 

Liquor Zinci Chloridi, Solution 0/ Zinc Chloride,— is an aqueous solution, containing 

about 50 per cent, of the sail. A clear, colorless, odorless liquid, of a very astringent, sweetish 

taste and an acid reaction. A' powerful disinfectant for sinks, drains, etc. Used also as an 

injection in gonorrhea, leucorrhea, etc., in dilute solution, i to 1 per cent. Burnett's Disin- 

, Fin id is similar to the above but slightly stronger. 

Zinci Iodidum, Zinc Iodide, ZnL, — a white, granular powder, very deliquescent, of 
sharp, saline and metallic taste and acid reaction; very soluble in water and in alcohol. 
Dose, gr. ss-ij [av. gr. j], in syrup. 

Zinci Oxidum, Zinc Oxide, ZnO, — an amorphous, white powder, odorless and tasteless; 
insoluble in water or alcohol; soluble without effervescence in dilute acids also in ammonia 
water. Dose, gr. j-x [av. gr. iv], in pill. 

Unguentum Zinci Oxidi, Ointment oj Zinc Oxide, — has of Zinc Oxide 20, Benzoinatcd 
Lard So. 

Zinci Phenolsulphonas, Zinc Phcnolsulphonate, {Zinc Sulpho-carbolate), — colorless, 
transparent, rhombic prisms, very soluble in water and in alcohol. Dose, gr. j-v [av. gr. ij]. 

Zinci Stearas, Zinc Stearale, — a very fine, w : hite, unctuous powder, insoluble in water, 
alcohol or ether. Used locally as a dressing powder and a vehicle for dry antiseptics. 

Unguentum Zinci Stearatis, Ointment oj Zinc Stearate, — strength 50 per cent., made 
with White Petrolatum. 

Zinci Sulphas, Zinc Sulphate, ZnSO.,+ 7H 3 0, — colorless, rhombic crystals, of astringent 
metallic taste, and acid reaction; soluble in 0.6 of water, insoluble in alcohol. Dose, as 
emetic, gr. x-xx [av. gr. xv]; as a tonic and astringent, gr. -pj-ij in pill. 

Zinci Valeras, Zinc Valerate, {Zinc Valerianate), — white, pearly scales, having the odor 
of valeric acid, and a sweetish, metallic taste; soluble in about 50 of water and in about 35 of 
alcohol. Dose, gr. ^-gr. iv [av. gr. ij], in pill. 

Zinol, (Unofficial) — is the trade name of a preparation composed of Zinc Acetate 1, Al- 
bumin Naphtho-sulphonate 4 parts, which is used in aqueous solution, gr. j-iij to the 5, as an 
injection for gonorrhea. 

The Bromide is described under Bromum. 

Incompatibles. 

Incompatible with Zinc Salts are: Acacia, Alkalies, Arsenates, Carbonates, Cyanides, 
Lead Acetate with Zinc Sulphate in solution, Lime-water, Milk, Oxalates, Phosphates, Sul- 
phates, Sulphides, Vegetable astringent decoctions and infusions. 

Physiological Action. 
Zinc Salts are astringents, but milder ones than the salts of lead. Its soluble 
compounds (the chloride, iodide, sulphate and acetate) are corrosive poisons, 
causing violent gastro-enteritis and in some cases profound nervous depression. 
The Chloride is a powerful and painful escharotic or rather mummifier of the 
tissues, having great affinity for water, coagulating albumin and shrivelling 
the vessels. It is a very active disinfectant. The Sulphate is an escharotic 
and a specific emetic, acting promptly by direct irritation of the stomach, without 
much depression or after-nausea. In small doses it is tonic and astringent, 
in larger ones it would be a severe irritant but for its causing prompt emesis. 
33 



498 ZINCUM. 

The Acetate resembles the sulphate in action. The Oxide used externallv is 
a mild, soothing astringent; used internally it enters the blood as a lactate or 
chloride, acting as a mild astringent and a nervous sedative. Being almost 
insoluble in the stomach, it has but feeble diffusive power and consequently 
but slight activity. The Carbonate resembles the oxide in action. The Iodide 
locally is a powerful escharotic and has been supposed to possess some alterative 
power when given internally, in addition to its astringent qualities as a zinc 
salt. The Stearate is feebly antiseptic but strongly astringent. The Valerate 
acts as a nervous sedative, but its properties are in all probability due to its 
zinc base and not to the acid combined with it. 

The continued use of Zinc salts produces symptoms similar to those of 
chronic lead-poisoning, but of much less gravity. These salts manifest less 
tendency to accumulate in the system than other metallic salts and are excreted 
much more rapidly. Elimination takes place chiefly by the liver and intestinal 
glands. 

The action of the Bromide is described under the title Bromum. 

Therapeutics. 
Zinc salts are chiefly employed in weak solution as mild astringent applica- 
tions in catarrhs of mucous membranes, as conjunctivitis and urethritis, also 
as unguents and lotions in skin diseases, particularly eczema, impetigo, herpes 
and erythema. The Chloride is made into a paste with flour and glycerin for 
the destruction of lupus, epithelioma and other morbid growths, also for opening 
abscesses in locations where puncture or incision might be dangerous. The 
cuticle, if unbroken, should be removed by strong water of ammonia before 
the paste is applied, as it will not act through the epidermic tissue. It is a 
commonly used disinfectant "and deodorant, and in weak solution (Xiij-v of 
the liquor to 3J of water) makes a good lotion for putrid ulcers. A solution of 
gr. j-iij to the § is an excellent injection for gonorrhea, and one of gr. ij to the 
§ is one of the best applications for purulent ophthalmia in the infant or adult. 
The Iodide is not employed as an escharotic, nor has it ever been a favorite 
remedy for internal use. It is chiefly employed in solution as an application 
to enlarged tonsils, and as an ointment (1 part to 8 of lard) for the reduction 
of glandular enlargements. The Sulphate is used locally as an astringent to 
mucous surfaces generally, internally as an emetic in narcotic poisoning and 
croup, and in small doses as a tonic and antispasmodic in convulsive diseases, 
as chorea, hysteria, epilepsy, angina pectoris and asthma. In diarrheas and 
dysentery it is a good astringent and is frequently combined with opium and 
ipecac. In weak solution, gr. j-ij to the §, it is the standard astringent injection 
for gonorrhea after the subsidence of the acute stage. The Acetate is used for 
the same purposes as the sulphate, but is usually preferred for collyria. The 
Oxide may be employed as a dusting powder in intertrigo, also as an ointment 
in eczema and excoriated surfaces generally. In combination with bismuth 



ZINGIBER. 409 

• 

and pepsin it is an excellent remedy for the summer diarrhea of children, and 

with aromatic powder and morphine it is very efficient in gastralgia. It is a 
good remedy in 3-grain doses for the night-sweats of phthisis, and lias be< D 
successfully employed in epilepsy and neuralgia, in whooping-cough, hysteria 
and nervous headache, and in bronchorrhea to check the profuse secretion. It 
is much employed as an ingredient of cosmetics. The Carbonate is by some 
preferred to the oxide for local use in skin diseases. Calamine Ointment, which 
is a mixture of the impure carbonate (calamine) with the oxide and an unguent 
basis, was until recently a favorite application as a soothing protective to abra- 
sions and inflammations of the integument. The Phenolsulphonate is used as 
an astringent and antiseptic for indolent or foul ulcers, and in solutions some- 
what stronger than those of the sulphate locally for subacute inflammations 
of mucous membranes. Internally it has been used with great satisfaction as 
a remedy for cholera infantum. The Valerate is employed in chorea, epilepsy, 
neuralgia, and various anomalous nervous affections, such as the nervous head- 
ache of hysterical women, nervous coughs and aphonia due to uterine and 
ovarian irritation. The Stearate is an excellent dusting and insufflating powder, 
much used in rhinological practice and in the treatment of gonorrhea. It may 
be mixed with boric acid, europhen, menthol, chrysarobin, salicylic acid, and 
other antiseptics, for use in intertrigo, burns, eczema, coryza, hay fever and 
many other local affections. 

ZINGIBER, Ginger, — is the dried rhizome of Zingiber officinale, a plant 
of the nat. ord. Zingiberacea?, having dingy-yellow flowers on a leafless flower- 
stalk and long, lanceolate leaves on a separate stem. The plant is a native 
of Hindostan, but is cultivated in Jamaica and Sierra Leone. It contains an 
aromatic volatile oil, and a resin. Dose, gr. x-xxx [av. gr. xvj. 

Preparations. 

Fluidextractum Zingiberis, Fluidextract 0} Ginger, — alcoholic. Dose, ttjx-xxx 
[av. npxv]. 

Tinctura Zingiberis, Tincture of Ginger, — 20 per cent. Dose, n£x- oj [av. njxxx]. 

Syrupus Zingiberis, Syrup oj Ginger, — has of the Fluidextract 3 per cent, in sugar and 
water. Dose, 5j-oj[av. 5iv]. 

Oleoresina Zingiberis, Olcorcsin of Ginger, — is extracted by acetone and contains all 
the virtues of the root. Dose, Ttjss-j [av. gr. ss], well diluted. 

('ringer is also a constituent of Pulvis Aromaticus and Pulvis Rhei Compositus. 

(linger is sialogogue when chewed, sternutatory when inhaled, and exter- 
nally a rubefacient. Internally it is a grateful stimulant and carminative, 
produces a sensation of warmth at the epigastrium and promotes the expulsion 
of flatus. It is employed as a carminative in colic, as a masticatory to increase 
the secretion of saliva and in relaxed conditions of the throat, also internally 
in atonic dyspepsia, to relieve flatulence, and as an adjunct to purgative agents 
to correct their griping properties. The syrup is in common use as a flavoring 
adjuvant in prescriptions. 



< 



5oo 



ZINGIBER. 



Ginger Beer is a favorite temperance beverage, but most of the preparations sold under 
its name are simply carbonated water flavored with ginger. The following recipe is fur- 
nished by Dr. William Hardman, of Blackpool, in whose family it has been used for over 
fifty years, and the excellence of which he guarantees: 

Take ij oz. of the best ginger well bruised, I oz. of cream of tartar, and it lb. of cane 
loaf sugar. Put all the ingredients into an earthen vessel and pour on a gallon of boiling 
water; when nearly cold add a gill of yeast, cover over with a blanket and let it stand in a 
warm place until next morning. Then skim it and run it through a filtering bag, bottle it. 
cork well with good corks and tie down the corks with string. In three days it will be fit for 
use. The bottles must be clean and sweet. A little lemon juice is considered an improve- 
ment by some. (Lancet.) 



PART II. 

PHARMACY AND PRESCRIPTION WRITING. 



Pharmacy (fltpiuumv, a drug or medicament), — may be defined as the art 
of selecting and preserving medicines, and preparing them for administration. 
It may be divided into — 

Official or Galenical Pharmacy, — dealing with the processes and preparations 
of the Pharmacopoeia ; and — 

Extemporaneous or Magistral Pharmacy, — which includes the operations 
of compounding and dispensing remedies as directed in the extemporaneous 
prescriptions of physicians. 

Pharmacopoeias and Dispensatories. 

A Pharmacopoeia is an official list of the drugs and their preparations 
recognized by the medical profession of a certain country. In other countries 
the Pharmacopoeia is published under government auspices and has the force 
of a legal standard; in the United States its publication is left to the medical 
and pharmaceutical professions and it is revised every ten years by a convention 
called for that purpose. The official Pharmacopoeias in the English languages, 
with the dates of their latest revision or additions, are as follows, viz. — 

The Pharmacopceia of the United States of America, 8th Decennial Revision, 
1900; official from September 1, 1905. 

The British Pharmacopceia, 1898. 

Besides the above there are — The Pharmacopoea Germanica; the Pharmacopee Francaise 
(Codex Medicamentarius) ; the Austrian, Pharmacopcea Austriaca; Russian, Ph. Rossica; 
the Swedish, Ph. Suecica, the Norwegian, Ph. Norvegica; the Danish, Ph. Danica; the 
Belgian, Ph. Belgica; the Swiss, Ph. Helvetica; the Spanish, Farmacopea Espanola; the Por- 
tuguese, Ph. Portugueza; the Indian, Ph. of India; the Hungarian, Ph. Hungarica; the 
Xt/therlands', Ph. Neerlandica; the Roumanian, Ph. Romafia; the Finnish, Ph. Finnica; 
the Chilian, Farmacopea Chilena; the Greek, Ph. Hellenica; the Japanese, Ph. Japonica; 
the Mexican, Neuva Farmacopea Mexicana; the Croatia-Slavonian, Ph. Croatico-Slavonica; 
and the Italian, Farmacopea Italiana. 

A Dispensatory is a commentary on one or more pharmacopoeias, giving 
the physical and medicinal history of drugs and preparations, with their doses, 
physiological action and therapeutics, and includes similar information about 
many drugs which are not official in any pharmacopoeia but are of occasional 
use or general interest. A dispensatory is a private publication, of authority 



> 



502 WEIGHTS AND MEASURES. 

according to the reputation of its author. The principal dispensatories are 
American publications, and are veritable drug-encyclopaedias, so elaborately 
do they deal with every subject embraced therein. Those of acknowledged 
value are — 

The Dispensatory of the United States of America, by Dr. Geo. B. Wood and Dr. 
Franklin Bache. 18th edition, revised and largely rewritten, by Professors H. C. Wood, 
J. P. Remington, and S. P. Sadtler. Philadelphia, J. B. Lippincott & Co. 1899. 

The National Dispensatory. 5th edition, revised by Professors Stille, Maisch and Cas- 
pari. Philadelphia, Lea Bros. & Co. 1896. 

The American Dispensatory, by King & Lloyd, Cincinnati, is the recognized author- 
ity of the "eclectic" practitioners. 18th edition, 1899. 

A Companion to the U. S. Pharmacopoeia, by Drs. Oldberg and Wall; New York, 
Wm. Wood & Co. — is an excellent book, but not so exhaustive as the others in its method of 
treating the subjects embraced in it. 

A Companion to the British Pharmacopoeia, by Peter Squire; 17th edition, London, 
1899; is the nearest English approach to the American dispensatories, and is the standard 
text-book on the general materia medica in Great Britain. Although a very good book it does 
not compare as a work of reference with either of the two great American Dispensatories first 
above named. 



WEIGHTS AND MEASURES. 



1 



The working formulae of the U. S. Pharmacopoeia of 1880 were constructed 
on the system of parts by weight for all articles, whether solids or fluids, except 
in the case of fluidextracts, for which the metric weights and measures were 
employed. On this system it really made no difference what unit of weight 
was adopted in official pharmacy. The pharmacopoeia of 1900 in most cases 
employs definite weights for solids, and measures for liquids, in terms of the 
metric system. In certain cases, where weighing is decidedly more convenient 
or where the product is adjusted to a percentage by weight which would be 
rendered uncertain if the ingredients were taken by measure, li quids are ordered 
to be weighed. In some cases (Aqua Destillata, Aqua Aurantii Florum), the 
quantities are directed simply by volume. In most cases, therefore, solids are 
officially directed to be weighed by grammes, and liquids to be measured by 
cubic centimeters. At the same time, however, the weights and measures gener- 
ally used by physicians in prescribing and by pharmacists in dispensing medi- 
cines, are and will doubtless continue to be, in the United States those of the 
Apothecaries' or Troy System of weights, having 480 grains to the ounce and 
5760 grains to the pound; and the Apothecaries' Measure. The drachm (60 
grains) and the scruple (20 grains), are intermediate units of weight which are 
still used but are becoming obsolete. 

The units of the Apothecaries' Measure are the minim (he), which in water 
at its maximum density equals gr. 0.95; the fluidrachm (60 minims) and the 



WEIGHTS AND Ml A St RES. 



503 



fluidounce (8 fluidrachms or 480 minims). Tin- signs used to denote these 
units are mi minim ;■) scruple, 3 drachm, 5 ounce, and in the case of liquids 
an f to denote tluid is often placed before the sign, thus f 3 for fluidrachm, Eg 
for fluidounce. The relations between these units of weight and measure in 
water at 4 C. or 39. 2° F. are as follows: — 



Measure. Wright. 

nnj, One minim = 0.95 grains. 

f 5j, One fluidrachm = 57.0 " 

f 3j, One fluidounce = 456.4 " 



Weight. 

grain j 

3j 



Measure. 
1.05 minims. 
63.1 " 
504.8 



( 



Pound. 
Libra. 

rb 

1 



Gallon. 
Congius. 

c. 



Table of Troy or Apothecaries' Weight. 

Ounce. Drachm. Scruple. 

Uncia. Drachma. Scrupulum. 

5 5 3 

12 96 = 288 

1 8 = 24 

1=3 = 



Table of Apothecaries' Fluid Measure. 



Pint. 
Oclarius. 

o. 



Fluidounce. 
FluidiiHcia. 

fS 

128 
16 

I 



Fluidrachm. 
Fluidrachma. 

f3 

1024 
128 



Grain. 
Granum. 

g r - 
5760 
480 
60 



Minim. 
Minimum. 

w 

61440 

7680 

480 

60 



i 



The British Pharmacopoeia recognizes only the Imperial Standard or 
Avoirdupois Weight, having 437^ grains to the ounce, 16 ounces to the pound 
(instead of 12), and 7000 grains to the pound; and the Imperial Measure, 
having 20 ounces to the pint (instead of 16, as with us). 

Table of British Pharmacopceial Weight. 
Troy grain, Avoirdupois ounce and pound. 



( 



Pound. 
Libra. 

rb 

1 



Ounce. 
Uncia. 



Grain. 
Granum. 



oz. gr. 

= 16 = 7000 

1 = 437i 

The Troy ounce contains 42 J grains more than the avoirdupois ounce, but the Troy pound 
contains 1240 gTains less than the avoirdupois pound. The grain is the only unit common to 
both. 

Table of British Pharmacopceial Measure. 



Gallon. 


Pint. 


Fluidounce. 


Fluidrachm. 




Minim. 


Congius. 


Oclarius. 


Fluiduncia. 


Fluidrachma. 




Minimum 


c. 


O. 


floz. 


fldr. 




min. 


I 


8 


= l6o = 


= 1280 


= 


76800 




1 


= 20 = 


= 160 


= 


9600 






I 


8 

1 


= 


480 
60 



The Metric, or Decimal System of Weights and Measures, is now offi- 
cial in the United States, having been adopted throughout the last two revisions 
of the U. S. Pharmacopoeia. It is in general use on the continent of Europe 



504 WEIGHTS AND MEASURES. 

and is employed by French and German physicians in this country. Its three 
standard units are as follows, — 

A Meter, the standard unit of linear measure and also of the whole system, is the ten- 
millionth part of the quadrant or fourth part of the terrestrial meridian, the quadrant being 
the distance from the equator to the pole. One-tenth of a meter is a Decimeter, the cube of 
which contains one Liter of pure water at 4 C, the temperature of its maximum density, 
which liter of water weighs one Kilogramme, or 1000 grammes. 

A Liter, the unit of volume, is the volume of one cubic decimeter (1000 cubic centimeters) 
of pure water at 4°C, which volume of water weighs one Kilogramme (1000 grammes). 
One-thousandth of a liter is a Milliliter (or cubic centimeter), which volume of pure water at 
its maximum density weighs one Gramme. 

A Gramme, the unit of weight, is the one-thousandth part of a kilogramme, and is 
therefore the weight of one-thousandth of a liter (a milliter or cubic centimeter) of water at 
4° C., the temperature of its maximum density. Its tenth is the Decigramme, its hundredth 
is the Centigramme, and its thousandth part is the Milligramme. 

The original and French spelling is metre, litre, gramme; the Anglicized form is meter, 
liter, gram. The U. S. Pharmacopoeia sanctions a combination of both, thus — meter, liter, 
gramme. 

The metric terms used in pharmacy are few, and are generally confined 
to the gramme, milligramme, and cubic centimeter (fluid-gramme); but the 
system embraces many other terms of increase and decrease of the units, as 
set forth in the following table, viz. — 



1 0000. 


Myriameter. 


10000. 


Myrialiter. 


1 0000. 


Myriagramme. 


1000. 


Kilometer. 


1000. 


Ki'loliter. 


1000. 


Kilogramme. 


100. 


Hectometer. 


100. 


Hectoliter. 


100. 


Hectogramme. 


10. 


Dekameter. 


10. 


Dekaliter. 


10. 


Dekagramme. 


1. 


Meter. 


1. 


Liter. 


1. 


Gramme. 


.1 


Decimeter. 


.1 


Deciliter. 


.1 


Decigramme. 


.01 


Centimeter. 


.01 


Centiliter. 


.01 


Centigramme. 


.001 


Millimeter. 


.001 


Milliliter (Cubic 
Centimeter). 


.001 


Milligramme. 



The figures are the numerals employed to represent the various terms of increase or de- 
crease, thus — 1000. represents a kilometer, a kiloliter, or a kilogramme; and .001 represents 
a millimeter, a milliliter, or a milligramme; therefore the unit should be added in each case 
to show which series it belongs to, thus — 1000. Meter, .001 Gramme. 

There is only one relation between the terms of these three series, which relation may be 
expressed by either of the following formula?, viz. — 

A Decimeter cubed contains a Liter, which weighs a Kilogramme. 

A Centimeter cubed contains a Milliliter {or Cubic Centimeter), which weighs a Gramme. 

If the three series were arranged so as to bring these three related terms on one line, the 
table would be deceptive, as no corresponding relation exists between the other terms which 
would also be on the same lines. 

Relations between the Metric Weights and Measures and those of the Apothe 
caries' system are as follows, — 

1 meter = 39.3704 inches. 1 grain = 0.0648 gramme. 

1 liter = 2. 1 1 34 pints. 1 minim = c.06 16 cubic centimeter. 

1 gramme = 15.4323 grains. 1 fluidounce = 29.5737 cubic centimeters. 

The Metric System is making way but slowly in this country, although its 
progress is aided by every process of forcing which scientific bodies can bring 
into action, and it remains to be seen how much its adoption by the U. S. Phar- 
macopoeia will influence the medical profession in its behalf. With all the 
influence brought to. bear in its favor it certainly has not yet been adopted by 
anv considerable proportion of native-born and home-educated physicians and 



\\ I lull rS \NI> Ml \SI R] 



505 



pharmaceutists. One of its greatest difficulties far the physician is the absence 
of any correspondence or relation between the unit of weight (gramme) and 
the unit of measure (liter), and the consequent want of fluid denominations 
below the cubic centimeter, corresponding with the decigramme, centigramme 
and milligramme of the weight scale. Its chief disadvantage is one which is 
inherent to any decimal system, — that the number ten cannot be divided more 
than once without producing a fraction. This is partly compensated for by 
the practice of dividing five into the three parts 2, 2 and 1, and on this principle 
metric weights are usually constructed. Our five-cent nickel coin is exactly 
2 centimeters in diameter, and weighs 5 grammes. 

Approximate or Domestic Measures become necessary in apportioning 
doses for a patient, when liquid medicines are used. Of these the measure 
most commonly employed is the teaspoonful, which is generally taken as equiva- 
lent to a fluidrachm, though as now manufactured the teaspoon usually contains 
about 75 minims, or 25 per cent, more than the theoretical quantity. The 
dessertspoonful is about equal to two teaspoonsful, and the tablespoonful to 
about 4 teaspoonsful or 13SS, while the wineglass is supposed to contain about 
f.^ij. The use of graduated medicine glasses is strongly recommended instead 
of these approximate measures. They may be obtained at a trifling cost in 
any well-stocked drug store. 

Drops (Guttae) are very variable in size, though generally supposed to equal 
minims; the variations in their relative dimensions being due to the viscidity 
of the liquid, the shape and surface of the orifice from which they escape and 
sundry other circumstances. The Syrups and Mucilages produce large drops, 
while Bromine, Chloroform and other heavy mobile liquids produce very small 
ones. These differences are well illustrated in the following table, which gives 
the number of drops in a fluidrachm of several liquids of certain classes, arranged 
in the order of their increase. A more complete table is given in the Appendix. 

Syrupus Acacia, 44 Oleum Ricini ( 77. 

Syrupus Scillae, 75. Oleum Copaiba, 123. 

Aqua, 60. Oleum Tunipcri, 148. 

Liquor Potassii Hydroxidi, 62. Spiritus Camphors, 143. 

Liquor Hydrargyri Nitratis, 131. Spiritus Chloroformi, 150. 

Acetum Opii, 90. Fluidextr. Digitalis, 134. 

Vinum Opii, too. Fluidextr. Ipecac, 120. 

Tinctura Opii Deodorati, no. Fluidextr. Cinchonae, 138. 

Tinctura Opii Camph., 130. Fluidextr. Zingiberis, 142. 

Tinctura Opii, 130. Fluidextr. Buchu, 150. 

Tinctura Iodi, 148. Fluidextr. Hyoscyami, 160. 

Tinctura Aconiti, 146. iCther, 176. 

Alcohol Dilutum, 137. Bromum, 230. 

Alcohol, 146. Chloroformum, 250. 

Specific Gravity is the relative weight of equal bulks of different bodies. 
The specific gravity of water at a certain temperature (generally 77 F.) is taken 
as 1, and that of all other substances is expressed in terms of this unit. The 



506 PRESCRIPTIONS. 

Pharmacopoeia gives very complete tables of percentages and specific gravities 
of Alcohol, Ammonia Water, Acetic, Hydrochloric, Nitric, Sulphuric and Phos- 
phoric Acids. The specific gravity of any substance is expressed by the quotient 
obtained by dividing the weight of a given measure of the substance by the 
weight of an equal measure of water. In pharmacy the specific gravity of solids 
is not of any importance, but that of liquids is a matter of constant value, and 
is determined in most cases by means of a specific gravity bottle or by a hydrom- 
eter, instruments which are described in any standard work on chemistry 
or physics. Modifications of the hydrometer with scales adapted to particular 
work are the urinometer, saccharometer, lactometer, etc. 

Specific Volume is the relative bulks of equal weights of different bodies. 
In pharmacy it means the volume of the weight of a liquid compared with the 
volume of an equal weight of water at 77 F. The specific volume of a body 
is therefore inversely as its specific gravity, and is expressed by the quotient 
obtained by dividing unity by the specific gravity. — - — = sp. vol. and there- 
fore sp. gr. X sp. vol. = 1. 



PRESCRIPTIONS. 



Extemporaneous Prescriptions are formulae written on the instant (ex 
tempore) to meet the requirements of individual cases. 

A prescription should begin with the name of the person for whom it is 
designed and the date on which it is written. Then follows the Latin word 
Recipe, usually abbreviated to the sign B, and signifying "Take;" next, the 
names and quantities of the ingredients to be used, which are also expressed 
in Latin; then the directions to the compounder, followed by the directions to 
the patient, the last being now usually expressed in English; and finally the 
signature and address of the prescriber. 

A prescription then has four component parts, as follows: the — - 

Superscription, — consisting of the name of the party for whom it is designed, the date and 

the sign 1$ signifying "Take thou." 
Inscription, — the body of the prescription, consisting of one or more of the following sub- 
divisions: the — 

Basis, — or chief, active ingredient. 
Adjuvant, — to assist the action of the basis. 

Corrective, — to correct some injurious quality of the other ingredients. 
Vehicle or Excipient, — giving the prescription a suitable form. 
Subscription, — the directions for the compounder, usually expressed in contracted Latin. 
Signature, — the instructions for the guidance of the one administering the medicine, ex- 
pressed in English, followed by the signature of the prescriber. 



PRESCRIPTIONS. 507 

A proscription may, however, contain the base alone, or the base with the 
adjuvant, or the base with a simple vehicle or diluent. A single ingredient 
may serve a double or a triple office, as the Syrupus Rhei Aromaticus with 
Quinine, in which case the syrup serves as an adjuvant to increase the action 
of the quinine, as an excipient to cover the taste, and as a vehicle to facilitate 
the administration of the dose directed. Again, the basis may need no aid in 
doing its work and may require no corrective of its action nor any special vehicle. 
On the other hand, there is no limit to the number of ingredients which may 
be used, provided that the prescriber has a clear idea of something to be accom- 
plished by each one, and that there is no chemical or medicinal incompatibility 
between them. In olden times prescriptions were very complex and contained 
a great many curious and incongruous ingredients. As Dr. Piffard has well 
said, "the tendency of the present age is toward mono- rather than poly-phar- 
macy, and prescriptions with the orthodox adjuvans and corrigens are less fre- 
quently seen than formerly." There is danger, however, in carrying this sim- 
plicity too far, for there is no doubt that proper combinations of medicines will 
often produce effects for the patient's good which could not be obtained from 
the use of any one remedy. 

Procedure in Writing a Prescription. 
In writing an extemporaneous prescription, the first step is to write the 
patient's name and address, the date and the sign R. Then the title of each 
ingredient should be written in Latin and in the genitive case, except that when 
a certain number only of an ingredient is ordered the name of the ingredient 
should be in the accusative case, for example, "Vitellum unum, — one yolk-of- 
egg." Next, the quantity of each ingredient sufficient for one dose should be 
mentally determined and multiplied by the number of doses which the mixture 
is to contain, and the result set down in signs and Roman numerals. The 
directions to the pharmacist and patient being added and the prescriber's name 
or initials affixed, the prescription is completed; but when very active agents 
are used, it is a good plan to go over the calculations a second time before let- 
ting the prescription leave the hands of the person most responsible for the 
result. For pills or powders the same process should be employed, slightly 
varied according to the requirements of each case. Frequently the ingredients 
and quantities for but one pill, powder or suppository are named, with instruc- 
tions to make a certain number after the formula. When an unusually large 
dose of any poisonous drug is prescribed, it is customary to underline the quan- 
tity, so as to call the attention of the compounder to the fact that the prescriber 
is aware that the dose is above the average. 

An Example will perhaps make the foregoing more comprehensible, and 
at the same time serve to indicate the style of writing usually employed. The 
following formula represents the preparation known as Black Draught, but 



508 PRESCRIPTIONS. 

officially styled the Compound Infusion of Senna; approximate weights and 
measures being substituted for the pharmacopceial metric weights. 



For Mrs. Gray. July jlh, 1905. 

Recipe, Take, — 

f Senna; semiunciam, 

,-d ■ \ I Of Senna, half an ounce, 

(.basis.) J. ,» .. „' 7i , .. ' 

1 Magnesn Sulphahs, 



} 



Superscription. 



-ounces. 



Of Magnesium Sulphate, 

/.,• „ . % f Manna;, ana unciam unam, T 

(Adjuvant.) < r\c-*r r v. r Inscription. 

v J ' I Of Manna, of each an ounce, 

(Cnrrpcu e } 1 Funiculi, drachmam unam, 

\ Of Fennel, one drachm, 

m 1 ■ 1 \ f Aqua Bullientis, fluiduncias octo, 

K emcle -> \ Of Boiling Water eight fluid-01 

Macera per horam in vase claitso, deinde cola. \ Q 

Macerate for an hour in a closed vessel, then strain. f bUBSCRIPTI0N - 

Signetur, Let it be entitled, — A wineglassful every jour hours ") 

until it operates. [■ Signature. 

J. F. Wood, M.D. J 

Abbreviated in the style usual among physicians, the above prescription 

would read as follows, — 

For Mrs. Gray. July yth, 1905. 

1$. Senna;, §ss. 

Magnesii Sulphat., 

Manna., aa o ]• 

Fceniculi, 5 j- 

Aqua Bull., f o viij. 

Mac. per hor. in vase clauso, deinde cola. 
Sig. — A wineglassful every four hours, until it operates. 

Wood. 

As the result of the above is nearly identical with the official preparation, we 
might write the same prescription more simply, as follows, — 
1$. Infusi Senna Compos., oviij. 

with the proper superscription and signature; this being the manner of pre- 
scribing the official preparations. 

It will be noticed that in the above analysis the term basis covers two ingre- 
dients; but it is obvious that either of them might be considered the principal 
agent, and the other one classed as an adjuvant. 

"These four parts of a formula are intended to accomplish the object of 
Asclepiades, curare cito, tide et jucunde; in other words, to enable the basis to 
cure quickly, safely and pleasantly." (Pareira.) 

Another Example will illustrate the mental operations which should always 
be followed by a prescriber; for no matter how good a memory he may have, 
he will some day make a grievous mistake if he follows the practice of writing 
prescriptions from memory. Furthermore, the unscientific character of the 
latter habit will, when appreciated, prevent any educated physician from in- 
dulging in it. Every prescription should be written with a definite purpose in 
view, consequently the mind of the prescriber should weigh each step carefully 
and should avoid all slavish subjection to ready-made formulae. 



PRESCRIPTIONS. cjoq 

Suppose, then, that we wish to order for Miss Graham an emulsion of Castor 
Oil, tlavored and sweetened so as to make it loss disagreeable to the taste than 
it naturally is. If the ingredients were simply mixed together, as in the previous 
example, the result would be an unsightly preparation, consisting of sweetened 
and Savored water with the oil floating on top. So we require that the process 
of emulsification be first accomplished, by which the oil is minutely subdivided 
and suspended in the water by the aid of the emulsifier, which may be any 
viscid excipient, as gum, soap, or yolk-of-cgg. Taking the last-named for the 
emulsifying agent, we would begin by writing down in order the following terms, 
as stated below in italics, viz. : — 

For Miss Graham. June 10th, 1905. 

1$. (Take thou—) 

Olei Ricini, (of Oil of Castor), 

Vitellum, (Yolk-of-egg), 
Tere bene simul; dein aide — (Rub well together; then add — ) 

Having gone so far, we begin to think of an agreeable vehicle, and choosing 
from the many syrups at our disposal that of Ginger, and from the flavored 
waters that of Cinnamon, we write further for these as the ingredients to be 

added, thus — 

Syrnpi Zingiberis, (of Syrup of Ginger), 
Aqua: Cinnamomi, (of Cinnamon Water). 

The ingredients are now all entered upon the prescription, but their respective 
quantities have not yet been decided upon. We proceed then by first taking into 
consideration the total quantity of the medicament required, — which, in this case, 
as the preparation is intended to purge the patient, need not embrace more 
than one or two doses. As it is well to provide for a repetition of the dose, 
in case the medicine should not act sufficiently, we will decide upon two doses 
in all. Now, the average adult dose of Castor-oil is about a tablespoonful or 
half-an-ounce, and as we want two such doses we insert the sign and numerals 
fsj, or simply 5J, opposite the title of the oil which is written in the genitive 
case. But to emulsify it properly we need about one-half as much of the emul- 
sifying agent, and we may express this by writing for half-an-ounce of yolk- 
of-egg, or for the yolk of one egg, or for one yolk-of-egg, which weighs about 
half-an-ounce. This would be expressed in Latin by either of the following 
methods, — 

Vitelli semi-unciam, ( 5ss). One-half-ounce of Yolk-of-egg. 
Vitellum ovi unius, (j). The Yolk of one egg. 
Vitellum unum, (j). One Yolk-of-egg. 

As the word Vitellus means Yolk-of-egg, we may omit the word Ovi, and 
accepting the latter as the best style, insert the numeral j opposite the word 
Vitellum, which is properly in the accusative case. The whole quantity so far 
specified is one ounce and a half, and if we add two and a half ounces of diluent 
we shall have a four-ounce mixture, or the full of a regular-sized bottle as found 
in the shops. There being considerable viscidity already present in the emul- 



I 



i 



5IO PRESCRIPTIONS. 

sion we do not need much syrup, so we assign to the Syrup of Ginger the odd 
half-ounce, leaving two ounces of the Water to make up the total bulk of four 
fluid-ounces. 

The prescription now only requires for its completion that the subscription 
and signature be added. We proceed to admonish the dispenser by telling him 
to mix the ingredients together, writing therefore the word Misce, or the abbre- 
viation M commonly used therefor; and to further point out the nature of 
the preparation we add, Let be made an emulsion, or in Latin, Fiat emulsum, — 
the passive verb taking as predicate-nominative the thing into which the making 
is to be. The final direction Label or Write thus, is expressed by the term Sig- 
netur, Let it be entitled, followed by the instructions for the patient or the person 
who is to administer the medicine, which should be in English though they 
may be written in Latin. Our completed prescription will stand thus, — 

For Miss Graham. June xoth, 1905. 

1$. Olei Ricini, 5 j- 

Vitellum, j . 

Tere bene simul, dein adde — 

Syrupi Zingiberis, oss. 

Aqua Cinnamomi, 5 ij- 

M. Fiat emulsum. 

Sig. — "One-half at once, to be repeated next day ij required." 

Potter. 

The last entry of the inscription might be written — Aqua Cinnamomi, quan- 
tum sufficiat ad giv, meaning "of Cinnamon- Water as much as may be necessary 
to [bring the whole quantity to] four ounces," usually expressed in contracted 
style, thus — 

A q. Cinnamomi, q. s. ad §iv. 

This style is preferred when any of the quantities are approximations, and 
the final item cannot be exactly stated to secure a certain total. In the fore- 
going case, the one yolk-of-egg might measure a little more than the half-ounce 
assigned to it; but by using the q. s. ad style at the end, we make sure of getting 
a total of exactly four fluid-ounces. 

The Use of Latin in Prescriptions. 

The use of the Latin language in writing prescriptions is a sore point with 
a certain class of patients who like to know what they are taking, or wish to 
exercise their critical judgment upon the prescription of a physician in whose 
learning, skill and judgment they professed to have confidence when they con- 
sulted him. This feeling crops out frequently in our State legislatures, where 
bills are periodically introduced making it a crime for a physician to write a 
prescription in any other than the vernacular tongue. It is well for the student 
to know the reasons for maintaining the use of a dead language in the ordinary 
affairs of life. These reasons are as follows : — ■ 

The names of plants vary in every modern language, and even in the same 
language several different plants not infrequently receive the same common name. 



PRESCRIPTIONS. 51 1 

For example, — the name "Starwort" is given to Aletris farinosa and Helonias 
dioica; "Colic-root" is one of the names of Aletris farinosa, also of Dioscorea 
villosa and Liatris spicata; "Mandrake" is applied to Podophyllum and Man 
dr agora; "Winter-green" to Chimaphila and Gaultheria; and "Snake-root" 
to live different plants, — Asarum, Cimicifuga, Eryngium, Senega and Serpcn- 
taria. There are many other instances of this diverse nomenclature in English, 
and as each plant has a different name in French, another in German, and still 
another in Italian, Spanish, Dutch, etc., the confusion, in so polyglot a country 
as this, would cause innumerable errors if any but a generally understood lan- 
guage were used in prescriptions. Latin is such a language, it is the accepted 
language of science throughout the world, the Latin names of plants are definite 
and cannot be confounded, and a prescription written in Latin by a physician 
of any nationality, in any part of the civilized world, can be readily understood 
and correctly compounded by a pharmacist in any other civilized country. 

Another reason, formerly more potent than at present, is the protection to 
the patient which the secrecy of a Latin prescription affords. A prescription 
ordering mercury and potassium iodide in plain language would be an awkward 
thing to send by one's child or servant to be put up, or to have ordered by tele- 
phone to be sent to Mrs. C. B. of a certain number and street. Again, there 
exists in many cases a strong prejudice against certain names of drugs, usually 
borne of ignorance but none the less potent, and in such it becomes necessary 
for the patient's good to conceal from him the name of the medicine he is taking. 
In this age of free education in all branches and the consequent smattering 
of everything possessed by almost everybody, the use of Latin does not afford 
the necessary secrecy, and the physician who does not dispense his medicines 
is often compelled to resort to private formulae deposited by him with a certain 
druggist. In France it is a criminal offense to make known or expose the con- 
tents or nature of a prescription to any person other than the party for whom 
it was written, the law recognizing the fact that prescriptions may betray secrets 
which should be carefully guarded. 

Opium, Morphine, Cocaine, and other agents likely to cause drug-habits, 
should never be ordered on written prescriptions for neurotic or hysterical 
subjects. The physician should keep such drugs in his own hands and thereby 
retain the absolute control of their administration in every case in which he 
finds it necessary to use them. He should protect his patient from such a result 
as drug-slavery by every means in his power. Many of the worst cases of the 
cocaine-habit, known to the author, were acquired by the use of cocaine in nasal 
sprays prescribed by physicians; and similar methods are responsible for many 
of the wrecks made by indulgence in opium and morphine. 

There is no royal road to prescription-writing; practice, care and knowledge 
of the whole subject are necessary to enable one to turn out habitually those 
elegant prescriptions which are properly termed "magistral," being the work 
of a magister or master of his business. A fair knowledge of the Latin language 



512 PRESCRIPTIONS. 

is a sine qua non to every professional man but especially to the physician. It 
is pitiable to see a Doctor write ignorantly of even the genitive case endings 
of the drug-names which he uses. The teaching of Latin is not within the 
scope of this work, and this part of the subject will be concluded with the advice 
to the physician who is ignorant of that language to write his prescriptions 
wholly in English if he cannot write them in decent Latin. A very full table 
of the Latin words, phrases and contractions used in prescription-writing, also 
a table of genitive case endings, will be found in the Appendix; but for a com- 
plete treatment of the subject the reader should consult Pareira's Seleda e Pra- 
scriptis, in which every detail of prescription-writing is explained. 

Principles of Combination. 

The principles of combination are so well laid down by Dr. H. C. Wood, 
that his words are appended verbatim, as follows : — 

The art of combining medicines is not a difficult one; but in practice certain 
principles should not be lost sight of. Chief of these are, to prescribe as few 
remedies as possible, and to use no powerful drug without a very distinct idea 
of what it is intended to do. Whenever it is desired to give a powerful remedy 
in increasing doses until its physiological effect is produced, it should always 
be given by itself. Thus, it may be necessary to give Arsenic so as to impress 
the system, at the same time that Iron is indicated; but the two remedies should 
be given separately, so that the dose of either can be increased or diminished 
independently of the other. The principles of combination formulated below 
were long ago enunciated by Dr. Paris, but are today as imperative as ever. 
Medicines are combined— . 

First. To augment, correct, or modify the action of a medicine. Thus, 
purgatives act much more kindly when a number of them are united together. 
The chief reason of this probably is, that as different remedies affect different 
portions of the gut, the whole intestine is best reached by a union of the diverse 
substances. It may take an intense irritation of the mucous membrane to purge 
as actively as does a mild irritation of both the mucous membrane and the 
muscular coat. 

There are powerful medicines which act similarly upon some parts of the organism but 
dissimilarly upon other parts. By combining such remedies powerful effects can be obtained 
at the points where the two lines of action cross each other, without influencing to a great ex- 
tent other portions of the system. Thus, Chloral produces sleep by its action upon the brain, 
and also has a distinct influence upon the heart but none upon the intestinal tract. Morphine 
acts upon the brain and does not influence the heart, but has a powerful effect upon the intes- 
tinal tract. By combining Chloral and Morphine we get an overwhelming conjoined influ- 
ence upon the brain in producing sleep with the least possible disturbance of the heart and of 
the intestinal tract. 

Secondly. To obtain the joint action of two or more diverse remedies. 
Thus, in a cough mixture Morphine may be included to quiet the cough, whilst 
Ipecacuanha and Squill (in accordance with the first principle) are added to 
affect the mucous membrane. The application of this principle requires caution, 



PRESCRIPTIONS. 513 

or the practitioner will be led into that chief abomination polypharmacy. It 
is worse than futile to attempl to prescribe for every symptom. The under 
lying cause of the disorder or the understratum of bodily condition must be 
sought out and prescribed for simply. 

Thirdly. To obtain a special combination, which is really a new remedy, 
or which experience has shown acts almost as a new remedy. Thus, when 
to Iodide of Potassium in solution Corrosive Sublimate is added, a new chemical 
compound is formed, which experience has shown to be of great value in syphi- 
litic diseases. Griffith's antihectic mixture is another instance of the use of 
chemical changes, the Proto-carbonate of Iron being formed out of the Sulphate 
of the metal and the Carbonate of Potassium. In the famous Dover's powder 
no chemical change occurs, but the ordinary action of Opium upon the skin 
is so enhanced that the combination may be looked upon almost as a new remedy. 

Fourthly. To afford a suitable form. Thus, Acacia is added to make an 
emulsion or Confection of Rose to make a pill. In the choice of excipients 
care should be exercised to select a substance free from medical properties, 
having no chemical incompatibility with the medicinal agent, and of suitable 
physical character. Bread crumbs often make a good basis for pills, but with 
Xitrate of Silver they are chemically incompatible, on account of the chlorides 
in them. 

When writing a prescription, the utmost care should be taken to use such excipients that 
the combination should not only be attractive to the eye, but also as little repulsive to the 
palate as may be. Whenever possible, the pill-form should be employed with bitter or dis- 
agreeable medicines. The pill may be readily coated with silver-foil; tonic pills may be 
coated with Iron by shaking or rolling them in Ferri Pulvis while soft and sticky. Sugar- 
coated pills and "compressed pills" are apt to get so hard and insoluble that their use re- 
quires caution. In regard to mixtures, flavoring oils should be freely used, and the power 
of Glycerin to conceal the disagreeable taste of many substances should be remembered. 
{Wood's Therapeutics, nth edition, page 68, el seq.) 

Metric Prescriptions. 
Metric prescriptions are written or compounded with sufficient accuracy 
by considering a Milligramme as equal to the -g^th of a Troy grain, a Gramme 
as equivalent to 15 Troy grains, and a Cubic Centimeter (fluid gramme, milli- 
leter) as equal to 15 minims or |th of a fluidrachm. All other metric terms, 
units and prefixes may be wholly ignored by the physician and the pharmacist. 
In fact the terms centigramme and decigramme are rarely used at all, the former 
being generally expressed by 10 milligrammes and the latter by 100 milligrammes. 
The term gramme when abbreviated is printed and written Gm., the term milli- 
gramme, Mg., and the term cubic centimeter, Cc; always beginning with a 
capital. In expressing quantities by metric weight or measure in writing the 
common or Arabic numerals are used, and are always placed before the term 
or abbreviation designating the unit, thus — 2.50 Gm., 30 Cc. When apothe- 
caries' weight is employed the numerals are placed after the sign or symbol 
designating the unit, and in Roman characters, thus — gr. x, 9ij, 3jss, jfvj, 
always using a small g in gr. The decimal point after the figure representing 
34 



< 



514 PRESCRIPTIONS. 

the number of grammes or cubic centimeters should be replaced by a line, in 
order to avoid such errors as might arise from the misplacement of a point, 
the dropping of ink, or the intrusion of a fly-speck, which might cause serious 
results in many cases. The simplest rule for writing a prescription in metric 
terms by one who is not practiced in the use of the system, is the following, — 

Write as though prescribing but one dose of each ingredient in grains or 
minims and decimals thereof; then substitute the term grammes or cubic centi- 
meters for grains or minims, and the prescription is correct for 15 doses in metric 
terms. 

Of course, when writing for a mixture or solution, the proper quantity of 
vehicle must be added to complete the one dose, and must also be expressed 
first in grains or minims. For example, — 

One dose. 15 doses metric. 

1$. Quininae Sulphatis, gr. j, 1 

Strychninae Sulph., gr. j'^or 0.016 016 

Fluidextr. Glycyrrhizae, njjiv, 4 

Syrupi, ttjjLx, 60 

This gives a two-ounce mixture approximately, of which the dose would be a teaspoonful. 

One dose. 15 doses metric. 

J£. Quininae Sulphatis, gr. j 1 

Massae Ferri Carb., gr. ij, 2 

Extr. Nucis Vomicae, gr. \ or 0.25, 25 

Ft. pil. no. xv. Sig. — One pill thrice daily after meals. 

The above rule will answer for all liquids except those which are very heavy, 
as Syrups and Chloroform, or very light, as Ether. Measures may be entirely 
discarded, and all fluid quantities expressed in grammes. The average drop 
of water may be considered equivalent to 0.05 cubic-centimeter (50 milligrammes), 
the average teaspoonful to 5 Cc, the tablespoonful to 20 Cc, the Troy 5 to 30 
grammes, the fluidounce to 30 Cc, and 8 fluidounces to 250 Cc. 

In prescribing Syrups or Chloroform, each Troy fluidounce should be reck- 
oned at something more than 30 grammes — say 40; and if this be done, the 
difficulty of converting one scale into the other will be obviated. The following 
table shows the actual weight in grammes of one or more fluidounces of the 
substances named: — 



Fluid oz. 




Water. 
(Grammes.) 


Tinctures. 
(Grammes.) 


SjTUp. 

(Grammes.) 


Chloroform. 
(Grammes.) 


Ether. 
(Grammes.) 


Si- 

oii- 

3iv. 


= 


29.52 

59-04 

118.08 


28.00 

56.00 

II2.O0 


38.00 

76.00 

152.00 


43-7° 

84.40 

174.80 


22.14 
44.28 
88.56 


.§viii. 


= 


236.16 


224.00 


304.OO 


349.60 


177.12 



Tables of equivalents between apothecaries' and metric weights and measures 
will be found in the Appendix, and on the inside of the cover of this book. 

Abbreviations. 
Abbreviations, though very commonly used by physicians in prescribing, 
are a source of much annoyance to the compounder, and frequently one of great 



PRESCRIPTIONS. 



515 



danger to the patient. Physicians who never know anything of the Latin gram 
mar, or those who have forgotten its rules, are very apt to use abbreviations 
to conceal their ignorance of case-endings. Many others use them through 
sheer laziness and some from force of habit. The educated and conscientious 
man will take pride in turning out a full and clear prescription, free from cabal- 
istic letters and all elements of uncertainty. In the Appendix will be found 
a list of the Latin terms used in prescriptions, with the abbreviations in vogue 
and the English meanings. Ambiguous contractions may result fatally to the 
patient, as is readily seen by studying the following list, which gives a few ex- 
amples of the dangers of careless abbreviation: — 



A co nit., 
Amnion 



Ac hi. Hydroc. — may mean 

I Aconitine. 
* \ Aconitum. 

J Ammonia. 
" \ Ammoniacum. 
■ , ,., ■ ( Aqua Chlori. 

1 Aqua Chloroformi. 

. - . ■ f Might easily be read 

Aq. Fonlts, -i P ,-. -. 

t Aqua e ortis. 

( Chlorine. 
Chlor I Chloral. 

( Chloroform. 

f Calomel. 
Hyd. Chlor., -j Corrosive Sublimate. 

1 Hvdrated Chloral. 



( Acidum Hydrochloricum. 
\ Acidum Hydrocyanicum. 

Hydrargyrum. 



Hydras. 

Hydriodas. 

Hydrochloridum. 

Hydrocyanidum. 

Sodium Sulphate. 

Sodium Sulphite. 

Sodium Sulphide. 

Sulphur. 

Sulphide. 

Sulphate. 

Sulphite. 

ZinciPhos., I Zj"c Phosphate. 

(. Zinc Phosphide. 



Hydr.,. 



Sod. Sal ph.,. 



Sul ph., 



Renewals of Prescriptions. 

It would be advisable for physicians to always write the words Non Repe- 
latnr, or some similar direction, on all prescriptions which should not be re- 
peated without their sanction. By so doing they would doubtless cut off a 
good many renewal charges from the receipts of druggists who might fear the 
legal consequences of disobeying the mandate. This inconvenience to the 
drug-seller would be more than compensated for in the advantage resulting to 
the drug-taker, who too frequently carries in his pocket-book a stock of receipts 
for his various complaints; and in protection to the physician, who by giving 
up the dispensing of his own medicines has placed it in the power of the druggist 
to connive at direct robbery of the just reward of professional skill and knowledge. 

It is doubtless a fact familiar to every observer, that the old-time confidential 
relations between the professions of physician and pharmacist have almost 
passed into oblivion. In fact, the tendency of pharmacy now-a-days is towards 
the position of a mere money-making trade, instead of in the exalted direction 
of a profession. The indiscriminate renewing of prescriptions, the open sale 
of quack nostrums and homeopathic pellets, the readiness with which counter- 
prescribing is indulged in, the insinuations too frequently made over the drug- 
counter in reflection on physicians, and many other similar practices, have 
caused the non-combatant profession to regard the average druggist with sus- 
picion. If physicians boldly took the dispensing of medicines more into their 



516 PRESCRIPTIONS. 

own hands many of these evils would soon eliminate themselves from the drug- 
stores. Right here it may be said that there is nothing unprofessional or deroga- 
tory in the dispensing of his own medicines by the physician. In England it 
has been the universal practice for centuries in all places except the largest 
cities, and it has been given up by a part of the medical profession only as a 
matter of convenience to themselves, not as a right belonging to the pharmacist. 
The homeopaths fought for the reclamation of this practice as a right belonging 
to the medical profession, and succeeded in securing its legality, but not from 
a worthy motive. They dispense their own medicines in order to cover up the 
fraudulent practices of which they are often guilty, and to give them the power 
of administering full doses of powerful drugs in a form which is apparently 
"homeopathic," with no tell-tale prescription on file in a drug-store to give 
mute but dangerous evidence against their honesty. In this way they administer 
several grains of calomel or eighth-grain doses of morphine, or correspondingly 
large quantities of active alkaloids, triturated with sugar of milk, or dissolved 
as many of the latter may be in alcohol. Chemistry, by isolating the active 
principles of plants, and furnishing them to commerce in the form of soluble 
salts, has enabled the homeopath to practice this fraudulent method of dispens- 
ing drugs, which the innocent and ignorant patient, who believes in the power 
of the minimum dose, supposes to be infinitesimal in amount. But the physician 
of the regular profession is too apt to think that if he uses a practice which 
charlatans have appropriated to themselves, he may be classed with them by 
his professional competitors. Hence, many regular physicians are absolutely 
afraid to use such drugs as Aconite, Belladonna, Gelsemium, and Arnica, all 
of which are official, and older in medicine than homeopathy; and avoid pocket- 
cases, drachm-vials and triturations, as badges of charlatanism. It is high time 
that we asserted our independence in all these matters, and made use freely 
of those means which are recommended by our individual judgments as pro- 
motive of the best results to our patients and to ourselves. With a small stock 
of reliable fluidextracts, and an equally moderate supply of gelatin-coated pills 
and compressed tablet-triturates from the best houses, physicians could check- 
mate the unscrupulous practices of many druggists to a great extent, save their 
patients many dollars, and retain many a dollar for their own pockets which 
under the present system goes to their enemies. The homeopaths understand 
the money part of the argument well. When their patients : medicine is ex- 
hausted, the doctor must be seen for a fresh supply, meaning of course another 
consultation about symptoms, a change perhaps from Mercurius Dulcis to 
Mercuriiis Vivus, and another fee. The expense is nothing, sugar of milk being 
cheap, and there is no prescription in the patient's pocket-book, to be renewed 
scores of times (paying toll however every time to the druggist), and finally to 
be copied by aunts, mothers, and friends, as a "sovereign remedy" for a cough, 
or a "really wonderful receipt" for a case of croup. 



i\ro\ir\i nui i r\ . 



5' 7 



Prescription I'.i l\KS. 

After many years' experience in prescribing on blanks furnished by drug- 
gists, the writer has come to the conclusion thai it is much belter, for many 
reasons, for the physician to have his own blanks, without the address of any 
drug-store thereon. These blanks should be furnished with stubs on which 
to write the prescription at first in rough, afterwards copying it out cleanly 
on the main blank. A careful prescriber always writes a formula twice before 
letting it go out of his hands. It he does the first writing on the stub of a book, 
of blanks he will always have a copy of the prescription in his possession, for 
which he may afterwards be thankful. The blank used by the writer measures 
4\ inches by 3 J, joined by a perforated edge to a stub 3 J inches by 2\ inches. 
On the main blank the physician's name and address are printed, together with 
his office-hours, and a place for number and date, also the sign !£., and a line 
for signature. On the stub are printed the words, "Copy of Prescription 
No For " 

These blanks are bound up in books of 100 each, with a flexible morocco 
cover, from which the book of stubs may be slipped and a fresh book inserted 
as required. The size is ample for all ordinary requirements, and permits of 
the book being carried in the breast-pocket. 



I 



i 



< 



INCOMPATIBILITY. 



Incompatibility may be Chemical, Pharmaceutical or Therapeutical, 
according as the prescribed combination results in chemical decomposition, 
physical disassociation or antagonistic action. In the first case the incompati- 
bility may be unintentional or intentional on the part of the prescriber, for in 
many cases the result of the chemical action affords the substance desired. 

Instances of intentional incompatibility are the mixtures of Calomel or Corrosive Sub- 
limate with Limewater, producing the Black and Yellow Oxides of Mercury respectively 
and commonly known as Black Wash and Yellow Wash. Such a combination should not 
be filtered (as a novice might suppose), but should be dispensed with a Shake-label, in order 
that the precipitate may be uniformly distributed before using. 

Chemical Incompatibility generally results from neglect on the part of 
the prescriber of the most common chemical reactions, such as that — 
Acids tend to combine with bases and to form salts. 
Weak acids or bases are displaced from their combinations by stronger ones, 



518 INCOMPATIBILITY. 

so that salts in solution when brought together generally exchange their radicles, 
especially if by doing so an insoluble compound can be formed. 

A salt in solution is easily decomposed by a strong alkali if the salt is one 
having a weak or volatile base. 

A substance in solution may be decomposed by another without precipitation, 
the product being soluble in the solution. 

Alkaloidal salts are precipitated from their solutions by the addition of fixed 
alkalies, their salts, or salts which produce insoluble compounds. Oxides of 
the fixed alkalies decompose salts of the metals proper and those of the alkaloids, 
precipitating their bases; but the base may be soluble in excess of the alkali. 

Tannic and Gallic Acids and vegetable substances containing them pre- 
cipitate albumin, alkaloids and most of the metallic oxides, and form ink}- solu- 
tions when brought into contact with the persalts of Iron. Tannic Acid pre- 
cipitates gelatin. 

Glucosides are incompatible with free Acids and with Emulsin. 

Examples of the neglect of these principles are seen in the prescribing of Quinine Sul- 
phate in mixture with Potassium Acetate, resulting in a voluminous precipitate of Quinine 
Acetate which cannot be poured from the bottle; — Vinegars or Syrups containing Acetic 
Acid (Syr. Allii, Syr. Scillae) added to a solution of alkaline carbonates, causing decomposi- 
tion of the latter with evolution of C0 2 ; — the addition of Liquor Potassii Hydroxidi to a solu- 
tion of Ammonia-alum, setting free gaseous ammonia; the mixing of Strychnine Sulphate 
and Potassium Bromide in solution, causing the decomposition of the alkaloid sulphate and 
precipitation of strychnine; — preparations of Cinchona with salts of Iron, forming an inky 
tannate of iron; — Elixir of Chloral with Alkalies, causing the elimination of chloroform and 
its subsequent evaporation. 

Insoluble Salts. — The following more or less insoluble salts will be formed 
whenever the materials of which they are composed are brought together in 
solutions: — the Hydroxides, Carbonates, Phosphates, Borates, Arsenates and 
Tannates of most earthy and heavy metals and alkaloids, and the metallic Sul- 
phides; the Sulphates of Calcium and of Lead, and the subsalts of Mercury; 
the Chlorides, Iodides, and Bromides of Bismuth, Silver, and Lead; the Iodides 
of Quinine, of Morphine, and of most alkaloids. 

Instances are — Limewater or Aromatic Spirit of Ammonia with Tincture of Chloride of 
Iron or solutions of Mercury salts, or neutral solutions of Quinine or Morphine salts. 

Ammonium, Potassium, and Sodium Carbonates or Bicarbonates with Limewater. 

Solutions of Magnesium Sulphate, Alum, Zinc Acetate or Sulphate, with solutions of 
salts of Iron, Manganese, Bismuth, Antimony, Lead, and most alkaloids. 

Ammonium or Sodium Phosphates with solutions of Iron Salts, with Limewater, solu- 
tion of Magnesium Sulphate, of Alum, etc. 

Liquor Potassii Arsenitis with Limewater, with solutions of basic salts of Iron, and with 
solutions of neutral salts of Quinine and Morphine, etc. 

Solutions, Decoctions, Tinctures, and Extracts containing Tannic Acid with solutions 
of salts of Iron, Mercury, Antimony, Lead, also with solutions containing albuminous sub- 
stances and Gelatin. 

Limewater with solutions of Quinine Sulphate or Morphine Sulphate. 

Solutions of Lead Acetate with Zinc Sulphate or Alum. 

Sodium Chloride with Silver Nitrate. 

Morphine Hydrochloride with Lead Acetate. 

Alkaline Iodides or Bromides with Bismuth Carbonate or Subnitrate, with Lead Acetate, 
with Subchloride of Mercury, or with neutral solutions of Quinine, Morphine and Strychnine 
salts. 



i\> durvniiii i rv. 



5*9 



Table of Precipitant Solutions. 

The following table shows the most important instances of solutions which mutually 
precipitate each other, the letter P meaning "forms a precipitate with" — 



Solutions of 



Alkalies P 

Tannic Acid, P 

Carbonic Acid and Carbonates P 

Sulphuric Acid and Sulphates, 

Phosphoric Acid and Phosphates P 

Boric Acid and Borates, P 

Hydrochloric Acid and Chlorides 

Hydrobromic Acids and Bromides, I 

H y d riodic Acid and Iodides, I P 

Sulphides 

Arsenical Preparations, . 

Albumin, 



r* w 3 





> 

£^ 
J" 5 

3 

"o 
ts> 

P 
P 
P 

P 
P 
P 

P 
P 
P 
P 
P 
P 


e 

3 

•o 

IS" 5 
5 

•a 

_3 
O 
(/} 

P 


i 

a 

M 

■a a 

3 

"o 
</3 


-Q 
« 

o 

■= 

3 

3 


•i 

3 

o 

'o 

o 
•a 

3 




P 








p 


P 




P 
P 
P 


P 










P 



















































































Explosive Compounds result from the admixture of powerful oxidizing 
agents with substances which are readily oxidizable. The most important 
members of these two classes are as follows:— 



Oxidizers. 
Chlorine and its Oxides. 
Free Hydrochloric Acid. 
Xitro-hydrochloric Acid. 
Chlorates. Hypochlorites. 
Chromates. Chromic Trioxide. 
Permanganates. 
Nitric Acid. Nitrates. 
Bromine. Bromates. 
Iodine. Iodates. 
Silver Oxide. 
Peroxides (Dioxides). 



Oxidizable, {Combustible) . 
Phosphorus. Hypophosphites. 
Sulphur. Sulphides. 
Glycerin. Sugar. Alcohols. 
Oils. Ethers. Tannin. 
Cork. Charcoal. Creosote. 
Dry Organic Substances. 
Powdered Iron and Zinc. 
Arsenic Trioxide. 
Cyanides. 
Oxalates. 
Ferrous, Mercurous and Stannous salts. 



Explosions have resulted from mixing Fluidextract of Uva Ursi with certain samples 
of Spirit oj Nitre, Chromic Trioxide with Glycerin, Potassium Permanganate with Glycerin, 
Nitric Acid with Glycerin, Silver Nitrate with Creosote, Silver Oxide in pill with Extract of 
Gentian, Potassium Chlorate with Glycerin and Tincture of Ferric Chloride. Calcium 
Chloride triturated with Sulphur in a mortar has exploded, so also has Calcium or Sodium 
Hypophosphite when triturated alone. Tincture of Iodine with Ammonia forms the Iodide 
of Nitrogen, which is highly explosive, especially if triturated in the presence of water. Cate- 
chu and Potassium Chlorate in a dentifrice have exploded in the mouth from the friction pro- 
duced by a dry tooth-brush. Lozenges of Potassium Chlorate, carried in the pocket with a 
box of safety matches, have exploded by rubbing against the composition on the outside of the 
box, causing an extensive burn of the thigh. 

Hydrogen Dioxide is peculiar in that it acts both as an oxidizer and as an oxidizable 
agent. It reduces oxidizing agents and is itself reduced at the same time, hence it is incom- 
patible with all the substances mentioned above. Nitrites may act in the same way under favor- 
able circumstances. 

Poisonous Compounds may be formed by the admixture of many sub- 
stances in solution, such as — 



520 INCOMPATIBILITY. 

Potassium Chlorate with Potassium Iodide, in solution together do not react 
at ordinary temperatures, but in the system they evolve a poisonous agent, 
probably Potassium Iodate. 

Potassium Chlorate with Syrup of Ferrous Iodide, liberates Iodine from the 
iodide in the warm stomach, causing severe gastric irritation, perhaps gastritis 
of dangerous degree. 

Dilute Hydrocyanic Acid or Potassium Cyanide with Calomel, forms the 
Bichloride and Bicyanide of Mercury, both virulent poisons; — with metallic 
hydroxides, carbonates, sub-nitrates or sub-chlorides, cyanides of the metals are 
formed which are even more poisonous than the acid itself in its usual diluted form. 

Pharmaceutical Incompatibility differs from chemical incompatibility 
in the absence of chemical action, and is generally produced by adding one 
substance to another which, through differences in solubility, cause a precipita- 
tion of solid matter or a separation of part of the liquid. The separated con- 
stituents may be active and hence important, or inert and therefore unimportant. 

Instances of this are — the addition of an acid to a Quinine and Licorice mixture, result- 
ing in precipitation of the Glycyrrhizin (relied on to cover the taste of the Quinine) by the acid; 
or the use of Quinine, Tincture of Ferric Chloride and Licorice together; or the prescribing 
of solutions of Chloral and Potassium Bromide with an alcoholic preparation, the Chloral 
separating to the top as an alcoholate, and therefore dangerously in excess for the first few 
doses; or the neglect to prescribe Acacia or some other emulsifier in mixtures of an alcoholic 
fluidextract of a resinous body with an aqueous preparation, which would result in the separa- 
tion of the resin to the surface and an overdose with the first teaspoonful. 

When a fluidextract is diluted with a liquid differing in composition from 
those used in the fluidextracts, the gum, albumin, resin and mucilage are often 
separated. In such a case as Fluidextract of Cannabis Indica the active resin 
would be thrown out of its alcoholic solution and floating on top might cause 
serious symptoms; but in many other instances the precipitate would be inert 
and filtration would be in order. Water is the solvent for albuminous, gelatinous, 
gummy and saccharine bodies and for a large number of inorganic salts; while 
Alcohol is the solvent for volatile oils and resins, gum-resins, resinoids, balsams 
and all drugs containing these as their active principles. The solvent power 
of either Alcohol or Water for their particular substances decreases in proportion 
to the amount of the other added. 

Instances oj Pharmaceutical Incompatibility. 
Resinous Tinctures or Fluidextracts with aqueous solutions. 
Tincture of Guaiac with Spirit of Nitrous Ether. 
Compound Infusion of Gentian with Infusion of Wild Cherry. 
Compound Infusion of Cinchona with Compound Infusion of Gentian. 
Essential Oils with aqueous liquids in quantities exceeding i drop to oj- 
Fixed Oils and Copaiba with aqueous liquids (except excipients). 
Tinctures made with Alcohol with those made with Diluted Alcohol. 
Alcoholic Tinctures and Fluidextracts with aqueous preparations. 
Spirit of Nitrous Ether with strong mucilages. 
Infusions generally with metallic salts. 

Therapeutical Incompatibility arises when two agents are administered 
together which oppose each other in their action on the human system. — as 



[NCOMPA riBIl l l \ 



>-' 



for instance Belladonna in any form with Physostigma. Bui in mam cases 
physiological antagonists are designedly prescribed together, one as a guard 
against the action of the other, as the hypodermic administration of Morphine 

and Atropine. The antagonists to each of the active medicinal agents may hi' 

Found in Part III, under the title Poisoning. They are summarized in the 
table of antagonistic poisons on page [9. 

Dangers of Incompatibility may in great measure be avoided by the use 
of the utmost simplicity in prescribing. The subject can only he glanced at 
within these pages, but the following simple rules may help the burdened memory 
of the student and practitioner. 

Never use more than one remedy at a time, if one will serve the purpose 
for which you are prescribing. 

Never use Strong Mineral Acids with other agents, unless you know exactly 
what reaction will ensue. They decompose salts of the weaker acids, and form 
ethers when combined with alcohol. Never combine Free Acids with hydroxides 
or carbonates. 

Select the simplest solvent, diluent or excipient you know of, remembering 
that the solvent power of alcohol and of water for their respective substances 
decreases in proportion to the quantity of the other added. 

Generally do not combine two or more soluble salts; for such salts in solu- 
tion, when brought together, usually exchange their radicles thereby forming 
an insoluble compound, (see page 518). 

Never prescribe a drug with any of its Tests or Antidotes. 

Never prescribe a Glucoside, as Santonin, Colocynthin, in combination with 
Free Acids or with a substance containing Eimdsin, as these agents will de- 
compose it. 

Aconite should be ordered in water alone, Corrosive Mercuric Chloride by 
itself in water or in simple syrup. The latter drug is incompatible with almost 
everything, even the compound syrup of sarsaparilla being said to decom- 
pose it. 

Potassium Iodide decomposes most of the metallic salts, and is one of the 
drugs which are best administered alone. 

The following-named substances are incompatible with so many others 
that they should always be prescribed alone; they are best given in simple 
solution: — 

Alum. Morphine Acetate. 

Dilute Hydrocyanic Acid. Morphine Hydrochloride. 

Dilute Nitro-hydrochloric Acid. Quinine Sulphate. 

Sulphuric Acid. Liquor Calcis. 

Mercuric Chloride (Corr. Sub.). Liquor Potassii Hydroxidi. 

Iodine and Iodides. Liquor Potassii Arsenitis. 

Syrup of Ferrous Iodide. Liquor Ferri Nitratis. 

Potassium Permanganate. Tinct. Ferri Chloridi. 

Potassium Acetate. Zinc Acetate. 

Potassium Bromide. Iron and Quinine Citrate. 

Tartar Emetic. Free Chlorine in solution. 

Tincture of Guaiac. Tannic and Gallic Acids. 



i 



i 



522 EXTEMPORANEOUS PHARMACY. 

Silver Nitrate and Lead Acetate and Subacetate, though incompatible with 
almost everything, may be combined with Opium, the latter forming therewith 
a compound which though insoluble is therapeutically active as an astringent 
and anodyne lotion. Silver Nitrate with Creosote forms an explosive compound. 

Tannic and Gallic Acids, and substances containing them (as the astringent 
bitters), precipitate albumin, alkaloids and most soluble metallic salts. They 
may be prescribed with the proto-salts of Iron, but not with its per-salts. Ca- 
lumba is the best vegetable tonic to use with ferric salts, as it contains neither 
tannic nor gallic acid. Tannic Acid precipitates gelatin. 

Iodine and the soluble Iodides are incompatible with the alkaloids and sub- 
stances containing them, also with most metallic salts. 

Alkalies neutralize free acids, and precipitate the alkaloids and the soluble 
non-alkaline metallic salts. Oxides of the Alkalies decompose salts of the metals 
proper and salts of the alkaloids, precipitating their bases; but the base may 
be soluble in an excess of the alkali. 

Resinous Tinctures or Fluidextracts, (e. g., Tinct. Cannabis Indicse), when 
combined with aqueous solutions should always have Acacia or some other 
emulsifying agent added, to prevent the separation of the resin, which otherwise 
will be deposited on the sides of the bottle or will float on top of the mixture. 

Tincture o) Digitalis should not be mixed with aqueous or syrupy solutions, 
for in such cases precipitation or decomposition of the active principles may 
occur. This tincture is injured by admixture and is best administered on sugar 
or dropped on a piece of bread. 



EXTEMPORANEOUS PHARMACY. 



This is the most important division of Pharmacy, embracing as it does the 
preparation and dispensing of those medicines which are designed for immediate 
use and are compounded on the prescriptions of physicians. Hence it com- 
prises the chief portion of the daily work of the pharmacist, and can be learned 
only at the dispensing counter under the personal supervision of a competent 
master. In the following pages are given the most important of the general 
directions pertaining to this subject, with the object, so far as the limits of the 
book will admit, of enabling the young medical practitioner to familiarize him- 
self with the compounding and dispensing of drugs. The drug-store of the 
present day has degenerated so much from its legitimate business that ere long 
physicians will be compelled in self defense to dispense their own medicines, 
thereby protecting themselves and their patients from the patent-medicine 
vending, the counter-prescribing, and the many other nefarious methods which 



EX 11 UPOB VNEOl s ni \km \cv. 

have degraded the pharmacist from his old professional position to that of a 
mere trader in drugs and nostrums. The first outfit of every young doctor 
should include a few pharmaceutical instruments and a small stork of drugs. 

Bj the daily handling of these, the tools of his profession, he will insensibly 
become familiar with the technique of the art, and even if he does not continue 
to dispense his medicines in after years he will never regret possessing the prac- 
tical knowledge which such a course will give him. 

Compounding means the mixing or preparing of the drugs ordered in a 
prescription, and comprises all the operations of official pharmacy together with 
many other manipulations which will be described in their appropriate places. 

Dispensing is the operation of putting up and issuing the drugs ordered 
in a prescription, and may apply to the already compounded preparations of 
official pharmacy as well as to those prepared extemporaneously. 

Filling a Prescription means a combination of operations which requires 
great care, undivided attention, and a special practical apprenticeship at the 
dispensing desk. In the following discussion of extemporaneous preparations 
such hints are incorporated as are particularly applicable to the compounding 
of each article under consideration; and they may be prefaced by a few general 
suggestions which will serve to point out the most approved method of dealing 
with this important part of the druggist's work. 

The prescription should first be slowly read over in a critical spirit, but no 
word or action of unfavorable criticism should reach the ears or eyes of the 
messenger. To shrug the shoulders when scanning the items, to laugh or even 
smile at the phraseology, to question the person offering it as to whom it is 
for, or for what complaint it is given, are instances of such flagrant treason to 
the prescriber as would justify the most complete professional ostracism of the 
offender. The compounder has no business whatever with the propriety of the 
prescription for its purpose. It might have been given as a placebo for reasons emi- 
nently wise and judicious; or if not so constituted it has at least been ordered 
by one who is in possession of facts about which the druggist knows nothing, 
even if by education and experience the latter were competent to judge in the 
matter, which he seldom is. His criticism should be directed only to the dosage 
and the pharmaceutical compatibility of the ingredients. Even in the latter 
case he must remember that incompatibles are often prescribed with the view 
of forming another agent by the chemical reaction produced. If he thinks that 
there is any mistake, or that the quantities ordered are in any degree poisonous, 
it is his duty to make an excuse for delay to the messenger and at once com- 
municate with the physician. This course, in these days of telephones, is nearly 
always practicable. 

After reading the prescription, it is well to first number it and then write 
the label. This gives time for the label to dry, and avoids the use of blotting 



524 EXTEMPORANEOUS PHARMACY. 

paper, which often mars the writing and renders the directions all but illeg- 
ible. 

A clearly defined method should then be decided on by which to compound 
the prescription. Directions for such plans of procedure will be found in the 
succeeding pages under the titles of the various preparations. Next, the ingre- 
dients should be carefully weighed or measured out, each one being checked 
off so as to avoid the danger of its being duplicated. In many cases the ex- 
cipient is not specified, its choice being left to the druggist; but in all such a 
note should be made on the prescription to show the article used, in order that 
in the event of a renewal being ordered there may be no perceptible difference. 
No alteration or addition should be made which would in any degree affect 
the medicinal action of the prescription or interfere with the intention of the 
prescriber. 

The labelling of the package and the numbering and filing of the prescription 
are matters of mechanical detail which are best learned at the counter. Various 
devices for simplifying these operations are in vogue and may be seen in any 
well-appointed drug-store. Poisonous articles sold by druggists should always 
be labelled Poison, and the transaction entered in a book usually required by law 
to be kept for that purpose; but in the case of prescriptions the word "Poison" 
should not appear on the package or label unless so directed by the prescriber. 

Stock Solutions of the salts most frequently prescribed are kept in many 
establishments for convenience in dispensing. Those most generally used are 
the following: — 

Alum, — oijss in a quart of distilled water. Of this solution each fluidounce repre- 
sents oss of the salt. 

Potassium Bicarbonate, — oj in f oiv of distilled water; of which 5ss contains 5j 
of the salt. 

Potassium Chlorate, — 1 in 24 of distilled water, will not crystallize as the temperature 
changes. 

Potassium Bromide, — 1 in 6 of distilled water, makes a very convenient solution for 
dispensing purposes, each 5 containing 10 grains of the salt. 

Hydrated Chloral, — 1 in 1 of distilled water, of which each minim contains one grain of 
Hydrated Chloral; or 1 in 6 of distilled water, of which each 5 contains 10 grains. 

Morphine Sulphate, — gr. xvj in oj of distilled water, with a grain of Salicylic Acid or 3 
drops of Phenol to prevent change. Of this solution, known as Magendie's, each minim 
contains gr. -^ of the salt, and ttjx contain gr. \. A safer solution, as it requires less mental 
calculation, is one of one-half the above strength, viz. — gr. viij in oj, of which each fluid- 
drachm contains gr. j of Morphine Sulphate. 

Phenol, — oj in f oiv of glycerin, makes a convenient solution which will mix with water 
in all proportions. Ttjjivss represents gr. j of Phenol. 

Tannic Acid, — oj in f oiv of glycerin, dissolved by the aid of a gentle heat. igjivss 
represent gr. j of Tannic Acid. 

Rules for the Pharmaceutical Student. The following rules are quoted 
from the Chemist's and Druggist's Diary, and are well worth remembering by 
the student : — 

Read a prescription through rapidly and in a manner suggesting no suspicion or doubt. 
Write directions invariably before dispensing. Avoid thus the use of blotting-paper; 
a good dispenser uses almost none. 



01 I HI \1 I'll \KM \('Y. 



5 = 5 



If a mixture contains readily soluble ingredients, never use a mortar. 
Avoid effecting solution by heat, for fear of recrystallization. 

With syrups and also ingredients not water, arrange in dispensing to rinse out the m< 
.mil leave it clean; a skilled dispenser shows very little tr.u es of his work. 

Carefully clean and put away weights and seales after each operation. 

Hold the seales firmly by the left hand, never lift them high above the 1 otintcr, and judge 
of the weight as much by the indicator as lw tin- position of the scale. 

Seleet glass pans for seales, preferably of heavy make, and discard flimsy brass material, 
which eorrodes speedily and becomes inaccurate. 

Learn to judge of the quantity to be weighed with tolerable accuracy; train the 1 
well as the hand. 

If in doubt, always begin with that about which you have no doubt. 

Be rapid in manipulation. Finish wrapping, tying, or sealing quickly. Slowlv dispens- 
ing is bad dispensing, and arises either from deficient practice or want of knowledge. 

Never hesitate when in doubt to ask advice from a fear of compromising your own dignitv. 



OFFICIAL PHARMACY. 



Official Operations are those processes which are directed in the pharma- 
copoeia to be used in the preparation of medicines. Many of them are processes 
which are common to both chemistry and pharmacy, as precipitation and crys- 
tallization, — while others are peculiar to pharmacy, as percolation and tritura- 
tion. The most important of the pharmaceutical operations are briefly de- 
scribed below; for full details of the various apparatus used the student is 
referred to the more exhaustive treatises on Pharmacy. 

PHARMACEUTICAL OPERATIONS. 
Carbonization is the heating of organic substances without exposure to the 
air until the volatile constituents are driven off, and the residue assumes the 
characteristic appearance of carbon. 

Clarification is the separation from liquids of solid matter which prevents 
their being transparent, without using filters or strainers. It may be effected 
by heat (as in the case of Mel Depuratum), by adding a lighter liquid, by adding 
albumin, gelatin, milk, or paper-pulp, by fermentation, or by the subsidence 
of the particles in the form of a sediment through long standing. 

Colation or Straining is usually a very simple operation, so familiar to 
every one of ordinary experience as to be scarcely worth describing. The 
strainers are made of cotton flannel, fine muslin, gauze, woolen felt and other 
fabrics. 

Comminution is the process by which the aggregation of the particles of 
a solid body is overcome, and the body is reduced to pieces of varying sizes. 
Its object is to increase the area of the surface exposed to the action of solvents, 



( 



526 PHARMACEUTICAL OPERATIONS. 

and it includes the operations of cutting, rasping, grating, crushing, stamping, 
grinding, pulverizing, triturating, levigating, elutriating, and granulating. Ap- 
paratus of various kinds, as cutters, mortars and pestles, mills, etc., are used 
for the comminution, while spatulas are employed to loosen the particles, and 
sieves to sift the coarser from the finer. These last-named contrivances are of 
five sizes, designated by the number of their meshes to the inch, 80, 60, 50, 40, 
and 20, respectively permitting the passage of powders termed very fine, fine, 
moderately fine, moderately coarse and coarse. 

Crystallization is the process which bodies undergo in passing from the 
liquid or the gaseous state to the geometrical forms called crystals. Six systems 
of crystals are recognized by crystallography, which has assumed the dignity 
of a separate science. Bodies which" are not capable of crystallization are 
termed amorphous. Every crystallizable body assumes its own peculiar form, 
or some other form derived from or related to it. The process of crystallization 
is effected (1) by fusion and partial cooling, as in the cases of some metals and 
Sulphur; (2) by sublimation, as Benzoic Acid, and Mercuric Chloride; (3) by 
deposition from hot saturated solutions while cooling; (4) by deposition from 
a solution during evaporation; (5) by deposition caused by passing a galvanic 
current through the solution; (6) by precipitation as in the case of Mercuric 
Iodide; (7) by the addition to the solution of a substance having a strong affinity 
for water, as the adding of Calcium Chloride to an aqueous solution of sodium 
chloride, or Alcohol to a solution of potassium nitrate or to an aqueous syrup. 
In a few cases amorphous solids may crystallize without undergoing liquefaction, 
as Sulphur, Barley-sugar and Iron wire. The methods most frequently em- 
ployed are those by deposition from supersaturated solutions, and by deposition 
during evaporation. The more slowly the process is carried on the larger and 
more regular will be the crystals. The process is facilitated by use of foreign 
bodies as nuclei around which the crystals are deposited; a familiar instance 
being the thread in the centre of a mass of rock-candy. 

The Water of Crystallization is the H 2 with which most substances combine in the 
act of crystallization, and the number of molecules thereof differs for each body and for the 
same body frequently under different conditions. Exsiccation is the removal of this com- 
bined water by heat, the crystals assuming thereby the form of a dry powder. Efflorescence is 
a similar process occurring spontaneously on exposure of the crystals to the air, the effloresced 
portion appearing as a dry powder on the surface of the crystals. Deliquescence, on the other 
hand, is the act of absorbing water from the atmosphere, a property possessed by some sub- 
stances which are therefore said to be hygroscopic. 

Decantation is the pouring or drawing off a supernatant liquid into another 
vessel. If done by pouring, a guiding-rod for the liquid to run on is an effective 
adjuvant; if by drawing, the siphon in some form is usually employed. 

Decoloration, or the removal of coloring-matter from liquids or from solids 
in solution, is effected by the use of animal charcoal, which in small operations 
may be arranged in a funnel or a percolator, and the liquid placed thereon. It 



PHARM ui i riC U OPERA DIONS. 527 

should not be forgotten that charcoal absorbs many other principles be [1 
coloring-matter, especially alkaloids, bitter and astringent principles, so that 

the process oi decoloration may be one of serious injury to the efficiency of the 

preparation. 

Deflagration is the heating of an inorganic substance with another which 
yields oxygen (usually a nitrate or a chlorate), the result being* the decomposition 

of the body with violent and sudden combustion. 

Desiccation is the process of removing moisture from solids, and has for 
its object either the preservation of the substance, the reduction of its bulk or 
the facilitation of its comminution. The operation should be conducted at as 
low a temperature as possible. Roots, leaves and seeds are generally dried by 
being placed in trays of wire network and exposed to a uniform temperature 
in a room heated by steam. A better method is to suspend organic substances 
from the ceiling of an attic during warm weather; a slow process, but one which 
does not result in much loss of active volatile principles. Crystals and pre- 
cipitates require a higher temperature and are usually dried on a water-bath. 
When the water of crystallization is to be expelled, as in desiccating alum and 
ferrous sulphate, a temperature of about 400 F. is required. In absorbing 
water from alcohol Potassium Carbonate and slaked Lime heated are employed, 
and in several instances Sulphuric Acid is the desiccator used. 

Dialysis is a process by which crystallizable substances are separated from 
non-crvstallizable ones, by suspending a solution containing both upon a porous 
diaphragm having its under surface in contact with water. The crystalloids 
pass through the diaphragm, while the non-crystalline remain above it, and 
are termed colloids. Examples of the latter class are gelatin, gum, glue, starch, 
dextrin, albumin and extractive matters, which are generally the inert and 
valueless constituents of vegetable drugs. Parchment-paper and bladders are 
used for the diaphragm; the whole apparatus being termed the dialyzer, while 
the water into which the crystalloids pass is called the difjusate. 

The unofficial preparation known as Dialyzed Iron (Ferrum Dialysatum) is a colloidal 
substance obtained by treating Ferric Chloride in solution with Ammonia, whereby ferric 
hydroxide is precipitated and then dissolved by agitation. The mixture being placed on a 
dialyzer, the crystalloids formed (ammonium chloride and ferric chloride), together with any 
free acid present, pass into the diffusate, leaving the neutral colloidal liquid (solution of ferric 
oxychloride) above on the septum. 

Distillation consists of two processes, the evaporation of a liquid, and the 
condensation of the vapor into a liquid in a separate vessel. The agent used 
in the first part of the operation is heat, in the second part cold. Its object 
is to separate mixed volatile and fixed substances, or to combine volatile sub- 
stances which cannot otherwise be mixed, as in the preparation of some of the 
Waters. The apparatus used is of great variety, from the simple retort and 
receiver to elaborate and costly stills. 



< 



528 PHARMACEUTICAL OPERATIONS. 

Destructive or Dry Distillation is a process of decomposing an organic substance by 
heat into volatile products, which are collected in a separate vessel, the residue being said to 
be carbonized. It is employed only by large manufacturers, for the preparation of Acetic 
and Succinic Acids, Oil of Amber, Wood Tar, etc. 

Fractional Distillation is the separation by distillation of substances which are volatile 
at different temperatures, each being separately driven over and received in a vessel by itself. 
Different degrees of heat are successively employed in accordance with the volatilizing points 
of the substances to be obtained. 
1 

Expression is the forcible separation of liquids from solids, by subjecting 
them to pressure. Hand-pressure through straining-cloths may be employed, 
but mechanical presses are more efficient and are coming into general use. 
Oils obtained in this manner are called expressed or fixed oils, to distinguish 
them from the volatile oils obtained by distillation. 

Exsiccation or Calcination is the process of depriving a solid of its moisture 
or other volatile constituents by the application of heat without fusion. The 
term Exsiccation is usually applied to the vaporization of the water of crystal- 
lization from a crystalline body; Calcination to such operations as the expulsion 
of carbon dioxide and water from carbonates, as in the manufacture of lime, 
and magnesia. 

Filtration is a process of straining through a medium so fine as to deliver 
the filtrate in transparent condition. The filters are made of paper usually, 
though charcoal, asbestos, sand and other articles are sometimes employed, 
being supported in a funnel of glass or other material held by the ring of a retort- 
stand. The best filtering-paper is made in Sweden by Munktell, and is white; 
but a good paper for ordinary use is the Prat Dumas White, which should be 
employed for filtering alkaline or alkaloidal solutions. The gray French papers 
answer well enough for fluidextracts, tinctures or colored liquids, but should 
never be used for solutions containing free alkali. 

Filtering-paper is folded by doubling a sheet upon itself, and then folding it again directly 
in the middle. When opened four distinct sections appear, one of which is separated from the 
other three, and the filter thus formed is placed in a funnel. This arrangement is known as a 
plain filter, which by repeated creasing is converted into the plaited filter; the latter being the 
form generally used in pharmaceutical operations of small extent. In large laboratories 
special processes are employed with apparatus of more or less complexity for hot filtration, 
rapid filtration, etc. 

Fusion is the process of liquefying solids by the application of high heat 
without the use of a solvent. It is employed in making ointments and plasters, 
in purifying resins, and for the purpose of decomposition. The degree of heat 
required varies from a temperature of 90 F., sufficient to melt lard in an open 
vessel, to one of 8oo° F., employed in fusing Zinc in an earthen crucible; and 
may be regulated by the aid of the water-, steam- or sand-bath. The two former 
appliances limit the degree of heat applied, while the sand-bath prevents sudden 
changes in the temperature. Oil-baths and glycerin-baths are employed in 
fractional distillation. 



PHARMACi i trie u operations. 529 

Granulation is a process of reducing a coarsely crystalline substance to a 

granular powder, by dissolving it in water and evaporating the solution with 
constant stirring until the product becomes perfectly dry. Main salts are thus 
treated for convenience in dispensing, as the bromide, the iodide, the carbonate 
and the citrate of potassium. Ferrous Sulphate, though generally dispensed 
in the exsiccated powder, may be granulated into minute crystals by tillering 
an aqueous solution of it into alcohol. 

Ignition in pharmacy means the process of strongly heating solids or semi- 
solid substances, the residue left being the product desired. It is used in the 
quantitative tests for phosphoric acid, ammonium phosphate and purified anti- 
mony sulphide. 

Incineration is the heating of organic substances with access of air until 
the carbon is consumed, the ash being the product desired. 

Maceration is one of the processes of extracting the soluble principles from 
drugs, and consists in steeping the comminuted substance in a suitable liquid 
called the menstruum, generally alcohol, for a period varying from 2 to 14 days, 
during which it is occasionally agitated. The liquid is then poured off, the 
residue is expressed, and the mixed liquors are filtered. Several of the official 
tinctures are prepared by this method, and many others by maceration first 
and percolation afterwards. A few active principles may be extracted by water 
alone (e. g. morphine), and in some cases the addition of acids or alkalies to 
the water will effect the chemical solution »f many ingredients which are in- 
soluble in plain water. As a rule however Alcohol is the most generally appli- 
cable of all simple solvents, but from its hardening the cell-membranes instead 
of softening them it prevents the osmosis of their contents. Drugs subjected 
to alcoholic or other menstrua should have their cells thoroughly broken or torn, 
so that the solvent may be brought into actual contact with the principles con- 
tained in them. The degree of disintegration required depends upon the size 
of the cells, ducts, tubes, intercellular spaces, etc., in which the active principles 
are enclosed. A very finely powdered state is open to objection from the packing 
of the particles together into an almost impenetrable mass when treated by the 
solvent. The average size of vegetable cells is about 3^-5- of an inch, while 
resin cells and other cavities are larger, averaging about T ^-jj inch. The Phar- 
macopoeia prescribes in each instance the degree of fineness of the powdered 
drug employed in making certain of its preparations, or its bruising, slicing, etc., 
when such operations will answer. [Compare the article on Comminution.] 

Percolation or Displacement is a process of obtaining the soluble con- 
stituents of a powdered substance by the descent of a solvent through it. Though 
an ancient process for the making of lye from wood-ashes (lixiviation), it has 
only within the last fifty years been adopted as an official process in pharmacy, 
35 



i 






53° PHARMACEUTICAL OPERATIONS. 

but it is gradually taking the place of maceration as a means of extracting the 
soluble principles of drugs. The vessel used to hold the powdered drug is called 
the percolator, of which there are many forms employed by the manufacturers. 
The liquid used as a solvent is called the menstruum, and when coming from 
the percolator it is termed the percolate. The U. S. Pharmacopoeia gives very 
full directions concerning this process. 

Precipitation is the process of separating solids from their solutions, and 
is usually effected by chemical reaction, though it may be accomplished by 
other methods, as by adding a second liquid in which the substance is insoluble, 
by heating albuminous solutions, or by exposing solutions of silver salts to the 
action of light. The most familiar example of chemical precipitation is the 
addition of a solution of Mercuric Chloride to one of Potassium Iodide, the 
result being a double decomposition of the salts and the formation of Mercuric 
Iodide, which falls to the bottom of the vessel as a brilliant, red, insoluble and 
crystalline powder. The precipitate is the separated substance, which is usually 
thrown down, but it remains suspended in some cases, and in others it rises 
to the top. The precipitant is the substance which is added to produce the 
precipitation. A magma is a thick, tenacious precipitant remaining behind after 
the supernatant liquid is removed by decantation or otherwise. Precipitates 
are termed flocculent, gelatinous, curdy, granular, crystalline, etc., according to 
the forms assumed. In small operations they are usually collected on plain 
filters, and washed by the repeated addition of water. 

Separation of liquids which do not mix with each other is a simple mechan- 
ical process performed with pipettes of various forms, or with funnels having stop- 
cocks in their necks. Special forms of receivers are used for the separation of 
volatile oils from the water which may accompany them during distillation. 

Solution is the dissolving of a solid or gaseous substance in a liquid, and 
may be simple when the substance undergoes no alteration, being recovered 
unchanged on evaporation; or chemical when the dissolved body is chemically 
altered by the solvent or some other substance present, and cannot be recovered 
on evaporation. Syrup is an instance of simple solution, the Syrup of Lime one 
of chemical solution. The liquid employed is termed a solvent before the sub- 
stance is added to it, after the operation is completed the combined preparation 
is called a solution. If fully charged with the dissolved substance so that it 
will retain no more, it is known as a saturated solution. One liquid may be dis- 
solved in another, or a gas may be dissolved in a liquid. The solution of solids 
is greatly facilitated by pulverization and by stirring the menstruum. Heat 
generally aids solution, most substances being more soluble in hot liquids than 
in cold ones. A" saturated solution of one substance may still be capable of 
dissolving others. Rapid solution of solids without chemical change causes 
reduction of temperature, while chemical solution produces elevated temperature. 



PHARMACEUTICAL OPERATIONS. 53] 

Circulatory Solution is performed by suspending the substance to be dissolved 
near the surface of the solvent in a gauze bag or on a porous shelf. The portion 

first acted on descends and produces a circulatory movement in the fluid, I'aeili 
tating the solution of the whole. 

>./.? employed arc chiefly Water, Alcohol, Glycerin, Acids, and Oils. Others less 
frequently used are Ether, Chloroform, Benzin and Carbon Bisulphide. 

Sublimation is the distillation of a volatile solid, the product being termed 
a sublimate. Its objects are to purify volatile solids from impurities and to 
collect such as result from chemical action at high temperatures. The operation 
is carried on in iron, glass or stoneware retorts, and results in cake sublimates 
or powder sublimates according as the temperature of the condensing surface 
is high or low. 

Testing and Assay are directed by the Pharmacopoeia in certain cases, 
for the purpose of determining the identity and purity of its drugs and their 
preparations. The Pharmacopoeia contains a very complete section on Rea- 
gents, in which full directions are given for the preparation and use of Test 
solutions and Volumetric solutions; also instructions for Gasometric estimations, 
for the determination of the Optical Rotation of organic substances, and for 
Alkaloidal Assay by immiscible solvents. 

Pharmacopceial testing and the volumetric method of determination are neces- 
sary to the work of the practical pharmacist, and as the apparatus used is simple 
and the operations are those in the line of his daily work, he should be familiar 
with them. On the other hand the proximate analysis of organic substances 
for their principles, and the ultimate analysis of the same bodies for their ele- 
ments, require a high degree of skill and long experience, and should be left 
to the professional chemist. 

The apparatus used in testing consists of graduated flasks and jars, burettes, 
pipettes, funnels, beakers, test-tubes, capsules, crucibles, reagent-bottles, etc. 
The metric system is directed for all work, and the apparatus employed should 
be graduated accordingly. 

Torrefaction or Roasting is the application of heat, in a less degree than 
for carbonization, to an organic substance for the purpose of modifying some 
of its constituents, as in the roasting of coffee and of rhubarb. The latter sub- 
stance, when subjected to this process, loses its cathartic properties, but retains 
its astringency, and is known as Torrefied Rhubarb. 

Trituration is the comminution of a solid to an extremely fine powder by 
continued rubbing in a wedgewood mortar with an inert and gritty powder, 
Sugar of Milk being the substance directed to be used. The product is called 
a Trituration (see that title under Official Preparations). The surfaces of 
the mortar and pestle-head should coincide closely, and the thorough comminu- 
tion of the trituration is best accomplished by a circular motion of the pestle 



532 PHARMACEUTICAL OPERATIONS. 

in gradually increasing circles, until the side of the mortar is reached, then 
reversing the motion and gradually lessening the circles until the pestle reaches 
the centre again. The process is greatly facilitated by having the pestle attached 
to a long handle playing in an opening made in a piece of wood nailed at a con- 
venient height. A weight may be fixed on top of the handle if a greater degree 
of friction is desired. 

Pulverization by Intervention is only another name for trituration when performed 
in a mortar and with solid bodies, the foreign substance used being subsequently removed. 
Potassium Sulphate may be employed as the medium for the pulverization of Gold and 
then dissolved out by water. Alcohol or Chloroform may be added to Camphor to aid its 
pulverization, and then removed by evaporation. Phosphorus may be pulverized by placing 
it in water, gently heating the latter until the phosphorus is melted, and agitating the whole 
while cooling. 

Levigation is the trituration of a substance made into paste with water or some other 
liquid, and resembles the old process of grinding oil paints by hand on a slab of stone. The 
process is used for coarse materials, as chalk, where the refuse is rejected, or for such sub- 
stances as red mercuric oxide, and zinc oxide. When performed with a porphyry slab and 
muller it is termed Porphyrization. 

Elutriation is a water-sifting process for separating the coarser particles of insoluble sub- 
stances from the finer. The substance is mixed with water and after the larger particles have 
fallen to the bottom, the liquid is decanted into another vessel, in which the light and powdery 
particles are collected. 

Vaporization includes the various operations by which volatile matters are 
separated from fixed substances or from other matters which are less volatile, 
heat at varying temperatures being the agent used. The operations under this 
head are— Evaporation, Distillation, Desiccation, and Sublimation, the last three 
of which have been described. 

Evaporation in pharmacy is the process by which the more volatile con- 
stituents of a liquid are driven off by heat for the purpose of reducing its volume 
or purifying it, as in the preparation of extracts and fluidextracts, and the crys- 
tallization of salts. The vessels used should be shallow so as to expose a large 
surface of the liquid to the atmosphere. The heat used may be regulated by 
a water-bath, a steam-bath or a sand-bath, and ordinarily should be kept below 
but near to the boiling point of the liquid treated. As organic substances are 
usually injured by long heating, small portions only of vegetable preparations 
should be subjected to this process, and the liquid should be frequently stirred 
in order to hasten the operation. In large laboratories vacuum-pans are em- 
ployed to remove the atmospheric pressure, enabling the evaporation to be 
accomplished at a much lower degree of heat than if the liquid were exposed 
to the air. Ebullition (boiling) is a form of evaporation. 

Spontaneous Evaporation is the evaporation of a liquid without the direct applica- 
tion of strong heat, but at the temperature of the room or closet used for the purpose. It 
is especially applicable to cases in which the residue is liable to injury or loss from much 
heat, or to secure finer crystals than can be obtained by the quick evaporation of their solution. 

Washing is a simple mechanical process for separating soluble from insoluble 
matter, by pouring upon it a liquid which will dissolve the soluble portion. 
Various methods of doing this are in vogue and are often dignified with verv 



PHARMACEUTICAL PREPARATIONS. 533 

high-sounding terms, as Lotion, Affusion, and Ablution. An ordinary wash- 
bottle, with two glass tubes perforating the cork, is a convenient implement for 
directing a continuous stream upon a precipitate, while for continuous washing 
a combination of bottles with a funnel may be used. 



PREPARATIONS. 



Official Preparations may be presented under various methods of classi- 
fication, one of the simplest being that which divides them into liquids and 
solids, the former being subdivided into groups named after their principal 
bases, viz.: — 

Liquid Preparations. 

Acetone Preparations, — all Oleoresins except one, that of Cubeb. 

Acetous Preparations, — the Vinegars, two in number. 

Alcoholic, — Fluidextracts, Tinctures, Wines, Spirits, Elixirs, and one Oleoresin, that of 
Cubeb; one Liniment, that of Belladonna. 

Aqueous, — Waters, Solutions, Infusions, Decoctions, Syrups, Honeys, Mucilages, Emul- 
sions, Mixtures; the last five containing sweet or viscid substances. 

Ethereal, — Collodions, four in number. 

Glycerines, — Glvcerites, six in number. 

Oleaginous, — Liniments, except that of Belladonna; also Oleates. 

Solid Preparations. 



Cerates. 


Extracts. 


Ointments. 


Pills. 


Poultices. 


Suppositories 


Confections. 


Masses. 


Papers. 


Plasters. 


Powders. 
Resins. 


Triturations. 
Troches. 



In the following descriptions of the pharmaceutical groups the composition 
and dosage of the various preparations are omitted, as they are fully detailed 
in the section on Materia Medica, under the title of the principal constituent 
in each case. 

PHARMACEUTICAL PREPARATIONS. 

Pharmaceutical Preparations include the pharmacopceial (official) ones, 
also those of extemporaneous pharmacy (unofficial). Both classes are described 
together in alphabetical order, for the sake of easy reference. 

Aceta, Vinegars, — are solutions of the active principles of certain drugs in 
diluted Acetic Acid. They are made by maceration and straining, and each 
one contains the soluble principles from 10 per cent, of drug. Acidulous men- 
strua form soluble salts with the alkaloids and possess antiseptic qualities. 
The official Vinegars number 2, viz.: — 

Acetum Opii. Acetum Scilhe. 



534 



PHARMACEUTICAL PREPARATIONS. 



Aquae, Waters, — are aqueous solutions of volatile substances, which may 
be solids, liquids or gases, dissolved by solution in cold or hot water, by filtration 
through an absorbent powder, by percolation through cotton saturated with the 
substance, or by distillation. All waters deteriorate when long kept, microscopic 
plants being propagated in them from spores derived from the atmosphere. 
They should be prepared only in such quantities as are needed for immediate 
use. The official waters number 19, including two forms of Aqua itself, viz.: — 



Aqua. 

Aqua Destillata. 

Aqua Ammonias. 

Aqua Ammonias Fortior. 

Aqua Amygdala? Amaras. 

Aqua Anisi. 

Aqua Aurantii Florum. 

Aqua Aurantii Florum Fortior. 

Aqua Camphoras. 

Aqua Chloroformi. 



Aqua Cinnamomi. 
Aqua Creosoti. 
Aqua Foeniculi. 
Aqua Hamamelidis. 
Aqua Hydrogenii Dioxidi. 
Aqua Menthas Piperita:. 
Aqua Menthas Viridis. 
Aqua Rosa;. 
Aqua Rosas Fortior. 



Of the above 5 are prepared by simple solution, 4 by passing gases through water, 3 by 
distillation, and 6 by trituration of the medicament with purified tale, addition of water and 
filtration. 



Balnea, Baths (Unofficial). Baths are often medicated, and then become 
medicinal preparations. The ingredients only are ordered in a prescription, 
as in the following examples, each of which is intended for a bath of 20 to 30 

gallons : — 



Balneum Acidi Nitrohydrochlorici. 

T$. Acidi Nitrici, 

Acidi Hydrochlorici, aa oj- 

M. Sig. — Use with 30 gallons of 
water, as a bath. 



hot 



Balneum Sulphuris Compositum. 

1$. Sulphuris Prascip., oij- 

Sodii Hyposulphitis, o j- 

Acidi Sulphurici DiL, Sss. 

Aquae, Oj. 

M. Sig. — For a 30-gallon bath. 



Capsular, Capsules, (Unofficial). Gelatin Capsules of various sizes from 
o to 10 are to be obtained in the drug-stores. They are a convenient means 
of administering oils or nauseous solids, and when filled may be swallowed as 
easily as a large pill. Soluble Elastic Capsules are also prepared, each con- 
taining an ordinary dose of such medicines as castor oil and cod-liver oil. The 
largest of these capsules makes a bolus which may be swallowed with a little 
effort, as it is quite compressible and changes its shape to suit the calibre of 
the passage. The ordinary capsules are easily filled by the aid of a paper 
funnel, and the end of a pen-holder as a packer; but simple devices (capsule- 
fillers') for facilitating the operation may be purchased. 



I£. Pulv. Opii, gr. x. 

Pulv. Camphoras, gr. xx. 

Sacch. Alb., q. s. 
Triturat., et fiant capsulas x. 
Sig. — One at bedtime for chordee; 
peat in two hours if necessary. 



1$. Copaibas, Sijss. 

Oleoresinas Cubebae, 3ss. 

M., et fiant capsulae xij. 

Sig. — Two capsules to be taken three 
times daily, soon after meals, for gonor- 
rhea. 



Cataplasmata, Poultices, — are usually prepared at the residence of the 
patient, the ingredients only being ordered from the druggist. They are gener- 



PHARMACEUTICAL PREPARATIONS. 535 

ally employed as a means of applying heat and moisture to a certain portion 
o\ the body, but are sometimes medicated with anodyne, counter irritanl or 

disinfectant agents. An excellent method of preparing poultices is to make 
several bags of various sizes, of either of the fabrics known as Swiss and Cheese 
cloth, filling each bag half full with the linseed meal or other agent used, then sew 
ing up the open end. When wanted for use one of these bags is submerged in 
boiling water for a few minutes, and on taking it out the meal is found to have 
swelled so as to fill the bag, which should then be squeezed to rid it of superfluous 
water, laid on the part and covered with oiled silk and a bandage. 

The ordinary filthy poultice of flaxseed, slippery elm, bread and milk, has 
no place among the resources of the aseptic surgeon. The common poultice is 
a hot-bed for bacteria, and as such, it should be discarded. In the treatment 
of an ordinary furuncle with poultices, almost every surgeon must have seen 
occasionally the development of innumerable minute daughter-furuncles in the 
surface covered by the poultice. In phlegmonous inflammation of the fingers 
or hand, the prolonged use of the poultice is followed by maceration of the skin, 
extensive edema of the superficial structures, a flabby condition of the granula- 
tion — in fact all the evidences which point to the poultice as a means of favoring 
the extension of the infectious process (Senn). 

A Sinapism is a poultice or plaster containing Mustard (Sinapis), used for 
the purpose of counterirritation. If applied too hot and kept on too long the 
skin will become inflamed and ulcerated, and extensive gangrenous sores may 
result. 

The only Cataplasm official in the U. S. Pharmacopoeia is the Cataplasma 
Kaolini, in which Glycerin is the active agent. Poultices of Charcoal, Hem- 
lock, Yeast, Linseed, Mustard, and Chlorine, were formerly official in the 
British Pharmacopoeia, but have been omitted from the edition of 1898. 

Cerata, Cerates, — are unctuous preparations similar to ointments, but of a 
much finer consistence. They all contain Wax (cera), and do not melt at tem- 
peratures below 104° F. They are intended for external use, and are generally 
spread on lint before being applied. There are 6 official Cerates, including 
Ceratum itself, which is made by fusing together 30 of white wax, 50 of ben- 
zoinated lard, and 20 of white petrolatum, but for use in southern latitudes 
and during the heated season in other localities 5 of the lard may be replaced 
by an equal quantity of wax. The composition of the others may be found in 
the section on Materia Medica under the appropriate titles, but the figures in 
parentheses below give the percentage of drug to basis in each. 

Ceratum. Ceratum Plumbi Subacetatis (5). 

Ceratum Camphors (2). Ceratum Resina: (35). 

Ceratum Cantharidis (32). Ceratum Resina? Compositum (22J). 

Chartae, Papers, — consist of strips of paper medicated by impregnation of 
its libers with medicinal substances or by being coated therewith. There is only 
one official Paper, Charta Sinapis, which is made with sized paper, and is in- 



536 



PHARMACEUTICAL PREPARATIONS. 



tended for external application as a vesicant or counterirritant. The formerly 
official Charta Potassii Nitratis, is unsized paper impregnated with nitre and 
intended for the inhalation of its fumes while burning. 

Collodia, Collodions, — are liquid preparations having for their base a solution 
of Pyroxylin in a mixture of Ether and Alcohol. They are intended for external 
use, being applied to the skin by means of a brush, producing a film on the 
surface after the evaporation of the menstruum. There are 4 official Collo- 
dions, viz. : — 



Collodium. 

Collodium Cantharidatum. 



Collodium Flexile. 
Collodium Stypticum. 



The Flexible Collodion contains 5 per cent, of Canada Turpentine, and 3 per cent, of 
Castor Oil. Styptic Collodion contains 20 per cent, of Tannic Acid. 



Confectiones, Confections, — consist of medicinal substances formed into a 
mass with Sugar, Honey, Water, etc., with the object of rendering them palatable 
and preserving them from change. Electuaries are similar preparations, but 
this term is now obsolete. There are only two official Confections, viz. : — 



Confectio Rosas. 



Confectio Sennae. 



Confections and Electuaries are very seldom prescribed, and therefore can 
have but little place in extemporaneous pharmacy. A few old formula" for 
such preparations are given below as pharmaceutical curios. The first is a 
meritorious prescription, the second is said to have been purchased by Lord 
Anson for the sum of £300. 



Electuary for Piles. 



V 



Potassii Bitartratis, 

Potassii Nitratis, 

Pulv. Jalapas, aa o ss. 

Confectionis Sennas, o j- 

Syrupi Zingiberis, q. s. 
M. Fiat electuarium. 
Sig. — A piece the size of a marble to be 
taken thrice daily. 



The Chelsea Pensioner. 



B. 



Sulphuris Loti, 3 ij. 

Potassii Bitart, oj- 

Pulv. Rhei, 3 ij. 

Guaiaci Resinae, 5j- 

Mellis Depurat., rbj. 

Myristicam Pulv., j. 

M. Fiat electuarium. 

Sig. — A dessertspoonful twice daily, as a 
laxative in chronic rheumatism. 



Confectio Damocratis. 
[An ingredient of Warburg's Tincture, see page 231.] 
This preparation was official in the London Pharmacopoeia of 1745. It contained 1 grain 
of Opium in oss, and consisted of 45 ingredients, as follows, viz.: Cinnamon, 14 parts; 
Myrrh, n parts; — White Agaric, Spikenard, Ginger, Spanish Saffron, Treacle, Mustard Seed, 
Frankincense and Chian Turpentine, of each 10 parts; — Camel's Hay, Costus Arabacus, Zedo- 
ary, Indian leaf, Mace, French Lavender, Long Pepper, Seeds of Harwort, Juice of ripe 
Cistus, strained Storax, Opponex, strained Galbanum, Balsam of Gilead, Oil of Nutmeg, 
Russian Castor, of each 8 parts; — Water Germunder, Balsam-tree Fruit, Cubeb, White Pep- 
per, Seeds of Cretian Carrot, Poley Mont, strained Bdellium, of each 7 parts; — Gentian root, 
Celtic Hard, Leaves of Dittany of Crete, Red Rose, Seeds of Macedonium, Parsley, Sweet 
Fennel Seeds, Seeds of Lesser Cardamom, Gum Arabic, Opium, of each 5 parts; — Sweet 
Flag, Wild Valerian, Anise-seed, Sagapenum, of each 3 parts; — Spigrul, St. John's Wort, 
Juice of Acacia, Catechu, Dried Bellies of Skunk, of each i\ parts; — the roots finely pow- 
dered and the whole mixed thoroughly into a paste with Clarified Honey. 



PHARMACEUTICAL PREPARATIONS. 537 

Decocta, Decoctions, are made bj boiling vegetable substances with water. 
As very few drugs contain active ingredients which are not injured by heat, 

those preparations have never obtained favor with scientific physicians. The 
official genera] formula for Decoctions prescribes that when the strength is not 
directed by the physician, nor specified by the Pharmacopoeia, they shall be 
prepared in the proportion of 5 grammes of the substance with 100 Cc. of water; 
hut that the strength of decoctions of energetic or powerful substances should 
be specially prescribed by the physician. 

Elixiria, Elixirs, — are sweetened, aromatic, and spirituous preparations, 
containing active medicinal substances in small quantities. There are 3 official 
Elixirs, viz.: — 

Elixir Adjuvans. Elixir Fcrri, Quinine, et Strychninse Phosphatum. 
Elixir Aromaticum. 

The first-named is a mixture of Licorice and Elixir Aromaticum. The latter 
is intended to represent a type of the large class of unofficial elixirs employed 
in manufacturing and extemporaneous pharmacy. It is practically an alcohol- 
ized syrup, flavored with Orange, and is designed for use as an excipient for 
extracts, tinctures, salts, etc. The manufacturers have put on the market a 
great variety of elixirs, and most druggists keep a stock of them on hand pre- 
pared in the shop; but they may be ordered by prescription just as any other 
mixture would be. The substances generally used in this form are — 

Arsenic. Hydrated Chloral. Ferric Phosphate. 

Bismuth. Coca. Ferric Pyrophosphate. 

Ammonium Bromide. Gentian. Quinine Phosphate. 

Lithium Bromide. Guarana. Strychnine Phosphate. 

Potassium Bromide. Ammonium Valerate. Pepsin. 

Calisaya Bark. Ferric Chloride. Taraxacum. 

Many of these agents may be combined with one another, as the Elixir of Bismuth and 
Strychnine; Elixir of Calisaya, Iron and Strychnine; Elixir of Gentian with Tincture of Chloride 
of Iron; Elixir of Iron, Quinine and Strychnine Phosphates. 

Emplastra, Plasters, — are solid compounds, insoluble in w-ater, of a tena- 
cious but pliable consistence and intended for external application to limited 
areas of the body surface. They are prepared by incorporating medicinal sub- 
stances with certain bases, which are usually Lead Plaster or Adhesive Plaster. 
The heat employed should be low, to avoid decomposing the active agents, and 
should not be continued long enough to drive off an)- volatile constituents. The 
plaster mass is then spread on chamois skin, kid skin or muslin. The con- 
stituents of the following-named 7 official Plasters may be found in the section 
on Materia Medica, under their appropriate headings. 

Emplastrum Adhsesivum. Emplastrum Capsici. Emplastrum Opii. 

Emplastrum Belladonna;. Emplastrum Hydrargyri. Emplastrum Plumbi. 

Emplastrum Saponis. 

Plasters are rarely prepared extemporaneously, the official and many others 
being produced on a large scale by the manufacturers, and are kept in stock 



< 



538 



PHARMACEUTICAL PREPARATIONS. 



by all druggists. As a consequence the compounding and spreading of a plaster 
by the pharmaceutist has become a lost art. The official plasters may be ordered 
by prescription in the manner illustrated below. Blisters may be produced bv 
the application of any preparation of Cantharides sufficiently strong for the 
purpose. The official Cerate of Cantharides may be spread on adhesive plaster 
making a blistering plaster, or Cantharidal Collodion may be painted over the 
surface. Plasters are usually ordered by the square inch, but a diagram of the 
shape and size may be drawn on paper, and the plaster be directed to conform 
thereto, as in the first following prescription. 



Emplastrum Vesicatorium. 
J^. Cerati Cantharidis, q. s. 

Extende supra Emplastrum Adhaesivum 
hujus formae et magnitudinis. 

Sig. — Blistering Plaster, to be applied 
over the region of the heart. 



Counter-irritant and Anodyne. 
I}. Chartae Sinapis, 

Emplas. Belladonnas, aa 3" x 6". 
Sig. — Apply the mustard paper first, to 
be followed by the plaster when the surface 
has been well reddened. 



Emulsa, Emulsions, — are aqueous, liquid preparations containing an in- 
soluble medicinal substance, as an oil or a resin, in a state of minute subdivision, 
and suspended by the aid of some viscid excipient, as gum, which may be con- 
tained in the medicinal ingredient itself (e. g., asafcetida), or may be added by 
the pharmaceutist. The official Emulsions are 6 in number, viz. — 



Emulsum Amygdalae. 
Emulsum Asafoetidae. 
Emulsum Chloroformi. 



Emulsum Olei Morrhuae. 

Emulsum Olei Morrhuae cum Hypophosphitibus. 

Emulsum Olei Terebinthinae. 



Natural Emulsions comprise two classes of substances, — (1) those emulsions 
which exist ready formed in nature, as milk, yolk of egg, the milky juices of 
plants, etc., and (2) the mixtures formed by rubbing up gum-resins (as ammo- 
niacum, myrrh, asafcetida) with water. Each of these substances contains, 
together with its resin, enough gum to make a perfect emulsion when triturated 
with water. The manufactured emulsions are simply imitations of the natural 
ones, sufficient gum being added in case of a resinous substance to cause its 
suspension in the aqueous diluent. 

Emulsification consists in the division of the oily or resinous substance into 
very minute globules, and the surrounding of each globule with a thin envelope 
of the excipient. If properly done the globules will remain mechanically sus- 
pended in the water, without any tendency towards recombination. Milk is 
the best illustration of a natural emulsion, its butter existing in the aqueous 
portion as very minute globules, each surrounded by a thin film of casein. Yolk 
of Egg is a dense emulsion, consisting of oil suspended in water by means of 
albumin. 

Excipients which may be used for emulsification are the following, arranged 
in the order of their most frequent employment, viz. — 

Mucilage of Acacia, — used for oils and resins. Powdered Acacia is even better, being 
made into a mucilage by the process of emulsification; such a mucilage having the advantage 
of being perfectly fresh when incorporated with the other ingredients. To give good results 
the following proportions in parts by weight should be used, — 



rn \K\! u i i nc \i PR] PAK \i [QNS. 



539 



1 liun \. .» ia. v. 

t part of Fixed Oil or Copaiba requires J j 

i " " Balsam of Peru " 2 1 

1 " " Oil of Turpentine " 1 1 

Mucilage of Tragacanth, ni.n be u ...1 lor oils am! n-siu.-,, hut it has not proved so 
satisfactory as the preceding. The same may be said of powdered Tragacanth. 

Vitellus, Yolk of Egg, — is an excellent agent for emulsifying oils, but mixturi made 
with it musl be used within a few days, as they will not keep long. One yolk will emulsionize 

unce of fixed oil, and is about equal to half an ounce of acacia. It is best suited to emul- 
sions of cod-liver oil intended for immediate administration. 

Liquor Potassii Hydroxidi, — may be used for oils, the resulting compound being how- 
ever a soap rather than an emulsion. Copaiba is usually emulsified by using both a gum 
and an alkali; a similar process being employed for many of the fixed oils. 

Tincture of Senega, — will emulsify fats and oils very efficiently, even in very small 
quantities, ttgx emulsifying an ounce of fixed oil. 

Tincture of Quillaja (Soap-bark), — is a good emulsifier of oils, and is much used in 
Europe for this purpose. 

Milk, — is used to emulsify Scammony in the Mistura Scammonii, which was formerly 
official in the British Pharmacopoeia. 

Syrups, Confections and Extracts, — may be used in making emulsions, but are rarely 
so employed. 

The method of preparing an emulsion which experience has shown to be 
the best is as follows: — Add the oil, resin, etc., to a proper quantity of the ex- 
cipient and mix both in a mortar. Then add enough water to equal one-half 
the weight of the previous mixture, and triturate the whole rapidly and un- 
ceasingly until the emulsion is homogeneous and of a whitish color. Next, add 
the remainder of the water slowly, with continual stirring; finally incorporating 
the other ingredients, if any. 

Emulsions are sometimes flavored and at the same time colored with such 
a preparation as the Compound Tincture of Cardamom, but they present a 
better appearance when white. Alcoholic preparations should not be added in 
large quantity to emulsions made with acacia or yolk of egg, as alcohol will 
precipitate the emulsifying agent. Volatile Oils require admixture with a fixed 
oil before being made into an emulsion. Soluble salts should never be pre- 
scribed with emulsions of oils. Acids are incompatible with mixtures which 
have been emulsified by an alkali. Mucilage used for emulsions should always 
be freshly prepared. 

The following examples of prescriptions for emulsions will represent those 
generally met with, but an official formula differing from the first is given in 
the pharmacopoeia. 



Cod-Liver Oil Emulsion. 

1$. Olei Morrhuas, §ij- 

Yini Albi, ojss. 

Acidi Phosphorici Dil., oiij- 

Syrupi, 5 v. 

Yitellum, j. 

Aq. Amygd. Amar., q. s. ad oviij. 
Misce, et fiat emulsum. 

Sig. — Tablespoonful doses as directed. 



Alkaline Emulsion oj Copaiba. 



TI- 



Copaibas, 

Liq. Potassii Hydroxidi, .aa 5ij- 
Misce, et adde — 

Pulv. Acaciae, 

Pulv. Sacchari, aa Hij. 

Aq. Menth. Viridis, q. s. ad 3 iv. 
Misce, et fiat emulsum. 

Sig. — Tablespoonful doses. 



540 PHARMACEUTICAL PREPARATIONS. 

Extracta, Extracts, — are solid or semi-solid preparations obtained by 
evaporating solutions of vegetable principles. The drug is first powdered, 
then percolated with the appropriate menstruum to exhaustion. The first third 
of the percolate is reserved, the remainder is evaporated at a temperature not 
above 122 F., until its weight is ten per cent, of that of the drug used, then 
mixed with the reserved portion, and both are evaporated to a pilular consistence. 
The above is the general rule, but in several instances maceration is directed 
for 1 to 4 days before percolation; and in other cases, instead of reserving a 
portion of the percolate, the whole quantity is distilled until the alcohol is re- 
moved and the residue is evaporated to a pilular consistence. The menstrua 
used are, — in 3 cases Alcohol, in 5 cases Diluted Alcohol of varying strength, 
in 7 Water, in 1 Water with Aqua Ammoniae, in 1 a diluted Acetic Acid, and 
in 1 Acetic Acid and Diluted Alcohol. One extract is an inspissated juice 
(ext. taraxaci); 9 are made by evaporating a fluidextract, one by mixing an 
extract with other ingredients (ext. colocynthidis comp.), and one (ext. glycyr- 
rhizas) is an ordinary commercial product. The official extracts number 28, 
and are named as follows; — 

Extractum Aloes. Ext. Euonymi. Ext. Opii. 

Extr. Belladonnas Foliorum. Ext. Gentians. Ext. Physostigmatis. 

Ext. Cannabis Indicas. Ext. Glycyrrhizae. Ext. Quassias. 

Ext. Cimicifugas. Ext. Glycyrrhizae Purum. Ext. Rhamni Purshianae. 

Ext. Colchici Cormi. Ext. Haematoxyli. Ext. Rhei. 

Ext Colocynthidis. Ext. Hyoscyami. Ext. Scopolae. 

Ext. Colocynthidis Composi- Ext. Krameriae. Ext. Stramonii. 

turn. Ext. Leptandrae. Ext. Sumbul. 

Ext. Digitalis. Ext. Malti. Ext. Taraxaci. 

Ext. Ergotas. Ext. Nucis Vomicae. 

The Proximate Principles generally present in extracts, besides the peculiar 
principles of plants, are sugar, tannin, extractive, chlorophyll, coloring-matter 
and salts. When an alcoholic solvent is used there are also present resins, fats 
and often a volatile oil, and when the menstruum is not purely alcoholic there 
is more or less of gum and starch. One of these ingredients, named Extractive 
or Apotheme, is a deposit, soluble in water and alcohol, which has the singular 
property of passing into an insoluble substance under the influence of the at- 
mospheric air with heat. It also has a tendency, when precipitated from solu- 
tions, to unite with other principles carrying them down with it. It is frequently 
present in extracts, hence its name. 

Fluidextracta, Fluidextracts, — are permanent and concentrated solutions 
of vegetable drugs, of uniformly definite strength if the crude drugs are sp, a 
cubic centimeter (i\ 16.23) in each case representing the medicinal powers of 
one gramme (gr. 15.43) of the drug, or approximately a minim of the finished 
preparation representing the active constituents of a grain of the drug. They 
are officially directed to be prepared by percolation and partial evaporation, 
the menstrua employed being usually Alcohol, diluted Alcohol, or Alcohol and 
Water in various proportions, though a few are percolated with water, the alcohol 



ni.\K\i \cri ruwi i-ki t\k wions. 



541 



being afterwards added. In several instances Glycerin in different proportions 

is added to the first menstruum; and in the menstrua used for the fluidextrai ts 
of Conium, Ergot, Lobelia, Nux Vomica, Sanguinaria, and Squill, Acetic Acid 
is an ingredient. In the preparation of the fiuidextract of Primus Virginiana, 
the extraction is preceded by maceration with water and glycerin, in order to 
permit of the formation of hydrocyanic acid by the reaction of the amygdalin 
and emulsin of the bark upon each other, which takes place only in the presence 
of water. The glycerin aids to keep the dissolved matters in perfect solution, 
and also to better retain the acid and volatile oil formed during the process. 
The menstruum directed in each case is intended to be that which will thoroughly 
extract all the active constituents of the drug and at the same time leave the 
inert soluble matters behind in the rejected portion, known as the marc. In 
manufacturing fluidextracts on a large scale modifications of the official proc- 
esses are necessary, the methods used being generally percolation and macera- 
tion with hydraulic pressure, vacuum maceration followed by percolation, per- 
colation with incomplete exhaustion, or repercolation. The official fluidextracts 
number 85, and are named in the following list. 



Fluidextractum Aconiti. 


Fluidextr. Gelsemii. 


Fluidextr. Rhei. 


Fluidextr. Apocyni. 


Fluidextr. Gentianas. 


Fluidextr. Rhois Glabrae. 


Fluidextr. Aromaticum. 


Fluidextr .Geranii. 


Fluidextr. Rosas. 


Fluidextr. Aurantii Amari. 


Fluidextr. Glycyrrhizas. 


Fluidextr. Rubi. 


Fluidextr. Belladonna; Radici 


3. Fluidextr. Granati. 


Fluidextr. Sabinas. 


Fluidextr. Berberidis. 


Fluidextr. Grindeliae. 


Fluidextr. Sanguinariae. 


Fluidextr. Buchu. 


Fluidextr. Guaranae. 


Fluidextr. Sarsaparillas. 


Fluidextr. Calami. 


Fluidextr. Hamamelidis Fol. 


Fluidextr. Sarsaparillas Comp 


Fluidextr. Calumbae. 


Fluidextr. Hydrastis. 


Fluidextr. Scillas. 


Fluidextr. Cannabis Indicae. 


Fluidextr. Hyoscyami. 


Fluidextr. Scopolas. 


Fluidextr. Capsici. 


Fluidextr. Ipecacuanhas. 


Fluidextr. Scutellaria;. 


Fluidextr. Chimaphilas. 


Fluidextr. Kramerias. 


Fluidextr. Senegas. 


Fluidextr. Chiratas. 


Fluidextr. Lappas. 


Fluidextr. Sennas. 


Fluidextr. Cimicifugas. 


Fluidextr. Leptandras. 


Fluidextr. Serpentarias. 


Fluidextr. Cinchonas. 


Fluidextr. Lobelias. 


Fluidextr. Spigelias. 


Fluidextr. Cocas. 


Fluidextr. Lupulini. 


Fluidextr. Staphisagrias. 


Fluidextr. Colchici Seminis. 


Fluidextr. Matico. 


Fluidextr. Stillingias. 


Fluidextr. Conii. 


Fluidextr. Mezerei. 


Fluidextr. Stramonii. 


Fluidextr. Convallarias. 


Fluidextr. Nucis Yomicas. 


Fluidextr. Sumbul. 


Fluidextr. Cubebae. 


Fluidextr. Pareiras. 


Fluidextr. Taraxaci. 


Fluidextr. Cypripedii. 


Fluidextr. Phytolacca;. 


Fluidextr. Tritici. 


Fluidextr. Digitalis. 


Fluidextr. Pilocarpi. 


Fluidextr. Uvas Ursi. 


Fluidextr. Ergotae. 


Fluidextr. Podophylli. 


Fluidextr. Valeriana;. 


Fluidextr. Eriodictyi. 


Fluidextr. Pruni Yirginianas. 


Fluidextr. Veratri. 


Fluidextr. Eucalpyti. 


Fluidextr. Quassias. 


Fluidextr. Yiburni Opuli. 


Fluidcxtr. Euonvmi. 


Fluidextr. Quercus. 


Fluidextr. Yiburni Prunifolii. 


Fluidextr. Eupatorii. 


Fluidextr. Quillajae. 


Fluidextr. Xanthoxyli. 


Fluidextr. Frangulas. 


Fluidextr. Rhamni Purshianas 
Flext. Rham. Pursh. Aromat. 


Fluidextr. Zingiberis. 



Gargarisma, A Gargle (Unofficial), — is a mixture or solution for ap- 
plication to the pharynx or the mouth (mouth-wash). It should not contain 
any very active drug, which would produce dangerous symptoms if swallowed, 
or any agent which would injure the teeth or the mucous membrane. Gargles 
are ordered and compounded in the same manner as mixtures. They usually 
contain astringent or disinfecting salts (alum, borax, potassium chlorate, zinc 



542 



PHARMACEUTICAL PREPARATIONS. 



sulphate), with a vegetable astringent and often honey. The following formulae 
will illustrate prescriptions of this class : — 



1$. Tinct. Guaiaci Ammoniatae, 

Tinct. Cinchonae Comp., aajss. 

Mellis Depurat, o jss. 

Bene simul agita, et adde — 

Potassii Chloratis, 5 ijss. 

Aquae, q. s., ad oviij. 

Fiat gargarisma. Sig. — Gargle. 



1$. Aluminis, 5ij. 

Granati Corticis oiv. 

Petal. Rosae Rubr., 5j- 

Mellis Depurat., o j- 

Aquas Bullientis, 5 vj. 

M. Sig. — Gargle. 

(Goddard.) 



Glycerita, Glyceriles, — are mixtures of medicinal substances with Glycerin, 
in which some of them are dissolved. They are very useful preparations for 
dispensing purposes, as they can be readily diluted with water or alcohol without 
precipitation. There are 6 official Glycerites, the figures following their names 
in the list below indicating the percentage of drug in each. The Glycerite of 
Starch contains io per cent, of water, and that of Hydrastis has for its menstruum 
a mixture of glycerin, alcohol and water. 



Glyceritum Acidi Tannici (20). 
Glyceritum Amyli (10). 
Glyceritum Boroglycerini (31). 



Glyceritum Ferri, Quininae, et Strychninae 

Phosphatum. 
Glyceritum Hydrastis (100). 
Glyceritum Phenolis (20). 



Haustus, A Draught (Unofficial), — is an extemporaneous mixture consisting 
of a single dose, and usually ordered in a vial containing from one to two fluid- 
ounces. 

Effervescing Draught is one of the best known. It is prepared by neutralizing a 
watery solution of Potassium Bicarbonate with Lemon-juice or Citric Acid, and may be 
drank during effervescence. When the C0 2 has escaped it is a solution of Potassium Citrate 
in water, and corresponds to the official Liquor Potassii Citratis. 

Black Draught is another well-known preparation of this class. It is official as Infusum 
Sennas Compositum. 

Infusa, Infusions, — are prepared by treating vegetable substances with 
boiling water. The drug should be coarsely comminuted, sliced or bruised, 
and treated by maceration with the proper quantity of water, which in the ab- 
sence of specific directions to the contrary should be 5 parts by weight of the 
drug to 100 of water, or 5 grammes in 100 Cc. Infusions should be freshly 
made as required for they are very prone to decomposition. Those official num- 
ber 3 and are named in the following list, the figure after each representing the 
percentage of drug to menstruum, viz. — 



Infusum Digitalis (i£). 



Infusum Pruni Virginianae (4). 
Infusum Sennae Compositum (6). 



The last-named infusion contains also 12 per cent, each of Manna and Magnesium Sul- 
phate and 2 of Fennel. Alcohol, in the proportion of 10 per cent, is an ingredient of the In- 
fusion of Digitalis to prevent decomposition. 

Many dispensing pharmaceutists are in the habit of making infusions from 
concentrated alcoholic tinctures or from fluidextracts. This is a very repre- 



PHARMACEUTICAL PREPARATIONS. 



543 



hensihle practice, especially in those cases where the active ingredients ir< oi 
a resinous nature and therefore precipitate when the alcoholic solution is added 
to water. 

Inhalationes, Inhalatiotts, and Vapores, Vapors, (both Unofficial), arc 
medicines in the form of a vapor, a gas or an atomized spray, to be inhaled by 
the patient for their local action on the respiratory tract. The well-known 
steam atomizer is the agent by which most of these preparations arc administered, 
though many substances may be inhaled from the surface of hot water, from 
a -ponge in a bottle surrounded by a hot cloth, or from a heated shovel. They 
are prescribed in the usual manner, as follows: — 



Stimulant Inhalation. 

\\. Olei Cubebae, 5ij. 

Magnesii Carbonat ,~ j- 

Aquae, o iij • 

M. Sig. — A teaspoonful in a pint of 

water at 150 F., for each inhalation. 

Oil of Pine. 

1$. Ol. Pini Sylvestris, 3ij- 

Magnesii Carb., 5j- 

Aqu;e, 0"j. 

M. Sig. — A teaspoonful on a pint of hot 

water for each inhalation. 



Phenolized Inhalation. 

Ttf. Phenolis, itjxlviij. 

Aquae, q. s. ad §ij. 

M. Sig. — Use one-half in the cup of a 
steam-atomizer for each inhalation. 



Tar and Turpentine. 

1$. OI. Picis Liquidae, 

Ol. Terebinth., aagij. 

M. Sig. — Pour slowly on a hot shovel in 
the sick-room, keeping the vapor confined 
therein. 



The Charta Potassii Nitratis (Nitre-paper), is a preparation intended for use as an inhala- 
tion, its vapors while burning being taken into the lungs. 



Injectiones, Injections, (Unofficial), — are liquid preparations intended for 
introduction into the cavities of the body by means of a syringe. When thrown 
into the rectum they are termed Enemata (enemas or clysters), and are usually 
prepared at the bedside. Enemata may be demulcent, laxative, nutritive, stim- 
ulant or vermifuge in character; and always have warm or tepid water as their 
diluent, with which are incorporated such medicaments as may be desired. 
They may consist simply of water as a wash for the cleansing of the bowel. 
Injections are termed vaginal, urethral, vesical, nasal, hypodermic, etc., according 
to the locality in which they are employed. A special form of syringe is used 
in each case, the discussion of which belongs rather to the domain of surgery 
than to medicine. Those used for the nasal cavities are often arranged with 
small holes or an atomizing attachment, so as to deliver the injection in the 
form of a fine spray. A CoUunarium is a nasal douche or wash. In the British 
Pharmacopoeia four hypodermic injections are official; those of Apomorphine, 
Cocaine, Ergot, and Morphine, the formula for which are stated under the 
titles of their principal ingredients. In the Appendix will be found a number 
of formulae for hypodermic injections; a few prescriptions for other forms are 
the following: — 



544 



PHARMACEUTICAL PREPARATIONS. 



Enema jor Stricture oj the Rectum. 

1$. Bismuthi Subcarb 3 j- 

Extracti Opii, gr. ij. 

Glycerini, Aquae, aa oVJ- 

M. Fiat enema. Sig. — Two tablespoon- 
fuls to be injected thrice weekly. 



Demulcent Enema. 



1$. Tincturae Opii, ttjjxx. 

Decocti Amyli, 5iv-vj. 

M. Fiat enema. 



Vermifuge Enema. 

1$. Fluidextr. Quassias, ojss. 

Aquas, 5 ijss. 

M. Sig. — A tablespoonful with an equal 
quantity of warm water, as an enema, to 
be retained as long as possible. 



Ij 



Nasal Injection. 

Phenolis, cryst., gr. xxiv. 

Sodii Boratis, 

Sodii Bicarb., aa o i j - 

Glycerini, 3 ss. 

Aquas Destil. q. s. ad Oj. 

M. Sig. — To be used twice daily in : 
nasal syringe or sprayer. (D obeli's Solution). 



Injection for Gonorrhea. 
(Injection Brou.) 

1$. Zinci Sulphatis, gr. viij. 

Plumbi Acetatis gr. xv. 

Tincturae Opii, §ij. 

Tinct. Catechu, 3 j. 

Aquas Rosas, q. s. ad 5 vj. 

M. Fiat injectio. Sig. — Use with a u 
thral syringe. 



Injection jor Chronic Urethritis. 



R. 



Hydrarg. Chi. Corrosivi, . . gr. \. 

Zinci Chloridi, gr. ss. 

Aquas Destillatas, 5 viij. 

M. Sig. — A tablespoonful to be injected 
well down into the urethra thrice daily, 
through a gum catheter. 



Vaginal Injections jor Leucorrhea. 

~ty. Aluminis, 5 j- 

Zinci Sulphatis 5ss. 

Sodii Boratis, gr. iv. 

M. Sig. — Dissolve in half-a-pint of warm 

water, and use with a vaginal syringe. 

1$. Acidi Tannici, oj- 

Glycerini, 3 iv. 

M. Sig. — One-half with an equal 

quantity of water to be injected twice 

daily. 



Lamellae, Discs, — are small discs of gelatin with some glycerin, and medi- 
cated with a minute quantity of an alkaloid, for use on the ocular conjunctiva. 
In the British Pharmacopoeia four such preparations are official, viz.— 

Lamellae Atropinae, Discs oj Atropine, — each disc contains 5507 grain of Atropine Sul- 
phate. 

Lamellae Cocainae, Discs oj Cocaine, — each disc contains 55 grain of Cocaine Hydro- 
chloride. 

Lamellae Homatropinae, Discs oj Homatropine, — each disc contains jfo grain of Ho- 
matropine Hydrobromide. 

Lamellae Physostigminae, Discs oj Physostigmine, — each disc contains ytfW g ra ' n °f 
Physostigmine Sulphate. 

Linimenta, Liniments, — are very thin ointments for external application, 
intended to be applied with friction to the skin. They are solutions of various 
substances in oily liquids or in alcoholic liquids containing fatty oils. Of the 
following 8 official Liniments 2 have as their basis Cotton-seed Oil, 1 Linseed 
Oil, 1 Oil of Turpentine, 2 Alcohol, 1 Alcohol and Water, and 1 a fluidextract 
(Linimentum Belladonna;). 



Linimentum Ammonias. 
Linimentum Belladonnas. 
Linimentum Calcis. 
Linimentum Camphoras. 

Besides the above, (except Lin. Saponis Mollis), the Br. Phar. contains Lin. Aconiti, Lin. 
Camphoras Ammoniatum, Lin. Crotonis, Lin. Hydrargjri, Lin. Opii, Lin. Potassii Iodidi cum 
Sapone, Lin. Sinapis, and Lin. Terebinthinae Aceticum. 



Linimentum Chloroformi. 
Linimentum Saponis. 
Linimentum Saponis Mollis. 
Linimentum Terebinthinas. 



I'll VRM \i 11 riCAl I'Rl' PAR \l l"\s. 



545 



Extemporaneous Liniments may correspond to the official ones or they may 

be simple mixtures of fluids without either fal or soap. A prescription for i 
kind is appended. The official Linimcntum Saponis (soap liniment) is a good 
basis for extemporaneous preparations of this class. 



R 



Compound Chloroform Liniment. 
3ss. 



Fluidextr. Belladon. Rad., 
Fluidextr. Aconiti, 

Chloroformi iia 3 ij - 

Spiritus Cam hone o j. 

Alcoholis Diluti, q. s. ad ... §viij. 
M. Fiat linimcntum. 

■^i^. — Poison. To be rubbed on the pain- 
ful part. 

Anodyne Liniment. 

R. Tinct. Aconiti 3ij. 

Tinct. Opii, ,~>iv. 

Tinct. Arnica', O j- 

Chloroformi, oij. 

Linim. Saponis, q. s. ad oiv. 

M. Fiat linimcntum. 
Sig. — Poison. Liniment. 



r. 



Stokes' Liniment. 

Old Terebinthinffi 3iij- 

Addi Acetici 5ss. 

( >lei Limonis 5j> 

Vitellum,.' j. 

Aqua- Rosa-, f, iij. 

M. Fiat linimcntum. 
Sig. — Liniment. 



Army Medical Wagon Liniment. 

1$. Aqute Ammonia?, 
Ol. Terebinthinas, 
Ol. Olivas, 

aa, partes squales. 
M. Fiat linimcntum. 
Sig. — Liniment. 



>ig. — x uiaun. i.iuiincin. oig. — i_animeni. 

An Embrocation is a similar preparation, but of thinner consistence 
obsolete. 



The term is almost 



Liquores, Solutions, — comprise all aqueous solutions of non-volatile sub- 
stances, except the syrups, infusions and decoctions, which naturally form dis- 
tinctive classes. There are 25 official solutions, 13 of which are simple solutions 
of the medicament, the rest being chemical solutions, in which the dissolved 
substances are altered by chemical action and new ones formed. They are 
named as follows: — 

Iodi Compositus. 

Magnesii Citratis. 

Plumbi Subacctatis. 

Plumbi Subacetatis Dilutus. 

Potassii Arsenitis. 

Potassii Citratis. 

Potassii Hydroxidi. 

Soda; Chlorinate. 

Sodii Arsenatis. 

Sodii Hydroxidi. 

Sodii Phosphatis Compositus. 

Zinci Chloridi. 

Lotio, .4 Lotion or Wash (Unofficial), — is a solution or mixture of medicinal 
agents, intended for external application; usually consisting of some soluble, 
astringent salt, dissolved in water, with perhaps some glycerin or alcohol. A 
Fomentation (Foltts) is a similar preparation used hot, or flannel may be wrung 
very dry out of boiling water, applied and covered with oiled silk. Spongio- 
piline, a fabric composed of sponge and wool coated with rubber, is an excellent 
vehicle for the application of warmth and moisture. The inner surface is 
moistened with hot water; and its utility may he increased by sprinkling the 
36 



Liquor Acidi Arsenosi. 


Liquor 


Liquor Ammonii Acetatis. 


Liquor 


Liquor Antisepticus. 


Liquor 


Liquor Arseni et Hydrargyri Iodidi. 


Liquor 


Liquor Calcis. 


Liquor 


Liquor Chlori Compositus. 


Liquor 


Liquor Cresolis Compositus. 


Liquor 


Liquor Ferri Chloridi. 


Liquor 


Liquor Ferri et Ammonii Acetatis. 


Liquor 


Liquor Ferri Subsulphatis. 


Liquor 


Liquor Ferri Tersulphatis. 


Liquor 


Liquor Formaldehydi. 


Liquor 


Liquor Hydrargyri Nitratis. 





546 



PHARMACEUTICAL PREPARATIONS. 



moistened surface with charcoal or yeast, or by saturating it with any desired 
lotion or liniment. A Collyrium is an eye-wash, and generally contains a soluble 
astringent salt dissolved in rose-water or distilled water, in the proportion of 
gr. j-iv to the 5- The only official preparation suitable for a lotion is the Liquor 
Plumbi Subacetatis Dilutus (Lead- water) . A well-known anodyne, refrigerant 
and astringent lotion is that represented by the upper two of the following pre- 
scriptions. 



Lead-water and Laudanum. 

1$. Liq. Plumbi Subacetatis, 3j. 

Tinct. Opii, 5 j- 

Aquas, q. s. ad 5 viij. 

M. Fiat lotio. Sig. — Lotion. 

(Gross.) 



Collyrium. 

1$. Sodii Boratis, gr. x. 

Aquae Camphors, 3ij. 

Mucil. Cydonii, 

Aquas Destil., aa oss. 

M. Fiat collyrium. Sig. — Eye-water; a 
few drops to be put into the eye three or 
four times daily. 



Lead and Opium Wash. 

IBf. Liq. Plumbi Subacetatis, 

Tinct. Opii, aa oj- 

Aquas, q. s. ad 5 viij. 

M. Fiat lotio. Sig. — Lotion. 

(Stitrgis.) 

Collyrium o} Four Sulphates. 
1$. Zinci Sulphatis, 
Ferri Sulphatis, 
Cupri Sulphatis, 

Aluminis, aa gr. j. 

Aquas Destillatas, 5 j- 

M. Fiat collyrium. Sig. — For use with 
brush to palpebral conjunctivas, and to be 
washed off with clean water. 



Massae, Masses, — are Pill-masses prepared as described under the subtitle 
Pilule. The official Masses number 2, viz. — 



Massa Ferri Carbonatis. 



Massa Hydrargyri. 



Mellita, Honeys, — differ from syrups merely in being prepared with honey 
as a base. The Oxymel and Oxymel Scillce of the B. P. are similar preparations, 
containing also Acetic Acid. There are 3 official Honeys, including two forms 
of honey itself, viz. — 



Mel. 



Mel Depuratum. 



Mel Rosas. 



Misturae, Mixtures, — in official pharmacy are aqueous preparations of 
insoluble substances held in suspension by a suitable vehicle. In extemporaneous 
pharmacy the term mixture has a wider signification, as explained below. Mix- 
tures are generally prepared extemporaneously upon prescriptions, as few of 
them have the stability necessary to insure their preservation beyond a few 
days. The official mixtures are 4 in number, and are named as follows, — 



Mistura Cretas. 

Mistura Ferri Composita. 



Mistura Glycyrrhizae Composita. 
Mistura Rh'ei et Sodas. 



In extemporaneous pharmacy the term Mixture is applied to every fluid 
compound intended for internal use, except a few which bear distinctive titles, 
as Emulsions, Draughts, Enemas, Elixirs and Drinks. The simplest form of 
mixture in this extended sense is that in which two or more liquids are mixed 
together; but a great variety of substances may be prescribed in this form. 



PHARMACEUTICAL PREPARATIONS. 



547 



chief among which are most of the soluble salts, light insoluble powders, salts 
which may be diffused by agitation, extracts, gum-resins, and the fixed essential 
oils.. They are generally ordered in 2, 3, 4, 6, S, 10 and 12-ounce vials. 

Substances suitable to the mixture-form, properly so called, are those which, 
though more or less insoluble in water, will mix therewith by means of agitation, 
trituration, etc. Those most frequently ordered are as follows: — 



Diffused by Agitation: — 

Calcii Phosphas Pra»cipitatus. 
Cinchona (powdered). 
Ipecacuanha (powdered). 
Magnesia. 
Quininae Sulphas. 
Sulphur Prascipitatum. 

Suspended by Viscid Excipients : — 
Essential Oils. 
Oleum Amygdalae. 
Oleum Morrhuae. 
Oleum Olivae. 
Oleum Ricini. 
Copaiba. 
Ferri Carbonas Saccharatus. 



Miscible only by Trituration . 

Ammoniacum. 
Asafcetida. 
Confectio Rosas. 
Confectio Sennae. 
E.xtractum Aconiti. 
Extr. Belladonnas Fol. 
Extr. Conii. 
Extr. Hyoscyami. 
Extr. Stramonii. 
Extr. Glycyrrhizae. 
Extr. Krameria:. 
Extr. Taraxaci. 
Guaiacum. 
Scammonium. 
Myrrha. 



Best Suspended by the aid of a Fixed Oil or Yolk of Egg: — 

Extr. Cannabis Indicae. Oleum Terebinthinas. 

Camphora. Chloroformum. 

Solutions intended for internal administration are classed as Mixtures in 
extemporaneous pharmacy, for the reasons already stated. The following list 
of acids and salts comprises most of the solids which are best adapted for use 
in liquid form, by reason of their solubility in water. 



Acidum Citricum. 
Acidum Tannicum. 
Acidum Tartaricum. 
Alumen. 

Ammonii Chloridum. 
Antim. et Potass. Tartras. 
Barii Chloridum. 
Calcii Chloridum. 
Calcii Hypophosphis. 
Ferri Pyrophosphas. 
Ferri Sulphas. 
Ferri et Ammonii Citras. 



Ferri et Potassii Tartras. 
Ferri et Quininas Citras. 
Magnesii Sulphas. 
Mangani Sulphas. 
Potassii Acetas. 
Potassii Bicarbonas. 
Potassii Bromidum. 
Potassii Carbonas. 
Potassii Citras. 
Potassii Chloras. 
Potassii Hypophosphis. 
Potassii Iodidum. 



Potassii Tartras. 
Potassii et Sodii Tartras. 
Morphinae Acetas. 
Morphinae Hydrochloridum. 
Morphinas Sulphas. 
Sodii Bicarbonas. 
Sodii Boras. 
Sodii Carbonas. 
Sodii Chloridum. 
Sodii Hypophosphis. 
Sodii Phosphas. 
Sodii Sulphas. 



A few require the use of viscid substances as vehicles or correctives, 
are as follows : — 



They 



Ammonii Carbonas. 
Plumbi Acetas. 



Potassii Hydroxidum. 
Potassii Cyanidum. 
Hydrargvri Chloridum Corrosivum. 



Certain salts are best ordered by prescribing such agents as when in solution 
together react upon each other and produce' the desired salt. Instances of this 
may be found in the pharmacopceial processes for most of the official Liquores, 
some salts so produced being the following: — 



548 



PHARMACEUTICAL PREPARATIONS. 



Ammonii Acetas. 
Magnesii Citras. 
Potassii Citras. 
Ferri Citras. 



Ferri Acetas. 
Ferri Chloridum. 
Ferri Nitras. 
Hydrargyri Nitras. 



Potassii Arsenis. 
Potassii Hydroxidum. 
Sodii Hydroxidum. 
Zinci Chloridum. 



Certain other substances require the addition of other agents in order to 
form eligible solutions. Such are the following: — 

Quinine Sulphate, — requires acidulated water for its solution, the acid used being 
generally Diluted Sulphuric, or the Aromatic Sulphuric. This method of prescribing the 
salt develops its bitter taste to the utmost, and is often avoided by ordering the drug to be 
suspended in a viscid liquid, such as Pulv. Acaciae in Syrup of Ginger. In such a case an 
officious dispenser anxious to show his smartness by adding some dilute Sulphuric Acid to 
dissolve the Quinine would thereby defeat the object of the prescriber. 

Quinine Sulphate may be prescribed with Aromatic Spirit of Ammonia, Spirit of Nitrous 
Ether, Tinctures or other alcoholic preparations together with Glycerin or Syrup and Water. 
In such cases the salt should be first dissolved in the alcoholic portion of the prescription, 
then the glycerin or syrup and finally the aqueous portions should be added gradually. It 
may also be ordered with Diluted Sulphuric Acid and some vegetable infusion containing 
Tannin, in which case a precipitate of Quinine Tannate will be produced. This of course 
should not be filtered, but should be dispensed with a "Shake-label." 

For the use of Velatine as a vehicle for the administration of Quinine Salts, see under the 
title Cinchona, in Part I. 

Chinoidin, Cinchonine Sulphate and Quinidine Sulphate, — also require the addi- 
tion of a dilute mineral acid for their solution in aqueous mixtures. 

Iodine, — requires the addition of Potassium Iodide for its solution in a convenient quan- 
tity of water, as in the case of the official Liquor Iodi Compositus. 

Hydrargyri Iodidum Rubrum, Red Mercuric Iodide, — requires the addition of Potas- 
sium Iodide or Mercuric Chloride for its aqueous solution. 

Potassii Bitartras, Cream of Tartar, — requires the addition of Borax or Boric Acid for 
its solution in water. 

Sodium Phosphate, — is theoretically soluble in 6 parts of water, but in practice it is 
soluble with difficulty in aqueous preparations unless Citric Acid be added. 

Benzoic Acid, — requires the addition of Borax to aid its solubility in water, an equal 
part of the latter making it 5 times more soluble than when alone. 

Lime, — is more soluble in sweetened water than in plain water, the sugar aiding its solu- 
tion. 

Excipients are substances which give form and consistence to prescriptions, 
and serve as vehicles for the exhibition of the other ingredients. Some of the 
excipients are Diluents, or agents which effect the dilution or division of the 
active ingredients; while others act in the double capacity of diluents and 
Flavoring agents. The Excipients most generally used in mixtures may be 
tabulated as follows, — 



Diluents. 
Water (Aqua). 
Medicated Waters (Aquae). 
Syrups. 
Mel Rosae. 
Elixir Aromaticum. 



Oleum Amygd. Amarae. Tinct. 

Oleum Cari. Tinct. 

Oleum Caryophylli. Tinct. 

Oleum Cinnamomi. Tinct. 

Oleum Gaultheriae. Tinct. 

Oleum Sassafras. Tinct. 

Tinct. Aurantii Dulcis. Tinct. 



True Excipients. 
Acacia (in powder or mucilage). 
Tragacanth (in powder or mucilage). 
Confections. Sugars. 
Some Extracts. 
Yolk of Egg (Vitellus). 



Flavoring Agents. 
Cardamomi. 
Cardamomi Comp. 
Cinnamomi. 
Gentianae Comp. 
Tolutana. 
Vanillae. 
Zingiberis. 



Spiritus Anisi. 
Spiritus Lavandulae. 
Spiritus Mentha? Piperitae. 
Spiritus Mentha; Viridis. 
Syrupus Tolutanus. 
Syrupus Zingiberis. 



rn \>m U'i i nc\! PR] PAB \no\s. 5.,,, 

Compounding the Mixture is a mailer of no slighl importance, and one 
which is best learned at the dispensing counter, though a few directions may 
not be out of place. In the case o\ the simplest form of mixture, where two 
or more fluid preparations are prescribed together, the only operations required 
are the measuring of the several ingredients and pouring them into the vial. 
In doing this the compounder should pursue a regular and definite order of 
procedure. Taking in his left hand a graduate of sufficient capacity to hold 
the whole quantity prescribed, he should walk alongside the shelves, and with 
the right hand pour from the stock-bottles the requisite quantity of each ingre- 
dient in the order in which they are entered on the prescription. A skillful 
druggist will hold the graduate between the thumb and first finger, the pre 
seription between the second and third fingers, and the stopper of the stock- 
bottle between the little finger and the hand, leaving his right hand free for the 
manipulation of the bottles containing the ingredients. 

When an actively poisonous agent is ordered it should always be the last 
thing put into the mixture. Attention to this rule will prevent the danger of 
the toxic substance being put in twice. 

The order in which the ingredients are put together is not of so much impor- 
tance in compounding a simple mixture as in the case of an emulsion, and the 
order of the prescription can usually be followed, with the exception noted in 
the preceding paragraph. Still, when several alcoholic preparations, syrups 
and waters are ordered together, it is good practice first to mix the alcoholic 
fluids, then to add the syrups and finally the water, so as to avoid the precipitation 
of resinous principles which would occur if the alcoholic solutions were added 
to the water. Distilled water should always be used, in order to insure uni- 
formity in taste and appearance, and also as a matter of purity and cleanliness. 
All mixtures should be well shaken before being labelled. 

Solids which are comparatively insoluble or slowly soluble require to be 
rubbed up in a mortar with one or more of the fluid ingredients. Glass mortars 
are much employed for this purpose, and many compounders mix all the ingre- 
dients in such a mortar before transferring them to the vial. Vegetable powders, 
(rhubarb, ipecac, etc.), or finely pulverized inorganic substances, are often 
ordered in intimate mixture with water, thickened with mucilage or syrup. In 
such cases the mixture should be made in a porcelain or wedgewood mortar, 
enough mucilage or syrup being added at first to make a thick paste, and after 
this is rubbed smooth the water may be gradually added during the continued 
process of mixing. This process will answer for all inorganic substances in 
powder, except Magnesia, which is best mixed by being thrown on the surface 
of the water; after it has sunk to the bottom as a uniform sediment the 
other ingredients may be added and the whole well shaken. Froth upon the 
surface of the liquid, which often arises after agitation and may prevent the 
corking of the bottle, will quickly subside on the addition of a few drops of 
alcohol. 



i 



55° PHARMACEUTICAL PREPARATIONS. 

The following are specimens of prescriptions for medicines to be admin- 
istered in mixture form : — 



Bismuth Mixture jor Children. 

^. Bismuthi Subcarbonatis, — 3 i j - 
Syrupi Acacia, 



Quinine Mixture jor Children. 

"fy. Quininae Sulphatis (pulv.),. 3ss. 
Acacias (pulv.), 3ss. 



Aquas Cinnamomi, aa 3ij. Syrupi Zingiberis, oiv. 

Misce. Sig. — A teaspoonful every hour ' Fiat mistura. Sig. — A teaspoonful thrice 
in choleraic diarrhea. ' daily. 

Mucilagines, Mucilages, — are thick, viscid liquids prepared by dissolving 
gum in water, or by extracting with water the mucilaginous principles from 
certain plants. They are easily spoiled and should be kept only in small quan- 
tities. The official Mucilages number 4, as follows, the first two being prepared 
without heat, the last two with heat, — 

Mucilago Acacias. Mucilago Tragacanthae. 

Mucilago Sassafras Medullas. Mucilago Ulmi. 

Oleata, Oleates, — are liquid solutions of metallic salts or alkaloids in Oleic 
Acid, intended for external administration. They are not definite chemical 
compounds, though the term is also employed in trade to designate certain solid 
preparations which are claimed to be chemical compounds of the same acid 
with various bases. [See under Acidtjm Oleicum, page 77.] There are 5 
official Oleates, three of which have olive oil, as well as oleic acid. They are 
named as follows: — ■ 

Oleatum Atropines (2 per cent.). Oleatum Hydrargyri (25 per cent.). 

Oleatum Cocainas (5 per cent.). Oleatum Quininae ( 25 per cent.). 

Oleatum Veratrinas (2 per cent.). 

Oleoresinae, Oleoresins, — are liquid preparations consisting principally of 
natural oils and resins extracted from vegetable substances by percolation with 
Acetone. They differ from fluidextracts in not bearing any uniform relation 
of Cc. to the gramme of drug, in containing principles which though soluble 
in acetone are not so in alcohol, and in some instances being devoid of principles 
which are insoluble in acetone but soluble in alcohol. They are the most con- 
centrated liquid preparations of drugs which can be produced, and are prepared 
by percolating the powdered drug with acetone until exhausted, recovering the 
greater part of the acetone by distillation, and exposing the residue in a capsule 
to spontaneous evaporation until the remaining acetone has evaporated. In 
one case, that of Cubeb, the medium of extraction is alcohol. The official 
Oleoresins are 6 in number, viz. — 

Oleoresina Aspidii. Oleoresina Lupulini. 

Oleoresina Capsici. Oleoresina Piperis. 

Oleoresina Cubebas. Oleoresina Zingiberis. 

Pigments, Paints, (Unofficial), — are preparations for external use, which 
cannot be classed with the preceding. They are generally prescribed in skin 



I'M \KM (ill I [C \i PREPAH VTIONS. 



551 



diseases, for use over inflamed joints, or for application to the throat with a 
camel's-hair brush. 



i; rinct. Iodi gj, 

/Etlu-ris 5»j. 

1. Vconiti 5ss. 

Fluidextr. Belladon. Rad.,. . 5iv. 

Morphine Sulph t;r. ij. 

Iodi 5 jss. 

Sig.— Paint 4 or 5 coats freely over the 
inflamed and painful parts. 



If . U iaponis Mollis, 

• 'I. i ( ladini fifi 5j. 

Sig. — Paint over the part. 

1?. ( )lei Tiglii, ~> i- 

Athens, ")ij. 

Tinct. Iodi v. 

M. Sig. — Paint on once in 3 days. 



Pilulae, Pills, — are spherical masses composed of medicinal agents and 
intended to be swallowed whole. The mass consists of the active ingredients 
and the excipient, the latter being the substance which gives to the mass its 
adhesive and plastic qualities. In official pharmacy the excipients are specified 
both as to composition and quantity in each case, and those directed to be used 
in the preparation of the 2 official Masses and the 14 official Pills are as follows, — 

3 are made with Soap and Water, — Pil. Aloes, Pil. Asafoetidas, Pil. Opii. 

1 is made with Water alone, — Pilulas Rhei Composite. 

3 with Diluted Alcohol, — Pil. Aloes et Mastiches, Pil. Cathartics: Comp., Pil. Ca- 
thartics Vegetabiles. 

2 with Syrup, — Pil. Aloes et Myrrhas, Pil. Laxativas Composite. 

2 with Glycerin and Water, — Pil. Ferri Carbonatis, Pil. Phosphori. 

1 with Acacia and Water, — Pilulae Ferri Iodidi. 

1 with Acacia, Glycerin and Syrup, — Pil. Podophylli, Belladonna; et Capsici. 

1 with Confection oj Rose, — Pilulas Aloes et Ferri. 

1 with Honey, Syrup and Water,- — Massa Ferri Carbonatis. 

1 with Glycerin and Honey of Rose, — Massa Hydrargyri. 

The pharmacopceial directions for the formation of the pill-mass vary in 
each case, but in general they prescribe that the ingredients shall be mixed 
intimately, then beaten with the excipient to form a mass and divided into a 
certain number of pills. Two of the official pills are directed to be coated 
with an ethereal solution of the balsam of Tolu, — Pilulas Ferri Iodidi and Pilulae 
Phosphori. Full descriptions of the various details of pill-making are given 
on the next page. 

The number of official pills is 14, for the composition of which the student 
is referred to their several titles in the section on Materia Medica. They are 
named as follows, — 



Pilulae Aloes. 

Pilulae Aloes et Ferri. 

Pilulae Aloes et Mastiches. 

Pilulas Aloes et Myrrhae. 

Pilulae Asafoetidas. 

Pilulae Catharticas Compositae. 

Pilulae Catharticae Vegetabiles. 



Pilulae Ferri Carbonatis. 

Pilulae Ferri Iodidi. 

Pilulas Laxativas Compositae. 

Pilulas Opii. 

Pilulas Phosphori. 

Pilulas Podophylli, Belladonnas et Capsici. 

Pilulas Rhei Compositas. 



Pills constitute a form of medicine very much used in extemporaneous 
pharmacy, and one with the preparation of which the compounder should be 
perfectly familiar, for it will constitute fully pne-third of his work at the dis- 
pensing counter. Pills should not exceed 5 grains in weight, unless the ingre- 
dients are very heavy, as Bismuth, Calomel, and Hydrargyrum cum Creta, of 



55 2 PHARMACEUTICAL PREPARATIONS. 

which 6, 8, or 10 grains may be made into a pill which may be readily swallowed. 
A Bolus is a similar mass, but larger than a pill, while the names Granule and 
Parvule are given to masses smaller than the average pill. 

The Process of Pill-making. 
The Process of Pill-making is briefly as follows: The ingredients ordered in 
the prescription are separately weighed out in the order of their bulk, commenc- 
ing with that one of which the smallest quantity is to be used. If any require 
pulverization they should be placed first in the mortar and reduced to powder, 
the other dry ingredients added, next the soft extracts and the excipient 
selected; the whole being worked up into a mass, the pill-mass, by the aid of 
the mortar and pestle. The perfect pill-mass should be uniform throughout, 
should not show any particles of any one ingredient, should have such a con- 
sistence that the pills made from it will retain their shape, should not be too 
hard, nor too dry, nor should it stick to the fingers. The mortar should be 
large and shallow, of unpolished wedgewood ware; having a thick, smooth and 
well-formed bottom and a pestle which fits it. The operation of working up 
the mass is one of kneading it between the end of the pestle and the side of the 
mortar, and if proper ingredients and excipient are used and the work is well 
done, the mass will eventually loosen itself from both mortar and pestle. If 
it does not do so it should be removed with a spatula when sufficiently worked, 
and may be kneaded for a few minutes between the fingers. It should then be 
placed upon the tile or slab previously dusted with a little Lycopodium or Starch 
in fine powder, and rolled into a long cylinder by the aid of a broad-bladed 
spatula, until the mass is of a length corresponding to the divisions on the 
tile-scale which represent the number of pills to be made. The mass should 
then be placed along the scale, and a cut made through it with the spatula at 
each division, the pieces being rounded separately into pills by the thumb and 
two fingers of each hand. A pill-machine is often employed, consisting of two 
metal plates having semi-cylindrical grooves on one side, set into wooden boards, 
the whole forming a convenient apparatus for rolling the mass and then cutting 
it into the required number of pills by one movement. The pills are then left 
to dry upon the slab while the label is being written, after which they are placed 
in a pill-box, or in a wide-mouthed bottle if they contain volatile ingredients, 
and surrounded by a conspergative powder (lycopodium, powdered chalk, dusted 
talc), to prevent their adhering together or losing their shape. 

Excipients used in pill-making are seldom mentioned in the prescription, 
but are usually left to the choice of the compounder. Some substances need 
no excipient, but may be made at once into pills; such being the softer extracts 
and some gum-resins, the former if too hard only needing a little water, and 
the latter a few drops of spirit to soften them to the required degree of plasticity. 
Every druggist has his favorite pill-excipient, many using a paste made of pow- 



rii \k\i u 1 1 riCAJ prepas mews. 553 

dered Tracaganth i. Glycerin 3^ and Water 1 part, while others use Ext 
of Malt or a mixture of Syrup and powdered Acacia for general use. Powdered 
Tragacanth to give tenacity, Glycerin to keep the mass soft, and Water to 
develop the adhesive qualities of many ingredients, will answer for fully nine 
tenths of all the eases which occur in practice. 'These three excipients should 
stand on the dispensing counter ready for use, and all ready made pastes or 
mixtures should he discarded as being slovenly, dirty and liable to change. 
The excipients described below are those in general use and are arranged in 
the order of their comparative importance. 

Liquid Kxcipif.nts. 

Glycerin, — is a very valuable excipient, as it continually attracts moisture from the 
atmosphere, anil pills made from it do not got hard. It should always he used for Quinine 
pills. Glycerite of Star,!: or Tragacanth arc generally useful excipients. The former is 
Official, the !al*.cr is made in the proportion of oss to the q. 

Glucose, — is a good excipient, being colorless, adhesive, and not readily volatilized at 
ordinary temperatures. Since its introduction by Mr. Lascheid for this purpose it has steadily 
grown in favor. 

Honey, — may be used for dark-colored substances. It should be evaporated to one- 
half its bulk, and then if mixed with a little Tragacanth it makes an excellent excipient for 
insoluble powders. 

Extract of Malt, — is a pretty fair excipient, but has the disadvantage of its dark color. 

Syrup, — is a fair excipient for powders, but it should not be used for metallic salts, espe- 
cially Calomel, which it reduces in a short time. Syrup of Acacia is good where there is 
little room left for the excipient, but pills made with it become very hard and insoluble if they 
are kept long. 

Mucilage of Acacia, — is very adhesive, but not a good excipient for the same reason as 
given for the syrup. 

Water, — is only used alone as an excipient when the ingredients possess sufficient ad- 
hesiveness to be developed by the water. Such are the following powders: Aloe, Rhubarb, 
Kino, Tannic Acid, Opium, Squill, Asafoetida, — also Ferric Citrate, Berberine Sulphate, 
and some other salts. 

Alcohol, — is used to soften Camphor, Compound Extract of Colocynth, Guaiac, resinous 
extracts, gums, etc. 

Solid Excipients. 

Tragacanth, — is an excellent excipient, especially for substances which are too soft, 
giving them body and elasticity. 

Acacia, — is added to give more adhesiveness than can be obtained from viscid liquids 
alone. Pills made with it are generally very hard. It is used for Silver Nitrate, which may 
explode if mixed with vegetable extracts or glucose. 

Soap, — is the best for resinous and fatty substances, increasing the solubility of the 
former. It should not be used for substances which are decomposed by an alkali, nor for 
Tartar Emetic. 

Bread-crumb, Mica Panis, — is an excellent excipient for Croton Oil, or other powerful 
liquid substances, as volatile oils. 

Confection of Rose, — is too bulky for general use, but is a good excipient for very active 
agents like Strychnine, which are used in small quantity. 

Althaea, — is good for absorbing and adhesive purposes, but is too bulky for general use 

Petrolatum, Cacao Butter, and Rosin Cerate, — are used for oxidizablc substances, 
as Potassium Permanganate. 

Kaolin, — is well adapted as an excipient for Silver Nitrate and other substances which 
are easily decomposed. 

Licorice, — is an old excipient, but not much employed now. In powder it may be used 
for oils. 



I 



554 PHARMACEUTICAL PREPARATIONS. 

Cons per gatives are absorbent powders which are dusted upon the finished 
pills and put around them in the box or vial in which they are dispensed, to 
keep them from sticking together and losing their shape. Powdered Licorice 
was formerly much used for this purpose, but the best conspergatives are Lyco- 
podium, Talc, Althaea and Rice Flour, the latter especially for white pills. 

Substances suitable for the pillar form of medicine are — 
Those acting in small doses. Heavy, insoluble substances. 

Those intended to act slowly. Fetid substances. 

Those to act on the lower bowel. Vegetable extracts. 

Gums-resins, Balsams, Turpentine. 

When the basis is an unadhesive substance, one of the other ingredients 
should be an extract or a vegetable powder which will form a mass by moisture 
alone. Attention to this rule in prescribing pills will often prevent the increase 
of their size by the use of inert excipients. 

Substances difficult to combine, except by peculiar treatment, are met with 
frequently. The following notes will cover most such cases : — 

Aloe, — is best treated on a heated slab with alcohol in very small quantity. Soap is the 
excipient in the official Pilulae Aloes. 

Butyl Chloral Hydrate, — should be treated with a little Confection of Rose and thick 
mucilage. 

Calcium Sulphide, — should be well triturated with an equal quantity of Sugar of Milk, 
and then worked up with a little powdered Licorice-root and Mucilage of Tragacanth. 

Camphor, — should be powdered with a little alcohol, and may be worked into a pill- 
mass with Glycerite of Tragacanth after the evaporation of the alcohol. 

Phenol, — requires nearly an equal part of wheaten flour or bread-crumb, with a very 
minute quantity of Glycerite of Tragacanth. Creosote may be made into a mass by the 
addition of Powdered Licorice with a very little bees' wax. If made into a pill with Silver 
Oxide it will explode unless the silver salt be first diluted by trituration with Licorice, Gen- 
tian, or some other inert powder. 

Iron and Quinine Citrate, — is very deliquescent with most excipients. Canada Balsam 
is the best for it. 

Copaiba, — may be made into a pill-mass by the addition of a little Magnesium Car- 
bonate or Wax. 

Croton Oil, — is best worked up with bread-crumb, though powdered Licorice and Mu 
cilage of Acacia may be used. 

Ferrous Iodide, — in pill form requires special manipulation and protection to remain 
unoxidized. The official Pil. Ferri Iodidi is prepared with Iodine and Reduced Iron, has 
Licorice, Sugar, and Acacia as excipients, and is protected by a coating of Balsam of Tolu 
In other formula, Acacia, Althaea, Cacao-butter, Elm bark, and Licorice are used as excip- 
ients. 

Ferrous Sulphate, — is used in Blaud's Pill and in the Pil. Ferri Compositae, with Potas- 
sium Carbonate, to form by mutual decomposition Ferrous Carbonate, which quickly passes 
into the ferric salt by exposure. 

Gallic Acid, — makes a good pill with a very small quantity of Glycerin. Tannic Acid 
requires about one-fifth its weight of Glycerin and one-tenth of Mucilage. 

Phosphorus, — presents the problem of combining it in pill without letting it oxidizi-. 
This is believed to be accomplished by the pharmacopceial directions for the Pil. Phosphori, 
according to which the Phosphorus is dissolved in Chloroform in a test-tube, then quickly 
worked into a mass with Althaea, Acacia, Glycerin and Water, and finally the pills are coated 
by shaking with an Ethereal solution of Balsam of Tolu. Carbon Disulphide is a better 
solvent, but when it is used the pill-mass retains its disgusting odor. 






rn vrm VCETJ i ic\i pki r \k mONS. 



555 



Potassium Acetate, — requires Canada Balsam to secure its stability in pill farm. Po- 
tassium Iodide is lu-st manipulated by rubbing it into a smooth paste with .1 very little 
water, then adding a sm.ill quantity of Licorice powder. Potassium Permanganate slmul. I 
be worked up with Kaolin and a very little water. Rosin Cerate, Soft and i tara Paraffin and 
Cacao-butter are also used as excipients. 

Quinine, — requires very clean hands and tools, and a colorless exdpient, as Gl 
or Glucose, to make a nice-looking pill. It one part ut' Tartaric A< id is added to four of the 
Quinine salt, the mass will be less likely to crumble and will be of less bulk. Quinine Sul- 
phate may be made into small and soluble pills by simply triturating it with Aromatic Sulplnn ii 
Aeid irgiij to each 5 grains of the salt. The moulding into pills should be done at the moment 
when the mass has begun to dry. A drop of syrup or honey, added at this time, will prevent 
the too rapid hardening of the mass. 

Rhubarb, — in powder makes a good mass with one-fifth of its weight of Glycerin; but 
Water is the excipient ordered for the official Pilula: Rhei Composite 

Substances unsuiied to the pilular form are — 
Those requiring large doses, and those which are volatile. 
Emetics, and other agents administered for immediate effect. 
Essential Oils in quantity exceeding half a drop to each pill. 
Oils and other bodies which require much solid matter to make a mass; except 

those prescribed in very small dose, as Croton Oil. 
Deliquescent Salts, unless intended to be used immediately. 
Efflorescent Salts, unless deprived of their water of crystallization. 



Deliquescent Salts. 

Ammonii Iodidum. 

Nitras. 

Valeras. 

Auri Chloridum. 

Calcii Chloridum. 

Chinolin Salts, except the Tartrate, which 

is stable. 
Lithii Citras. 

Bromidum. 

Salicylas. 

Magnesii Citras. 
Potassii Acetas. 

Carbonas. 

Citras. 

Cyanidum. 

Hydroxidum. 

Hypophosphis. 

Sulphis. 

-Tartr as . 

Hypophosphis. 

Iodidum. 

Zinci Bromidum. 

Chloridum. 

Iodidum. 



Efflorescent Salts. 

Alumen (slightly). 
Ammonii Carbonas. 

Phosphas. 

Antim. et Potassii Tartras (slightly). 
Cupri Acetas. 

Sulphas. 

Magnesii Sulphas (slightly). 
Potassii et Sodii Tartras (slightly). 

Ferrocyanidum (slightly). 

Quininae Bisulphas. 

Sulphas (after a time). 

Sodii Acetas. 

Arsenas (slightly). 

Benzoas. 

Boras (slightly). 

Carbonas. 

Hydroxidum. 

Hyposulphis. 

Phosphas. 

Sulphas. 

Sulphis. 

Strychnin* Sulphas. 
Zinci Acetas. 
Sulphas. 



Coated Pills are manufactured upon a large scale by the great drug houses, 
extensive machinery being employed for the purpose. The coating material 
used is either Sugar or Gelatin. The U. S. Pharmacopoeia directs that two of 
the official pills shall be coated by being shaken with a solution of Balsam of 
Tolu in Ether,— Pil. Ferri Iodidi and Pil. Phosphori. In extemporaneous phar- 
macy it is rarely practicable to coat pills with anything except gold or silver 
leaf, and this is sometimes directed by the prescriber, the word "Deaurenter — 



556 



PHARMACEUTICAL PREPARATIONS. 



let them be gilded" being used in the subscription. To do this neatly the pills 
should have no trace of powder on them, but should be first coated with a trifle 
of fresh mucilage by rolling between the mucilage-moistened fingers, each pill 
being then dropped directly on to a sheet of gold or silver leaf, until a dozen 
or more are so deposited. The leaf and its pills are then allowed to slide into 
a globular boxwood shaker, or the leaf may be first placed in the shaker and 
the pills dropped on it there. A cautious circular movement being given tc 
the shaker the pills are caused to travel around its walls, and when the cover 
is removed they will be found to have each received an even coating of the metal 
used. Gold leaf should always be employed for pills of Blue Mass or Asafcetida, 
as silver is amalgamated with the former and turned black by the latter. 

Albumin may be used for coating small numbers of pills, which should be of very 
consistence before the coating is applied. Each pill is rolled between two fingers with a little 
white of egg, and then revolved in a warm pan. Another method of finishing them is, after 
coating with albumin, to rotate them in a tray with powdered French chalk until their sur- 
faces become smooth and shiny. This process gives a very nice finish. 

The following prescriptions represent the composition of a few unofficial 
pills in general use. A complete pill formulary is easily obtained, being pub- 
lished annually by the principal manufacturers. 



Anaphrodisiac and Sedative. 

1 Bf. Camphors, gr. xxx. 

Lupulini, gr. xx. 

Fiat massa et div. in pil. xx. 
Sig.— One thrice daily. 



Astringent Pill. 

1$. Argenti Nitratis, gr. xx. 

Pulv. Crets (Gallics), gr. lxxx. 

Petrolati, q. s. 
Fiat massa et div. in pil. xl. 



Hooper's Female Pills. 

1$. Pulv. Aloes Purif., gr. xlviij. 

Ferri Sulph. Exsic, gr. xxiv. 

Extr. Hellebori Nig., 
Pulv. Myrrhs, 

Saponis, aa gr. xij. 

Pulv. Canells Alb., 

Pulv. Zingiberis, aa gr. vj. 

Aqus vel Syrupi, q. s. 
Fiat massa et div. in pil., quisque pondo 
gr. ijss. 

Sig. — One to three pills at a dose. 



R 



Astringent Pill. 

Plumbi Acetatis, gr. xvj. 

Pulv. Camphors, gr. xij. 

Pulv. Opii, gr. iij. 

Bismuthi Subcarb., gr. xij. 

Extr. Gentians, q. s. 
Fiat massa et div. in pil. xij. 
Sig. — One pill thrice daily. 



Pills oj Iron. 

fy. Ferri Reducti, gr. 1. 

Manns, gr. xv. 

Glucosi, q. s. 
Fiat massa et div. in pil. xxv. 
Sig. — One pill after each meal. 



Q. 



Emmenagogue Pill {Otto). 

Ferri Sulph. Exsic, gr. xlviij. 

Pulv. Aloes, gr. xij. 

Terebinthins, gr. xxvij. 

Ol. Terebinth., ttjjx. 

Fiat massa et div. in pil. xxx. 
Sig. — Two pills three times a day. 



Cholagogue Pills (Squibb). 

i. Resins Podophylli, gr. vj. 

Extr. Belladon. FoL, gr. iij. 

Pulv. Capsici, 

Pulv. Sacch. Lactis, aa gr. xxiv. 

Pulv. Acacis, gr. vj. 

Glycerini, Syrupi, aa q. s. 
Fiat massa et div. in pil. xxiv. 
Sig. — One or two pills as required. 



r« 



Aperient Pills. 
. Pulv. Aloes Purif., gr. xxiv. 

Pulv. Rhei, gr. xlviij. 

Hydrarg. Chlor. Mitis, gr. iv. 

Antim. et Potas. Tart., gr. ij. 

Fiat massa et div. in pil. xxiv. 
Sig. — One or two pills as needed. 



PHARMACEUTICS PREPARATIONS. 557 



Tonic Pill /or Women. 

\\. Strychnine Sulph., 

Arseni Trioxidi 8,5 gr. j. 

Extr. Belladonnae Fo] gr. v. 

Quinina- Sulph gr. xxxv. 

Massa.* Ferri Carb gr. xc. 

Fiat massa et div. in pil. xxxv. 
Sig. — One pill three times daily. 



Anti lUlioiis Pills. 

i. 1'ulv. Scammonii, 
i'mK Uoes Purif., 
1'ulv. Gambogi 
I [ydrarg. Chlor. Mitis, 

Potassii Bitart iia gr. xx. 

Extr. Taraxaci, q. s. 
Fiat massa ct div. in pil. xx. 



Potus, A Drink (Unofficial), — is a solution or a mixture intended to lie used 
ad libitum, and generally consists of a potassium or sodium salt, or a mineral 
acid, in dilute solution, sweetened and flavored. 

The Imperial Drink. P}. Potassii Bitartratis, oij; Olei Limonis, ti.tfv; Aqua Bul- 
lientis, q. s. ad 5xx. M. Fiat potus. Sig. — Use as a drink. 

Pulveres, Powders, — are usually prepared extemporaneously, but a few 
compound ones have been made official, the ingredients being directed to be 
rubbed together until reduced to a fine powder and thoroughly mixed. Special 
directions are given for the preparation of two, the Compound Effervescing 
Powder and the Compound Powder of Morphine. There are 9 official powders, 
named as follows, — 

Pulvis Acetanilidi Compositus. Pulvis Glycyrrhizae Compositus. 

Pulvis Aromaticus. Pulvis Ipecacuanha? et Opii. 

Pulvis Cretoe Compositus. Pulvis Jalapae Compositus. 

Pulvis Effervescens Compositus. Pulvis Morphinas Compositus. 

Pulvis Rhei Compositus. 

The composition of each of these preparations will be found in the section on Materia 
Medica under the title from which its name is derived, except that of the Compound Effer- 
vescing Powder, which is placed under the title Potassium. Pulvis Ipecacuanha; et Opii 
is really a trituration, its ingredients being rubbed together with sugar of milk into a very fine 
powder. 

As prepared extemporaneously Powders are generally compound and may 
be mixed on a slab with a spatula, but a better method of mixing them is by 
trituration in a mortar. The latter should always be employed except in the 
case of substances which may explode if so treated, as Potassium Chlorate with 
oxidizable substances. (See page 519.) The diluent best employed in powders 
is Sugar of Milk, on account of its hardness, density and comparative insolubility. 
A coloring agent, as Carmine in minute quantity, is a useful ingredient, enabling 
the eye to judge of the degree of mixing and subdivision obtained. Powders 
containing soluble salts, extracts, volatile oils, camphor, or any other hygroscopic 
or volatile substances, should be dispensed in waxed paper. For ordinary 
powders the plain white paper of the drug-stores will answer, but a better paper 
for small powders is a very thin one having a high surface finish, as the white 
glazed French demy. Powders are often ordered in Wafers (Cachets), to be 
swallowed without unfolding. The division of powders into the number of 
Papers (Chartulce) ordered and folding them neatly, require a considerable 
amount of practice. A small machine is used, over which the ends of the papers 
are bent, in order to have them of the proper size for the box in which they 



55» 



PHARMACEUTICAL PREPARATIONS. 



I 



are dispensed. If they are to be put into an envelope, less exactness of folding 

is required, and the mechanical contrivance may be dispensed with. 

Substances suitable to administration in the form of powders are those which 

are insoluble, those which would be chemically incompatible in fluid form, and 

certain pulverizable extracts. Those which are unsuited to this form are such 

as have a nauseous taste or odor, substances of which the dose is large, those 

which are deliquescent, efflorescent or very volatile, and those which liquefy on 

mixing. A list of deliquescent and efflorescent salts is found on page 555, while 

the following-named, though dry alone, become moist when triturated together, 

viz. — 

» Sodium Sulphate and Potassium Carbonate. 
Zinc Sulphate and Lead Acetate. 
Camphor and Hydrated Chloral. 

Many substances cannot be powdered without the intervention of another 
body: thus Opium requires a hard substance like sugar of milk or potassium 
sulphate, Camphor requires a minute quantity of alcohol. Myrrh needs sugar 
or gum. Substances, as the alkaloids and their salts, which are very active and 
are used in very small doses, require some inert substance to give them bulk 
enough for division and handling. Sugar of Milk is the best agent for this 
purpose. Prescriptions may order the ingredients for a single powder, with 
directions to dispense a certain number of the same composition; or they may 
give the quantities for the whole number of powders ordered, with instructions 
to divide into a certain number. The dispenser should carefully scan the pre- 
scription in order to avoid the multiplication of quantities where division is 
intended. The official powders are named on page 557, and the following 
formulae will serve to illustrate those generally prescribed: — 



Astringent Powder jor Infants. 

1^. Plumbi Acetatis, gr. ij. 

Pulveris Opii, gr. ss. 

Camphoras, gr. j. 

Sacchari Lactis, gr. iij. 

Trit. et div. in chartulas xij. 
Sig. — One powder every 2 or 3 hours in 
diarrhea of infants. For an adult the above 
represents one dose. 


Gastric Sedative. 

fy. Bismuthi Subnitratis, 3 j- 

Pulveris Rhei, 

M. et div. in chartulas vj. 

Sig. — One powder before each meal. 



Bismuth and Soda. 



P>- 



Bismuthi Subnitratis, 

Sodii Bicarb., aa 3ij- 

Pulv. Zingiberis, gr. xl. 

M. et div. in chartulas xij. 
Sig. — One after each meal. 
Corrective in dyspepsia, acne and eczema. 



Laxative Powder. 

T$. Hydrarg. Chlor. Mitis, gr. x. 

Sacchari Lactis, gr. xx. 

M. et fiant pulv. x. 

Sig. — One powder twice daily. 



Antipruritic Powder. 

1$. Pulveris Camphorae 5j- 

Zinci Oxidi, 5iv. 

Pulv. Amyli, o j- 

M. et fiat pulvis. 

Sig. — Use locally as a dusting powder to 
relieve itching. 

Catarrh Powder. 

Jy. Bismuthi Subnitratis, 5iij- 

Pulv. Acacia;, 5j- 

Pulv. Talci, 5ij- 

Morphins Hydrochlor., gr. j. 

M. Sig. — Use by insufflation. 



FHARMACH DICA] PREPARATIONS. 



559 



Compressed Tablets are really powders which have been compressed into 
tablet shape by machinery. A little pressure from the Made of a spatula will 
restore them to the powder form. 

Resinae, Resins. — Pharmaceutical resins are solid preparations obtained 
by precipitating the resinous principles of plants from their alcoholic solution 
by the agency of water. They differ from alcoholic extracts in containing only 
those principles which are soluble in alcohol and insoluble in water, while the 
extracts contain all principles which are soluble in alcohol. Including Resina 
itself, which is the residue left after distilling off the volatile oil from Turpentine, 
there are 4 official Resins, three of which correspond to the above description. 
They are named: — 



Resina. 

Resina Jalapa;. 
True Resins are defined on page 9. 



Resina Podophylli. 
Resina Scammonii. 



Spiritus, Spirits, — are alcoholic solutions of volatile substances, which may 
be solids, liquids or gases. They are officially prepared either by simple solution, 
by solution w T ith maceration, by gaseous solution, by chemical reaction, or by 
distillation. The menstruum is Alcohol in nearly all instances, 4 having Water 
in addition, and 2 being alcoholic liquors of a specified alcoholic strength (Whisky, 
Brandy). The official spirits are 20 in number, as follows, — 



Spiritus iEtheris (32J). 

Spiritus /Etheris Compositus (32 i). 

Spiritus /Etheris Nitrosi (4). 

v ;>iritus Ammonia; (10). 

Spiritus Ammonia; Aromaticus (9). 

Spiritus AjTiygdala; Amaras (1). 

Spiritus Anisi (10). 

Spiritus Aurantii Compositus (20). 

Spiritus Camphors (10). 

Spiritus Chloroformi (6). 



Spiritus Cinnamomi (10). 
Spiritus Frumcnti (37-47J). 
Spiritus Gaultheria;, (5). 
Spiritus Glycerylis Nitratis (1). 
Spiritus Juniperi (5). 
Spiritus Juniperi Compositus (64J). 
Spiritus Lavandula; (5). 
Spiritus Mentha; Piperita; (10). 
Spiritus Mentha; Viridis (10). 
Spiritus Vini Gallici (39-47). 



The figures placed after Spiritus Frumenti, Spiritus Juniperi Comp., and Spiritus Vini 
Gallici, represent the percentage of absolute Alcohol by weight in each; those placed after 
the others indicate the quantity of the principal ingredient in grammes to each 100 cubic centi- 
meters of the preparation. 

Succi, Juices, — are expressed from fresh medicinal plants, and preserved 
by the addition of alcohol 1 part to 3 of the juice. Limonis Succus (lemon- 
juice) is official in the U. S. Pharmacopoeia, and contains no alcohol; the fol- 
lowing-named are official in the British Pharmacopoeia : — 



Succus Belladonna;. 
Succus Conii. 



Succus Hyoscyami. 
Succus Limonis. 



Succus Scoparii. 
Succus Tara.xaci. 



Suppositoria, Suppositories, — are solid bodies containing medicinal sub- 
stances, and intended for introduction into the vagina, rectum or urethra. The 
Pharmacopoeia prescribes a general formula for their preparation, according to 

ich the medicinal portion may be incorporated with Oil of Theobroma, 
Glvcerinated Gelatin, or Sodium Stearate. 



560 PHARMACEUTICAL PREPARATIONS. 

In the U. S. Pharmacopoeia the only official suppositories are those of Glyc- 
erin, in which Stearic Acid is used to give the requisite consistence. In the 
British Pharmacopoeia the following 7 suppositories are official: — 

Suppositoria Acidi Carbolici, Phenol Suppositories, — Phenol, 12 grains; White Bees- 
wax, 24 grains; Oil of Theobroma, q. s. for 12 suppositories, each containing 1 grain of 
Phenol. 

Suppositoria Acidi Tannici, Tannic Acid Suppositories, — Tannic Acid, 36 grains; Oil 
of Theobroma, q. s., for 12" suppositories each containing 3 grains of Tannic Acid. 

Suppositoria Belladonnas, Belladonna Suppositories, — Alcoholic Extract of Bella- 
donna, 18 grains; Oil of Theobroma, q. s. for 12 suppositories, each containing ii grains of 
the extract or approximately ^ grain of the alkaloids of belladonna root. 

Suppositoria Glycerini, Glycerin Suppositories, — Gelatin, cut small, $; Glycerin, by 
weight, i\; Distilled Water, a sufficiency to make as many suppositories as desired, accord- 
ing to size, each containing 70 per cent, by weight of Glycerin. 

Suppositoria Iodoformi, Iodoform Suppositories, — Iodoform, 36 grains; Oil of Theo- 
broma, q. s. for 12 suppositories, each containing 3 grains of Iodoform. 

Suppositoria Morphinae, Morphine Suppositories, — Morphine Hydrochloride, 3 grains; 
Oil of Theobroma, q. s. for 12 suppositories, each containing \ grain of the Morphine salt. 

Suppositoria Plumbi Composita, Compound Lead Suppositories, — Acetate of Lead, 
36 grains; Opium, in powder, 12 grains; Oil of Theobroma, q. s. for 12 suppositories, each 
containing 3 grains of Lead Acetate and 1 grain of Opium. 

In extemporaneous pharmacy Suppositories are usually prepared with Oil 
of Theobroma (Cacao-butter) as a vehicle, but for those intended for the uterus 
or urethra a mixture of Gelatin and Glycerin is considered the best vehicle, 
being firmer and more plastic than cacao-butter, and more easily handled. 
Hollow cones of cacao-butter, or some composition resembling it, are kept in the 
shops, and will be used by the average druggist in filling prescriptions for rectal 
suppositories unless prohibited, as they save him considerable labor; the active 
drug being simply placed in the centre of the cone, which is then sealed by a 
plug fitting into its base. These contrivances are not so efficient as the regular 
suppository, in which the medicinal agent is thoroughly incorporated with the 
excipient, for the former smear the rectum with a quantity of melted grease 
before the active ingredient is permitted to come into contact with its walls. 
The agents used in suppositories are chiefly extracts and alkaloids, some few 
powders and a few metallic salts are occasionally employed. Those for the 
adult rectum should contain about 15 grains of the excipient, for the vagina a 
drachm of cacao-butter is the average quantity. Those for the uterus and 
urethra are made of cylindrical instead of conical form, and about the diameter 
of a no. 9 catheter. 

The methods of compounding suppositories are two — that by the use of 
moulds (the official method), and that by hand, which is as follows: The medica- 
ment is mixed with finely shaved Cacao-butter by the aid of a spatula, on a 
board or tile lightly dusted with lycopodium or starch. After a smooth and 
uniform mixture is thus obtained, the mass may be rolled into cylindrical form, 
cut into the required sizes and with the spatula given the required shape. When 
dispensed, they should be placed in a powder-box between layers of cotton. 

Bougies or Pencils, as urethral and uterine suppositories are often termed, 



I'll \K\I U'l ■[■ lie \l, PREP \K llTIONS. 



S61 



may be prepared by melting together White Gelatin 3, Glycerin 1, ami Distilled 

Water 1 part by weight, then adding the medicament ami drawing the mass 
into a glass tube previously oiled inside. Winn e..ld the bougie may be pushed 
out and cul into suitable lengths. 

Suppositories and Bougies may be prescribed in the manner illustrate! 
the following formulae: — 



>y 



.■1 nod v uc Suppository. 

1>. Extr. Opii, gr. vj. 

Extr. Belladonna Fol., gr ss. 

.1 1 vi>si \ ami, gr. ij. 

Olei Theobromae, q. s. 
M. Fiant suppositoria vj. 
Sig. — One into the rectum morning and 
Bight. 

Anthelmintic. 

\\. Santonini, gr. xij. 

Olei Theobroma;, j. 

R 1 . Fiant suppositoria vj. 

Sig. — One into the rectum as directed. 



Quinine Suppository. 

1$. Quininoe Sulphatis, gr. v. 

Olei Theobromae, gr. x. 

Fiat suppositorium unum, mitte tales sex. 



Wade's Bougies. 
', . Iodoform!, 

Bismuthi Subnitrat., . . . .aa 5j- 

Chlorali Hydrati, gr. viij. 

Morphines Sulphat, gr. iij. 

Ol. Rosa;, irjjx. 

Gelatin: et Glycerini, q. s. 
M. Fiant bougia xij. 
Sig. — One into urethra thrice daily. 



i; 



Bougie for Gleet. 

Zinci Sulphatis, gr. vj. 

Phenolis, ngiij. 

Pulv. Hydrastis, gr. xij. 

Extr. Belladonna; Fol., . . . . gr. xij. 

Gelatini ct Glycerini, q. s. 
M. Fiant bougia xij. 
Sig. — One into the urethra night and 
morning. 



Syrupi, Syrups, — are concentrated solutions of Sugar in water or in aqueous 
liquids. They sometimes contain acetic acid, and occasionally alcohol; and 
are termed simple, medicated or flavored, according as they are simple solutions 
of sugar in water alone, or contain soluble medicinal substances or flavoring 
ingredients. The sugar used should be very dry, and its official description 
corresponds with the granulated sugar of commerce. The permanence of these 
preparations depends chiefly on their possessing the proper relative proportions 
of sugar and water. They are prepared either by solution with heat, by agita- 
tion without heat, by adding a medicated liquid to simple syrup, by digestion or 
maceration, or by cold percolation. They are best preserved by being poured 
while hot into pint bottles, which should be corked securely while full, and the 
tops dipped into melted sealing-wax. Fermented syrups are useless for dispens- 
ing purposes. The number of official syrups is 29, as follows, — 



Syrupus. 

Syrupus Acaciae. 

Syrupus Acidi Citrici. 

Syrupus Acidi Hydriodici. 

Syrupus Amygdalae. 

Syrupus Aurantii. 

Syrupus Aurantii Florum. 

Syrupus Calcii Laectophosphatis. 

Syrupus Calcis. 

Syrupus Ferri Iodidi. 

Syrupus Ferri, Quinina? et Strychnine 

Phosphatum. 
Syrupus Hypophosphitum. 
Syrupus Hypophosphitum Compositus. 
Syrupus Ipecacuanhce. 

37 



Syrupus Kramerias. 

Syrupus Lactucarii. 

Syrupus Picis Liquid;e. 

Syrupus Pruni Virginianac. 

Syrupus Rhei. 

Syrupus Rhei Aromaticus. 

Syrupus Rosae. 

Syrupus Rubi. 

Syrupus Sarsaparillae Compositus. 

Syrupus Scilhe. 

Syrupus Scilla: Compositus. 

Syrupus Senegae. 

Syrupus Sen] 

Syrupus Tolutanus. 

Syrupus Zingiberis. 



562 



PHARMACEUTICAL PREPARATIONS. 



Tabellae, Tablets (Unofficial), — are largely manufactured by several reliable 
firms, and consist of various medicinal powders pressed into tablet shape by 
machinery. They are convenient preparations for the physician's use; quite a 
variety can be carried in a pocket-case, and as slight pressure is sufficient to 
reduce them to powder they can be dispensed with facility and accuracy of 
dosage. The terms Tabloid and Soloid are proprietary designations of com- 
pressed tablets manufactured in England. The following list includes the most 
important of these preparations, the figures representing the number of grains 
in a tablet in each case: — 



i, 



Acid, Arsenous, ^ ?o> TB> 2V 

Benzoic, 5. 

Gallic, 5. 

Salicylic, 2\, 5. 

Salicylic, i\, and Morphine, y 1 .,. 

Tannic, 2, 5. 

Aconitina, J^- 

Aloes, 2. Aloes et Ferri (U. S. P.). 

Aloes, 2, et Myrrh, 1. 

Aloes, f, et Rhei, 1$, et Gentian, §. 

Aloin, i, \, \. 

Ammonium Bromide, 5, 10. 

Ammonium Chloride, 3, 5, 10. 

Antiseptic, Hydr. Chlor. Corros., 7J. 

Atropine, ^. 

Bismuth Subcarb., 5. 

Subnitrate, 5,10. 

Borax, 5. 

Caffeine Citrate, 1. 
Calcium Sulphide, y 1 ^, J, 
Calomel, \, j, 1, 2, 3, 5. 
Calomel, 2, Opium, 1. 
Camphor Monobromated, 2, 
Carbo Animalis, 10. 
Cathartic, Compound (U. S. 

Vegetable (U. S. P.). 

Cerium Oxalate, 2. 
Chloramine Pastilles (Spencer). 
Cinchona Alkaloids (mixed). 
Cinchonine Sulphate, 2, 3, 4, 5. 
Cinchonidine Sulphate, 
Cocaine Hydrochloride, 
Codeine, \. 
Digitalin, J„- 

Extract of Cannabis Indica, \. 
Extract of Ignatia Amara, \, £. 
Extract of Nux Vomica, \, \. 
Fehling's Test for grape-sugar in urine. 
Ferrum (Quevenne's), 1, 2. 

Arsenate, \, \. 

Proto-carbonate, 3, 5. 

Lactate, 1. 



3.5- 
P.). 



2, 3; 



4, 5- 



Ferrum Pyrophosphate, 2. 

and Quinine Citrate, 2, 3, 5. 

Hydrargyrum, 1, 3, 5. 

Chloridum Corros., 75V, £g, 

Iodidum Rub., j'j , 



Iodidum Flavum, 



k h I- 



Oxidum Flavum, 5 ^j. 
Ipecac, et Opii, 2, 3, 5. 
Morphine Sulphate, T l 5 , J, £, \, h. 
Opium, Deodorized, 1. 
Opium, \, and Lead Acetate, 1 J. 
Pepsin, Saccharated, 2, 5. 
Podophyllin, T \,, J, \, \, 1, 2. 
Potassium Bromide, 5, 10. 

Chlorate, 5. 

and Borax, aa 2 J. 

Iodide, 5. 

Nitrate, 5. 

Permanganate, \, 1, 2. 

Quinine Bisulphate, \, 1, 2, 3, 4, 5. 

Salicylate, 2. 

Quinine Sulphate, i, r, 2, 3, 4, 5. 

Quinquinine, 2, 3. 

Rhubarb, 3. 

Rhubarb, 2, and Magnesia, 2. 

Salicin, 2%, 5. 

Santonin, 1. 

Santonin, 1, and Calomel, r. 

Sodium Bicarbonate, 5. 

Salicylate, 3, 5. 

Strychnine, j^, ^, up to J 5 . 
Zinc Phosphide, T V up to J. 

Hypodermic Tablets. 

Morphine Sulphate, T V to i. 
Morph. Sulph. and Atropine Sulph. 
Atropine Sulphate, j^o - sV- 
Strychnine Sulphate, T ^. 
Apomorphine Hydrochloride, sVSV 
Pilocarpine Hydrochloride, j\j— j. 
(And several others.) 






Tincturae, Tinctures, — are alcoholic solutions of medicinal substances, and 
with one official exception, Tincture of Iodine, are made from non-volatile 
bodies. They are prepared by percolation, maceration, solution or dilution; 
the menstrua employed being chiefly Alcohol, Diluted Alcohol, and Alcohol 
and Water in various proportions. Two ammoniated tinctures are made with 



PHARMACEUTIC^.] PREPARATIONS. S''.i 

Aromatic Spirit of Ammonia, in one Acetic Acid is an ingredient of the men 
struum, and several have- Glycerin. The official tinctures arc now practically 

in two classes as to Strength, 10 per cent, for the more powerful ones, and 20 
per cent, for the others, with a tew exceptions. They number 63, and are named 
in the following list, the figures placed alter ea< b giving the number of grammes 
of the drug in each 100 cubic centimeters of the tincture: — 

Tinctura Aconiti (,to). Tinctura Hyoscyami (10). 

Tinctura Aloes (10). Tinctura Iodi (7). 

Tinctura Aloes et Myrrhse (10). Tinctura Ipecacuanha; et Opii (10). 

Tinctura Arnica; (20). Tinctura Kino (5). 

Tinctura Asafcetidse (20). Tinctura Kramerias (20). 

Tinctura Aurantii Amari (20). Tinctura Lactucarii (50). 

Tinctura Aurantii Dulcis (50). Tinctura Lavandula- Composita (0.8). 

Tinctura Belladonna; Foliorum (10). Tinctura Limonis Corticis (so). 

Tinctura Benzoini (20). Tinctura Lobelia: (10). 

Tinctura Benzoini Composita (10). Tinctura Moschi (%). 

Tinctura Calendula; (20). Tinctura Myrrha; (20). 

Tinctura Calumbae (20). Tinctura Nucis Vomicae (2). 

Tinctura Cannabis Indicae (10). Tinctura Opii (10). 

Tinctura Cantharidis (10). Tinctura Opii Camphorata (0.4). 

Tinctura Capsici (10). Tinctura Opii Deodorati (10). 

Tinctura Cardamomi (ro). Tinctura Physostigmatis (10). 

Tinctura Cardamomi Composita (2$). Tinctura Pyrethri (20). 

Tinctura Cimicifugae (20). Tinctura Quassias (20). 

Tinctura Cinchona; (20). Tinctura Quillajae (20). 

Tinctura Cinchona; Composita (10). Tinctura Rhei (20). 

Tinctura Cinnamomi (20). Tinctura Rhei Aromatica (20). 

Tinctura Colchici Seminis (10). Tinctura Sanguinariae (10). 

Tinctura Digitalis (10). Tinctura Scillae (10). 

Tinctura Ferri Chloridi (13J). Tinctura Serpentariae (20). 

Tinctura Gallae (20). Tinctura Stramonii (10). 

Tinctura Gambir Composita (50). Tinctura Strophanthi (10). 

Tinctura Gelsemii (10). Tinctura Tolutana (20). 

Tinctura Gentianae Composita (10). Tinctura Valerianae (20). 

Tinctura Guaiaci (20). Tinctura Valerianae Ammoniata (20). 

Tinctura Guaiaci Ammoniata (20). Tinctura Vanilla; (10). 

Tinctura Hydrastis (20). Tinctura Veratri (10). 
Tinctura Zingiberis (20). 

For Tinctures of Fresh Herbs {Tinctura: Herbarum Recentium), the Pharmacopoeia 
prescribes a general formula, according to which, when not otherwise directed, they are to be 
prepared by macerating 50 grammes of the fresh herb, bruised or crushed, in 100 cubic centi- 
meters of alcohol, for 14 days, then expressing the liquid and filtering. 

Triturationes, Triturations, — form a class of powders having for their 
diluent Sugar of Milk, and possessing a definite relation between the active 
ingredient and the diluent. The Pharmacopoeia prescribes a general formula 
for these preparations, according to which 10 grammes of the substance and 
90 of Sugar of Milk are to be well mixed by a spatula, the latter being added 
in successive quantities, and both triturated in a mortar until the substance is 
intimately mixed with the diluent and finely comminuted. There is but one 
official trituration (Trituratio Elaterini), though the Pulvis Ipecacuanha; et Opii 
practically belongs to this class. Sugar of Milk is employed as the diluent 
because of its hardness and its comparative insolubility. The first of these 
qualities secures the fine comminution of the active ingredient, whereby the 
action of the medicine is increased and better distributed. Its insolubility makes 



564 PHARMACEUTICAL PREPARATIONS. 

it the best diluent for powders or triturations administered from a spoon or glass 
with fluid, as is so often done, for unlike cane sugar it is not readily dissolved 
and does not leave the active substance behind on the surface of the utensil. 
Triturations are excellent forms for the administration of powerful alkaloids, 
which may thus be divided with great accuracy into the minute quantities re- 
quired. Mercury and its salts are especially adapted to this method of prepara- 
tion, being more uniformly divided and hence more active than when administered 
in any other form. Triturations of mercury with sugar were commonly used 
in England a hundred years ago, and triturations of many substances were 
employed by the Arabian physicians of the 13th century; but the subsequent 
adoption of these preparations by the homeopathists produced such a prejudice 
against them in the ranks of the regular profession, that until recently any one 
using them stood in danger of being stigmatized as a homeopath. Their recog- 
nition by the U. S. Pharmacopoeia under their proper title does away with any 
such implication, though it is much to be regretted that the editors of the last 
two revisions of the British Pharmacopoeia should have shown their fear of a 
name by continuing the title Pulvis Elaterini Compositus to designate a prepa- 
ration which in every respect is a trituration. The preparations of Pepsin daily 
prescribed by physicians all over the country are really sugar-of-milk triturations 
of that ferment, and not pure pepsin as many suppose. Professor H. G. Piffard, 
in his treatise on the Materia Medica and Therapeutics of the Skin, after de- 
tailing the results of several microscopical examinations of pills and triturations, 
uses the following language: — 

"It is to be expected, therefore, that the protoiodide trituration will prove, ceteris paribus, 
more active than the pill, and such we have found it. . . . Since we have used the tritu- 
rations, however, in preference to the ordinary pills, patients more rarely complain of dis- 
agreeable sensations. We have been enabled to materially reduce the size of the dose in 
order to obtain the desired effect. In other words, a larger proportion of the drug is utilized 
for specific purposes, while but a small amount remains to give rise to local irritation. . . . 
I have nothing to add to this, except that I continue to use triturations of Mercury and other 
substances with increasing satisfaction. Beside those mentioned I employ Calomel, Cyanide 
of Mercury, Black Oxide of Mercury and Corrosive Sublimate in this form." 

The following examples will illustrate the mode in which Triturations may 
be prescribed: — 

1$. Hydrarg. Oxidi Flavi, gr. ss. I}. Morphinae Sulph., gr. j. 



Sacchari Lactis, gr- 1. 

Trit. et div. in chartulas xxiv. 
Sig. — One powder twice daily. 



Sacchari Lactis, gr. xvj. 

Trit. et div. in chartulas viij. 

Sig. — One powder every six hours. 



1$. Hydrarg. Chlor. Mitis, gr. x. 1^. Arseni Trioxidi, gr. ss. 



Sacchari Lactis, q. s. 
Trit. et div. in chartulas x. 
Sig. — One powder daily. 



Sacch. Lactis, gr. xl. 

Trit. et div. in chartulas xx. 
Sig. — One powder thrice daily. 



Trochisci, Troches, also called Pastilles and Lozenges, — are small flat- 
tened cakes of medicinal substances, prepared from a mass made with a basis 
of Sugar, some having Mucilage of Tragacanth, others Orange-flower Water, 
Syrup of Tolu, etc., as excipients. They are especially useful when the active 



ril \K\l \* 1 S I'U- \i PREPAS \ i IONS. 



56S 



ingredients are intended to conn- into contact with the mucous surface of tin- 
throat. There arc official Troches, named as follows: — 



I : . v'u.s 1 \l 1 h 1 im,i. 1. 

Trochisci Ainmonii Chloridi. 
Trochisci Cubebse. 
Trochisci Gambir. 



Free In:-: 1 ( 1-. z] rrhiza el ( >pu 

bisci Krameriae. 
Trochisci I'utussii Chloratis. 
Trochisci Santonini. 



1 t 'ii.--.ci S:-.dii Be. irbonatis. 



Troches are not readily compounded at the dispensing counter, but may 
be obtained in all first-class shops, being prepared in great variety by the manu- 
facturers. Besides the official Troches, those named in the following list ate 
generally for sale: — 



Alum, gr. ij. 

Alum, gr. 1 J, Catechu, gr. ij. 

Ammonium Chloride, gr. ij, and Cubeb, gr. j. 

Amnion. Chlor., gr. ij, Licorice, gr. viij. 

Benzoic Acid, gr. t. 

Borax, gr. iij. 

Bismuth, gr. ij, and Charcoal, gr. v. 

Bronchial, — Oleores. Cubebae, gr. -~, Tolu, gr. 
\, 01. Sassafras, gr. T j, and Extr. of Lico- 
rice, gr. vij. 

Brown Mixture. 



Santonin, gr. i, and Calomel, gr. i. 



Ginger and Sodium Bicarbonate. 

Guaiac, gr. ij. 

Kino, gr. ij. 

Lettuce, gr. j. 

Logwood, gr. ij. 

Magnesia, gr. iij. 

Pellitory, gr. j. 

Pepsin, gr. iij, Charcoal, gr. iij, Magnesia, 

gr. ij, and Ginger, gr. j. 
Potassium Bitartrate, gr. iij. 
Potassium Citrate, gr. iij. 



Unguenta, Ointments, — are soft, fatty mixtures of medicinal agents with 
a basis of lard, petrolatum, or fixed oils with a solid fat such as wax or spermaceti. 
They are intended for application to the skin by inunction, and have a melting 
point which is below the ordinary temperature of the human body. Of the 24 
official Ointments 1 is prepared by chemical reaction (Unguentum Hydrargyri 
Nitratis), 9 by fusion and 14 by incorporation of the ingredients with each 
other, they being mixed together by trituration or through the agency of a 
spatula and a porcelain slab. Unguentum itself is prepared by fusing together 
So of Benzoinated Lard and 20 of White Wax, and is the basis of 2 other oint- 
ments; while 9 have Benzoinated Lard, and 3 have Lard as their basis. The 
official Ointments are — 



i 



Unguentum. 

Unguentum Acidi Borici (10). 
Unguentum Acidi Tannici (20). 
Unguentum Aqua? Rosa?. 
Unguentum Belladonna (10). 
Unguentum Chrysarobini (6). 
Unguentum Diachylon. 
Unguentum Gallae (20). 
Unguentum Hydrargyri (50). 
Unguentum Hydrargyri Dilutum (33J). 
Ung. Hydrargyri Ammoniati (10). 
Ung. Hydrargyri Nitratis (7). 



Ung. Hydrargyri Oxidi Flavi (10). 
Ung. Hydrargyri Oxidi Rubri (10). 
Unguentum Iodi (4). 
Unguentum Iodoformi (10). 
Unguentum Phenolis (3). 
Unguentum Picis Liquids (50). 
Ung. Potassii Iodidi (10). 
Unguentum Stramonii (10). 
Unguentum Sulphuris (15). 
Unguentum Veratrinae (4). 
Unguentum Zinci Oxidi (20). 
Unguentum Zinci Stearatis (50). 



The figures in parentheses show the percentage of the extract or other active ingredi- 
ent in the ointment. The composition of each may be found in the section on Materia 
Medica under the title from which the preparation is named, except Unguentum, which 
will be found under the title Adeps, and Unguentum Diachylon under Plumbum. 



5 06 



PHARMACEUTICAL PREPARATIONS. 



I 



Ointments and Cerates are frequently ordered on extemporaneous formulas, 
though the numerous official preparations of these classes would seem to give 
the physician a sufficiently wide field for selection. The basis is usually either 
the official Ceratum or Unguentum, but Petrolatum, Lard, and Lead Plaster 
with a fixed oil, may be employed. Lard is probably the best basis for all oint- 
ments, as it softens the skin better than any other similar substance. Its dis- 
advantage is that it soon becomes rancid, so that preparations made with it 
must be quickly used. Cerates only differ from ointments in their firmer con- 
sistence, melting at temperatures above 104 F., while the latter melt below the 
ordinary temperature of the body. 

The process of compounding an ointment or a cerate is sufficiently simple, 
being generally a mere matter of triturating the ingredients together in a mortar, 
or their incorporation on a slab by means of a spatula. Rarely will melting 
be required in the compounding of extemporaneous ointments. When extracts, 
powders or gritty substances are ordered, the ingredients should be first pul- 
verized into a fine powder, then triturated with a small quantity of the basis 
into a smooth, impalpable paste, the remainder of the basis being added gradu- 
ally, until the whole is thoroughly incorporated. A warm mortar may be re- 
quired for hard extracts. Soluble salts should be triturated with a little water 
before adding the excipient. Camphor needs a little alcohol to enable it to be 
pulverized. Iodine should be rubbed to a fine powder, then a little alcohol 
added and finally the excipient by degrees. Sulphur Iodide requires persevering 
work with a small portion of olive oil. Borax should be triturated with glycerin 
and Red Mercuric Oxide with distilled water. A bone or horn spatula should 
be used for all ointments, as steel or iron blades will injure many substances, 
particularly alkaloids, free acids, tannin, iodine and several of the mercurial 
salts. Volatile substances are added last and quickly worked in, so that their 
evaporation may be as slight as possible. 

Ointments are dispensed usually in amber-colored glass pots with wooden 
or metalfic covers, or in porcelain jars called Gallipots. In hospital and dis- 
pensary practice the common chip pill-box is used, but soon becomes dirty and 
disagreeable to handle. 



Unguentum Iodojormi Compositum. 



R. 



Iodoformi 3 j- 

Ol. Anisi, ttjjxx. 

Ol. Rosae, 

Ol. Ylang-ylang, aanjv. 

Ung. Aquae Rosae, 5j- 

M. Fiat unguentum. 
Sig. — Ointment. 



Unguentum Anti-pruriticum. 

1$. Camphorae, 

Chlorali Hydrati, aa 5 j- 

Tere una ad liquorem, dein 
adde cum tritu — 

Unguenti Aquas Rosae, 5j. 

M. Fiat unguentum. 

Sig. — Ointment for itching. 



Vina, Wines, — when medicated are practically the same as tinctures. The 
menstruum directed to be used is the official white wine (Vinum Album), 
which should contain from 7 to 12 per cent, by weight of absolute alcohol. It 
is however reinforced by the addition of alcohol to the amount of 5 to 17^ per 



PHARMACEUTICAL PREPAB ITIONS. 



5<>7 



cent, in all the medicated wines." In the two Ferric wines the alcoholic rein 
forcement is in the shape of the tincture of sweet orange peel. The Wine <>! 
Coca is made with red wine. The official Wines arc 10 in numher, 2 of which 
are not medicated and stand first in the following list; 7 are prepared by solution 
or admixture, and 1 by maceration during seven days. They are — 



Yinum Album (7-12). 
Yinum Rubrum (7-12). 
Yinum Anlimonii (0.4). 
Yinum Coca; (6i). 
Yinum Colchici Scminis (10). 



Vinum ErgOtS (20). 
Yinum Ferri (4). 
Yinum Kcrri Amarum (5). 
Yinum Ipecacuanha; (10). 
Vinum Opii (10). 



The figures placed after the first two show the percentage of absolute alcohol by weight 
required in each; those placed after the others indicate the quantity of the principal ingre- 
dient in grammes to each 100 cubic centimeters of the preparation. 



i 



PART III. 

SPECIAL THERAPEUTICS. 



Authorities. The principal authorities to whom references are made, 
with their initials, are included in the following list. When a statement is not 
followed by any reference by name or initial, it is to be understood as coming 
from the writer of this book. 

References and Bibliography. 

(A) Aitken. — The Science and Practice of Medicine, by Wm. Aitken. 

(Ag) Agnew. — The Principles and Practice of Surgery, by D. Hayes Agnew. 

(B) Bartholow. — Materia Medica and Therapeutics; also On the Antagonism between 

Medicines and between Remedies and Diseases, by Roberts Bartholow. 
(Br) Brunlon. — Pharmacology, Therapeutics and Materia Medica, by T. Lauder 

Brunton. 

(C) Carter. — A Practical Treatise on Diseases of the Eye, edited by Green. 

(CI) Clarke. — A Manual of the Practice of Surgery, by W. Fairlie Clarke. 

(DaC) Da Costa. — Notes of Clinical Lectures, delivered by Professor J. B. Da Costa at 

the Pennsylvania and Jefferson Hospitals. 

(D) Druitt. — A Manual of Modern Surgery, by Robert Druitt. 

(E) Emmet. — Principles and Practice of Gynecology, by Thos. Addis Emmet. 

(El) Ellis. — A Practical Manual of Diseases of Children, by Edward Ellis. 

(F) F other gill. — The Practitioner's Handbook of Treatment, by J. M. Fothergill. 

(G) Goodell. — Lessons in Gynecology, by William Goodell. 

(H) Hamilton. — Nervous Diseases, etc., by Allan McLane Hamilton. 

(Id) Idem. — The same author mentioned last. 

(L) Irishman. — A System of Midwifery, by William Leishman. 

(M) Murrell. — A Manual of Pharmacology and Therapeutics, by Wm. Murrell. 

(Mn) Manson. — Tropical Diseases, by Patrick Manson. 

(M & P) Meigs and Pepper. — Diseases of Children, by J. F. Meigs and Wm. Pepper. 

(N) Niemeyer. — A Text -book of Practical Medicine, by Felix von Niemeyer. 

(O) Osier. — The Principles and Practice of Medicine, by Wm. Osier. 

(P) Phillips. — Materia Medica and Therapeutics, by Chas. D. F. Phillips. 

(Pf) Piffard. — Materia Medica and Therapeutics of the Skin, by H. G. Piffard. 

(R) Ringer. — A Handbook of Therapeutics, by Sidney Ringer. 

(Ros) Rosenthal. — Diseases of the Nervous System, by M. Rosenthal. 

(S) Slille. — Therapeutics and Materia Medica, by Alfred Stille. 

(St) Sturgis. — The Student's Manual of Venereal Diseases, by F. R. Sturgis. 

(T) Tanner. — An Index of Diseases and their Treatment, by Thos. H. Tanner. 

(Tr) Trousseau and Pidoux. — On Therapeutics, by Trousseau, Pidoux and Paul 

(Tt) Tait. — Diseases of Women, by Lawson Tait. 

(Ty) Tyson. — The Practice of Medicine, by James Tyson. 

(W) Wood. — Therapeutics, its Principles and Practice, by H. C. Wood. 

(Wa) Waring. — Practical Therapeutics, edited by Buxton. 

(Y) Yeo. — A Manual of Medical Treatment, by I. Burney Yeo. 

Besides the above-named, occasional references are made to other works by the same 
authors. References will also be found, with names in full, to Anstie, Brown-Sequard, 
Clymer, Cohen, Flint, Fordyce-Barker, Gross, Hammond, Hilton, Lister, Loomis, Mitch- 
ell, Nelaton, Noyes, Nussbaum, Ricord, Roosa, Simpson, A. A. Smith, Thomas, several 
authors in Allbutt's System of Medicine, and many writers in current medical literature. 

568 






ABASIA \M>o\ii\\i PLETHORA U30RTION. 



5<"> 



Applied Therapeutics may be studied either with the various therapeutic 
agents as the objects of chief consideration, as in the first pari of this work; 
or with the different diseases and morbid conditions forming the objects of stud} 
in respect to their modification and treatment by medicines. In the following 
pages the latter method is followed, the therapeutics of each a fleet ion being 
exhibited in the form of an Analytical Index to the recognized text books quoted. 
Every indication for the use of a drug, or statement regarding its value, is followed 
by the name or initial (in parenthesis) of its author: these references enabling 
the book to be used as an Index to the Authorities, for more strict differentiation 
between indicated remedies, — while the brief analyses given include sufficient 
material to make each section a synopsis of the therapeutics of the disease or 
symptom named in its title. 



Abasia and Astasia. 
Sodium Phosphate, by hypodermic injection, once a day for 25 days, cured a case 
of unilateral abasia-astasia (Charcot's "neurasthenie dimidiee"), in the municipal 
hospital at Jerusalem. The patient should be taught to walk as one teaches an infant, 
and compression of the posterior region of the trunk may be made with an appropriate 
bandage (Roux). [Compare Hysteria.] 



Abdominal Plethora. 

Cathartics, saline and hydragogue cathartics are of value in congestion of the portal 
circulation (B). Saline Mineral Waters, especially the purgative saline waters, as 
Vichy and Saratoga, in plethora of the abdominal viscera (B). Grape-cure has helped 
many cases, particularly those of hepatic engorgement and sluggish portal circulation; 
is best used after a preliminary course of powerful mineral waters (P). Aliment is 
very important; a dry diet is particularly indicated in cases of dyspepsia and hepatic 
enlargement due to excessive beer-drinking. Avoid much bread, also salted or twice- 
cooked meats, rich sauces, solid vegetables, especially cucumbers, soups and fruits. 
Biscuits, fresh meat, lemons, fish, fowl and game, may be used. [Compare Hepatic 
Congestion, Obesity.] 



i 



B- Potassii Bicarbonatis, 

Sodii Sulphatis, aa 3iv. 

Solve in Ojss Aquae, et adde — 

Acidi Tartarici (cryst.), .... 3ij- 
Cork quickly and firmly. $d to be taken 
thrice daily. 



1$. Resinae Podophylli, gr. vj. 

Ext. Colocynthidis Co., .... gr. xij. 

Ext. Belladonna; Fol gr. iij. 

Fiat massa, et div. in pil. no. xij. 
Sig. — One pill every night. 



Abortion. 

Opium, cautiously in threatened abortion, is often very valuable (Wa); the tinctuiv. 
nExx-xxx by rectum (Parvin); Opium to check uterine action and Ergot to restrain 
hemorrhage (B). Ergot, small tonic doses give excellent results in threatened abortion 
(P). Tannin, combined with Opium and Ipecac (W). Cimicifuga, to prevent mis 
carriage when uterus is irritable and prolapsed (R). Savin, the dried powder of tin- 
leaves, gr. xv-xx, thrice daily, one of the most powerful remedies against the hemorrhage 
indicative of approaching abortion (Wa); the tincture in doses of 5 to 10 drops, every 
i to 3 hours, useful against the hemorrhage (P). Viburnum Prunifolium, in threat- 
ened and habitual abortion, has a very high reputation. Aurum Chloride, to avert 
the tendency to habitual abortion (B). ' Potassium Chlorate, gr. x thrice daily, begun 



57° 



ABSCESS. 



in the 3rd week and continued until term, as a prophylactic against habitual miscarriage 
(Jardine); gr. iij daily the best prophylactic in cases of non-syphilitic origin (Remy); 
large doses 3ijss per diem (Brown); was recommended 50 years ago by Simpson for 
this condition. Iron, with Potassium Chlorate, throughout the pregnancy, when fatty 
degeneration the cause of habitual abortion (McLane). Asafcetida, is highly efficient 
in habitual abortion; given in pills of gr. jss each, 2 daily, gradually increased to 10 
daily, as soon as a new pregnancy occurs, and continued until the labor is over (Turazzo). 
Cotarnine Hydrochloride, is a powerful uterine hemostatic, and is not ecbolic, so 
it can be safely used for the hemorrhage in threatened abortion, in dose of gr. jss— iij 
hypodermically (Bosse"). Tamponade, of the cervix uteri, with cotton .or sponge, 
dipped in vinegar or glycerin, when abortion is inevitable and it is desirable to hasten 
it and restrain hemorrhage. Empty the uterus thoroughly with the finger, placenta- 
forceps liable to do harm (Barker). Abortifacients; Quinine and Ergotin, of each 
gr. ij in pill every 3 hours, the routine abortifacient of many irregular practitioners. 
Only by the production of such violent irritation of the abdominal and pelvic organs 
as generally endangers life, can the pregnant uterus be stimulated to expel its contents 
(P). The abortifacient effect of Savin and other drugs cannot be obtained unless by 
the administration of a quantity sufficient to endanger life (B). 



1$. Fluidextr. Ergotas, 5 v. 

Tinct. Opii Deodorat., 3 iij - 

Syrupi Limonis, §j- 

M. Sig. — A teaspoonful thrice daily. 



IJ. Acidi Tannici, gr. xv. 

Pulv. Ipecacuanha, gr. xij. 

Extracti Opii, gr. iij . 

Ft. pil. xij. Sig. — One every six hours. 



Abscess. 

Belladonna, as plaster to subdue (B); painted around areola (Wa); internally 
often successful in aborting abscesses (R). Calcium Sulphide, half-grain doses fre- 
quently repeated, to abort abscess or to hasten formation of pus (B); gr. T V every hour 
or two, gives striking results in healing large abscesses (R). Calcium Phosphate, 
in large abscesses (R). Mercury and Morphine, the Oleate locally, diminishes in- 
duration due to old abscesses and prevents the formation of new ones (R). Phenol, 
a weak solution used as injection after evacuation, also as a dressing (Lister). Ichthyol 
as ointment after lancing, applied until healing is complete; brings about union (Unna). 
Silver Nitrate, a strong solution in Nitrous Ether if applied early to adjacent surface 
will check inflammation (B). Blisters or Iodine, as counterirritants around or adja- 
cent to seat of disease (R). Potassium Permanganate, 3j to the pint of water, to 
correct fetor (B). Iodine, the tincture injected after opening large abscesses (R); 
especially in scrofulous abscess (Wa). Salicylic or Boracic Acid, as dressings (B). 
Sarsaparilla, a very useful remedy in chronic abscess with profuse discharge (P). 
Cod-liver Oil, improves and lessens discharge from scrofulous abscesses (Wa). PouL- 
tices, to check, or to promote maturation; may be smeared with extract of Belladonna 
or Opium (R). Opening is necessary in all deep abscesses, or when on face, near 
anus, mammary, or if danger of its opening into an internal cavity. Open with grooved 
director and forceps; never open a deep abscess with a plunge (Hilton). Drainage- 
tube may be required, also irrigation of the cavity and pressure (Agnew). Weaning 
of child necessary in chronic mammary abscess (Gross). Psoas abscess may result 
from strain or laceration of muscle, as by heavy lifting, effort to recover balance when 
skating, etc., as well as from spinal disease; the symptoms are often obscure, simulating 
those of chronic malaria. Early opening by lumbar incision necessary; then tonics, 
good food, and daily irrigation of the cavity with an antiseptic solution. [Compare 
Suppuration, Carbuncle.] 



IJ. Quininae Sulph., 3j- 

Ferri Pyrophosphatis, 3 j- 

Strychnines Sulph., gr. j. 

Ac. Phosphor. Dil., 3ij- 



Syrupi Zingiberis, 3 ij • 

Aquse, q. s. ad §iv. 

M. Fiat mistura. Sig. — A teaspoonful 
thrice daily. 



\r\i- \c\r ROSACEA. 



57' 



Acne. 

Alkalies, internally, yield the best results in a number of cists (Bulkley-); alkaline 
lotions for cases with seborrhea (B). Borax, a weak solution in rose-water ( 3j Sviij), 
of great benefit locally in acne simplex (Wa). Potassium Bromide, in moderate 
doses, has proved curative in some obstinate cases (R). Sulphur, internally as a 
lotion; in severe forms an ointment of the Iodide or Hypochlorite, Sij ad 5j (R)- 
Ichthyol, the best internal remedy and useful in all forms (Unna) improves the 
digestion decidedly (Jessner). Thigenol in aqueous solution, is used instead of Ich- 
thyol. Belladonna, locally, is of some service, checking the abundant secretion from 
the sebaceous follicles (R). Arsenic, in old cases, especially in acne indurata, but 
often disappoints; given with Bromides it prevents the bromic acne (R); Arsenic 
Bromide is adapted to most cases of acne vulgaris (Pf). Phosphorus, is an excellent 
substitute for arsenic (B); the compound syrup of the Hypophosphites in acne indurata 
(R). Mercury, in lotion, is much employed (B); a weak lotion of the Bichloride to 
the face two or three times daily (R); the Iodo-chloride (gr. v-xv ad 5) as irritant 
application (Fox); or ointments containing the Bichloride or Biniodide may be em- 
ployed instead of the green soap application (Pf). Glycerin, internally, has been used 
with success (B). Berberis, njjv of a fresh tincture thrice daily for the acne of girls 
at puberty. Calcium Sulphide is indicated in cases characterized by a tendency to 
pustulation (Pf). Bismuth, locally, as a cosmetic (B). Magnesium Sulphate, as 
a purgative daily before breakfast, in cases of acne vulgaris depending on derangement 
of the stomach and bowels (Duhring); the salt, finely triturated, is an excellent dusting- 
powder and in five-grain doses internally, 3 or 4 times a day, is often very efficient in 
acne vulgaris and other obstinate eruptions due to derangement of the gastro-intestinal 
tract. Ergot, is well used in various forms of acne (See Acne Rosacea). Sapo 
Mollis, as an active irritant in subacute cases, applied every night as long as bearable, 
then emollients until irritation subsides, when the soap should be removed (Pf). Water, 
hot sponging for 15 or 20 minutes several times a day, followed by Glycerite of Starch 
to allay irritation (R); the local use of very hot water is of the greatest benefit in all 
inflammatory forms of acne (Bulkley). Puncturing each papule with a lancet point, 
followed by very hot water, and ointments of Sulphur Iodide, or Ammoniated Mercury, 
diluted (Pf). Diet and Hygiene, require careful attention (B); powerful tonics are 
often required (Bulkley). Phototherapy, the ultra-violet rays are bactericidal and 
prove curative (Rosenberg). [Compare Acne Rosacea, Seborrhea.] 



R. Potassii Acetatis, 3iv- 5j- 

Tinct. Nucis Vom. 5ij- 

Infusi Quassia?, vel 
Tinct. Cinchonas Co., . . . ad oiv. 
M. Sig. — Teaspoonful in water after 

meals, as an antacid tonic. 



R. Sulphuris, 5j- 

Glycerini, §j. 

Aquas Rosa;, 5 vij. 

M. Sig. — Lotion. 



R. Magnesii Sulphatis, o jss. 

Ferri Sulphatis gr. xvj. 

Acidi Sulphurici, 5ij- 

Aquas, q. s. ad Sviij. 

M. Sig. — A tablespoonful in a glass of 

water before breakfast. 



R. Bismuthi Subnit., 5j- 

Ung. Hydr. Ammoniat.,. . . . 3ij- 

Ung. Aq. Rosas, ad oj- 

M. et fiat unguentum. 



Acne Rosacea. 

Resorcinol, as paste with equal part of Zinc Oxide, applied to affected part several 
times a day, to promote peeling of the skin in the treatment of acne rosacea. Ergot 
is well used in acne rosacea and other forms of acne; a good fluid extract with glycerin 
and water, giving 5ss internally per diem (B). Magnesium Sulphate, finely trit- 
urated, is an excellent dusting-powder for cases of acne rosacea; also in 5-grain doses 
thrice daily internally (See Acne). Bismuth, the Oleate as an ointment, and the 
greased surface powdered over with a mixture of Oleate of Zinc, Bismuth Subcarbonate 
and Starch (Shoemaker). Antipyrine, with Coca, often gives marked relief, when 



572 



ACTINOMYCOSIS — ADDISOX'S DISEASE — ADYNAMIA. 



abnormal irritability of the gastric nerve-endings leads to vaso-motor disturbances of 
the nose and face (Whitla). Bromides, with Arsenic, for women, when acne rosacea 
due to cessation of menstruation (Id). Ichthyol, both locally and internally, is very 
efficient, improvement commencing within a few days (Morris). Electricity, the gal- 
vanic current, 5 to 8 elements of an ordinary battery, both poles applied to the nose 
and continually moved about, or the anode on the zygoma and the nose gently stroked 
with the cathode; these applications repeated once in 2 or 3 days, for at least 10 to 15 
sittings, have proved uniformly successful in 31 cases (Helbing). Chloral will aggra- 
vate rosacea. 






R. Ichthyolis, 5j- 

Zinci Oxidi, 

Amyli, aa ij • 

Adipis, 5iv. 

M. ft. unguentum. Sig. — To be applied at 
night. 



1$. Potassii Iodidi, gr. xl. 

Potassii Bromidi, o j • 

Liq. Acid. Arsenosi, 5 jss. 

Tinct. Sumbul, oij. 

Aquae Cam phorae, ad 5xij- 

M. Sig. — oss in water after meals. 






Actinomycosis. 

Sodium Salicylate, produces amelioration of symptoms (Netter). Potassium 
Iodide, in full doses, 80 grains daily at first, diminished as its physiological effect is 
produced, is promptly curative, acting probably by augmenting tissue resistance. This 
drug has cured six human cases in Holland, and one in France; also 71 out of 185 
oxen so treated in Chicago (Netter). Iodipin, 3j-jss by injection, after puncturing 
the abscesses, completely cured three cases of actinomycosis of the cheek in four weeks 
(Kreibich). 



Addison's Disease. 

Arsenic, with cod-liver oil, gives the best results (Da C). Iron and other tonics 
are useful, especially a combination of the chloride, glycerin and chloroform (Green- 
how). Phosphorus, has seemed to exert a beneficial influence (Wilks). Adrenal 
Extract, cured 6 cases and improved 22, out of 48 cases treated (Kinnicut). Iron, 
is especially indicated when anemia is a prominent symptom (Tirard). Treatment 
must be symptomatic and is of little use, the disease being usually fatal (H). 



1$. Tinct. Ferri Chloridi, 

Spt. Chloroformi, aa § j. 

Glycerini, ovj. 

M. Sig. — A dessertspoonful in water 

thrice daily. (Greenhow). 



R\ Quininae Sulphatis, gr. xij. 

Ac. Sulphurici Dil., IJjxij. 

Ferri Sulphatis, 3ij- 

Aquae, q. s. ad 5yj. 

M. Sig. — A tablespoonful or two thrice 

daily. ( Tirard.) 



Adynamia. 

Cinchona, or Quinine, with Arsenic, for pale, badly-fed town -dwellers (R); as a 
general tonic when flesh flabby, skin perspiring (P). Arsenic, for swelled feet of old 
or weakly persons, and breathlessness from weak heart (R); as a tonic in continued 
doses of gr. ^V to T V (Wa). Nux Vomica, in adynamia of drunkards; Tinct. Capsici 
ovj; Tinct. Nucis Vom. 5ij; gtt. xx in water every four hours (B). Calcium Phos- 
phate, when from prolonged town -life or overwork; gr. j with grain j each of Iron 
Phosphate and Calcium Carbonate as a dose (R); Hypophosphites of Lime or Soda, 
in nervous or general debility (R). Iron, promotes appetite and digestion; gr. j-iij 
of the Sulphate, or the official Iron and Aloes pill, or with Manganese (B); anemic 
subjects (R). Hydrastine, as substitute for Quinine, to promote appetite and diges- 
tion and improve assimilation (B). Digitalis or Eucalyptus, in debility with weak 



AJTEB P UNS VGA] VCT1 \. 



573 



heart action (B). Bitters, especially Calumba ami Gentian, are useful for a 9hor1 
time (B). Sanguinaria, when stomach needs stimulation (P). Sarsaparilla, in 
broken-down, syphilitic constitutions (P). Orchitic Extract, in general adynamia, 

in exhaustion from wasting disease, and in decrepit subjects of old age, has seemed to 
be of some temporary service. Alcohol is of great value, but has been abused; hurtful 
when it increases temperature and pulse, dryness of tongue, etc. (B); a wine with 
much ether in debility of old age, especially where sleeplessness, indigestion and stomai h 
eramps (R). Aliment, sugar and saccharine fruits, vegetables, oil, milk, cod liver 
oil, wine of good body and strength (B); Porter or Rum-and-milk for town living 
women (RV Sea-bathing is useful in chronic illness, with much debility (R). Turk- 
ish Baths, when debility is caused by the tropics, but caution necessary; when 
town-dwellers become stout and flabby, are easily tired, suffer from a lack of energy 
and from mental depression, a course of baths is beneficial (R). [Compare Anemia, 
Convalescence, Neurasthenia.] 

Tonic Prescriptions. 



M. 



Liq. Potas. Arsenitis, nnx. 

Fluidextr. Nucis Vom...... njxx. 

Tinct. Gentians; Compos., 
Tinct. Cinchonae, 
Tinct. Calumba;, 

Vini Kola;, aa. o iv. 

Sig. — A wineglassful after each meal. 



R. Tinct. Nucis Vom., 5ij- 

Tinct. Cinchonae, ad §iv. 

M. Sig. — A teaspoonful after each meal. 



1$. Arseni Trioxidi, gr. j. 

Quininos Sulphat., oj. 

Ferri et Potass. Tart., oij. 

M. Ft. pil. no. xxx. Sig. — One pill after 
each meal. 



R. Quinina; Sulph., 5j- 

Strychninae Sulph., gr. j. 

Tr. Ferri Chloridi, 5 v. 

Ac. Phosph. Dil., oij. 

Syr. Limonis, ad 5 vj . 

M. Sig. — A teaspoonful in water thrice 
daily, in nervous debility. 



After-pains. 
Opium, more certain in action than any other remedy (Wa). Morphine and 
Atropine together hypodermically (B). Cotarnine Hydrochloride, as hemostatic 
and anodyne, for after-pains due to blood-clots (Freund); in dose of gr. j with Ergotin 
ur. v, every 2 hours. Belladonna, as ointment, much used in France (L). Camphor, 
gr. x with gr. J of Morphine, an effective remedy (B); oj in §vj of mucilage, table- 
spoonful doses every hour or two (Wa). Chloral, will stop the pains, but large doses, 
gr. xx-xl, are necessary (R). Chloroform, the Linimentum Chloroformi oj, with 
Linim. Saponis ovj, applied on flannel to the abdomen (Barker). Quinine, gr. v-x 
night and morning, with the above chloroform liniment locally, in neuralgic after-pains 
which do not yield to opiates, the uterus being tender on pressure (Barker). Gelse- 
mium, suspends them, large doses, texx, necessary (B). Cimicifuga, relieves the 
pains, and allays general nervous excitement (P). Ergot, is better than Cimicifuga 
R). Poultices, warm, over the hypogastrium, with soothing injections into the 
vagina (L). 



Agalactia. 

Ricinus, gr. v. of extract, or 5j-ij of strong decoction, daily in water; also the 
leaves, or an infusion, locally to mammae (T). Gossypium, an emulsion of the seeds 
has repute in India as a galactagogue ; a wineglassful of the decoction every 20 to 30 
minutes (P). Pilocarpus, remarkably increases the secretions (B); Pilocarpine is 
a galactagogue, and probably the only example of this class we possess, it distinctly- 
increasing the secretion of milk in nursing women (M). Tea, a good black tea is 
thought to promote the milk supply. [Compare Lactation.] 



,- 74 ALBUMINURIA — ALCOHOLISM. 

Albuminuria. 
Aconite, in incipient albuminuria with high body-temperature (R). Lead, dimin- 
ishes the albumin (R). Turpentine, gtt. ss-j, every 2 to 4 hours or one or two drop 
doses night and morning, of great value in chronic albuminuria without other marked 
symptoms of Bright's disease (P). Gallic Acid, the most efficient agent in the acute 
forrfto restrain loss of albumin (P). [See Aitken's formula below.] Cannabis Indica 
is indicated when bloody urine (R). Chimaphila, has unquestioned power over 
albuminuria (P). Cantharis, njy of the tincture every 3 hours, after the subsidence 
of acute symptoms, especially when bloody urine (R). Fuchsin, : "foses of gr. j-.ij, 
completely arrested albuminuria with edema in many cases (Bouchut) Alkalies, the 
Ses and acetates as diuretics (R); the Buffalo Lithia .Wate. : of Virginia is highly 
recommended. Strontium Lactate, has been used with benefit, but should not be 
given when scanty urine or symptoms of uremia are present. Nitro-glycerui, ny of 
a one per cent, solution to dilate the peripheral vessels, relieving the heart and lessening 
the renal congestion (B). Turkish Baths, benefit by relieving the kidneys of work 
(R) Milk-cure, with buttermilk, has proved very efficient in many cases (B). Chalyb- 
eate Waters, especially those having purgative qualities, are beneficial (B). |Compare 
Bright's Disease.] 



E;. Acidi Gallici, 3 H] • 

Ac. Sulphurici Dil ., 3 ss. 

Tinct. Lupuli, 5j- 

Infusi Lupuli, q.s.adoV- 

Sig. — Tablesp. thrice daily.— (Attken.) 



R<. -Liq. Ferri et Ammonii 

Acetatis (U. S. P.) 3vj. 

Sig.— Teasp. to a tablesp. according to age, 
well diluted, thrice daily. 

(Basham.) 



Alcoholism. 
Ammonia, a full dose of the Spirit, 3ss-j, will often sober a drunkard speedily (R); 
a few drops of Aqua Ammonia., diluted, have prompt action (S); 3] of the a mat 
spirit with Capsicum (see formula below). Ammonium Ch onde * remarkably 
efficient in straightening up a subject of acute alcoholism; 3ss in * pint of water, 
Sowed afone draugVby a patient.on the verge of dehr urn tremens^ is said to 
quickly restore the faculties. Ammonium Acetate, the solution, in full doses is 
one of the most efficient agents for quickly straightening up a drunkard. Arse ^ c ' 
a drop of Fowler's solution before breakfast for the morning vomiting of dnmkards (R). 
Capsicum for the dyspepsia of chronic alcohohsm and to induce sleep, aLo as a sub- 
stitute for alcohol by removing the distress at pit of the stomach; the tincture m 10- 
mmfm doses shouk/be taken "shortly before meals, or whenever there * a dcg««on 
or craving for alcohol; it obviates the mornmg vomiting, and promotes appetite and 
3. Cinchona, especially Cinchona Rubra, for gastric catarrh of drunkards 
(if Ouinine gr ij-vi daily to raise the nervous tone (P). Nux Vomica for stomachal. 
dSoVckr B)'; g n the tremor of chronic alcoholism is of much value (P); the torture 
fn s-minim doses with 15 of Tinct. Capsici, in water every 4 hours » exc eedmgfc 
effective in diminishing the craving for spirits and sustaining the nervous > system. 
Strychnine, the Nitrate, gr. *W* hypodemncally thrice daily for ten days ;,* an 
absolute cure for dipsomania (Luton); a very valuable remedy for chrome alcohohsm 
and dipsomania, not merely curing the attacks, but abolishing ; th. .desire fo -dank, 
the patients abstaining from spirits of their own accord (Pombrak); the Keeley ^ ejection 
contained Strychnine or Brucine, with Atropine or Hyoscine, and an occa, onal cross 
shot " of \Domorphine Caffeine in doses of gr. j-i every 2 or 3 hours, will m 48 hour 
ffectually 'quS the craving for alcohol to which it is ft^l^-JSJ^ 
(Hall) Kola is a good tonic for cases of chronic type. Chloral is >ery useful as a 
hypnotic and calmative; must be cautiously employed in old --n-out drunkard^ w , h 
weak hearts (B); in solution with Potassium Bromide is much used as a sedati e to 
The nervous system. Hydrastine, the sulphate in doses of gr. ,'„ increased to gr. lf> 



Al OPKC'I A. 



575 



hypodermically four times a day, is one of the "cures," and baa been used for this 
purpose in Canada for many years. Aurum and Arsenic Bromide, the solution 

clay's), is an excellent tonic remedy for alcoholism, and may lie used by hypo 

dermic injection, in doses of injx four times daily. Potassium Bromide with Chloral 

see above); 3j every 4 to 6 hours in the "horrors" (B). Cocaine has been pronounced 

of great benefit, restoring appetite, inducing sleep and promoting digestion, while it 

soothes the brain and induces a feeling of contentment and calm (R). Cimicifuga, 

lid to be useful in the treatment of the drunkard's stomach (R). Hyoscine is 
efficient against the tremor of chronic alcoholism. Picrotoxin, small doses for the 
tremor, gr. >V repeated (B). Lupulin, is the best substitute' for alcohol, and is ex- 
tremely serviceable in delirium tremens (B). Zinc Oxide, is very useful in chronic 
alcoholism, to diminish the craving, to relieve the gastric catarrh and lessen the tremor 
(B). Glycozone is one of the best remedies for the chronic gastric catarrh (Edson). 
Phosphorus is a useful remedy in chronic alcoholism (Anstie). Opium should be 
used cautiously if at all (B); Morphine, with tonics before meals, for pain, nausea, 
and anorexia (R). Apomorphine in dose of gr. $ as a sedative in the stage of excite- 
ment (Polk); gr. 5 V hypodermically is efficient for the insomnia of acute alcoholism 
(Shannon). Diphtheria Antitoxin in some cases has caused a positive disgust for 
alcohol, and may prove a curative remedy. Acute Alcoholic Poisoning requires an 
emetic or the stomach-pump, cold douche to the head and breast, warmth to the feet 
and limbs. Artificial respiration may be required. Milk, mucilaginous drinks, and 
black coffee, are the principal remedies. A milk diet often creates a disgust for alcohol. 
Kumvss is a valuable nutrient. Chronic Alcoholism is not a disease, as sentimen- 
talists would have us believe, but is simply a vicious drug-habit, and may be overcome, 
like any other drug-habit, by the exercise of the subject's will-power alone in abstaining 
therefrom. The effort to gradually reduce the amount consumed simply prolongs 
the agony and is much less efficient than the total and immediate withdrawal thereof 
entirely. This should be carried out in an inebriate asylum in most cases. [Compare 
Delirium Tremens, Neuritis, Poisoning by Alcohol, Vomiting.] 



B- Chlorali Hydrati, 

Potassii Bromidi, aa. 3ij- 

Tinct. Capsici, 3j- 

Aquae Cinnamomi,..q. s. ad oviij. 
M. Sig. — A tablespoonful or two every 

two hours in water, for acute alcholism. 

The dose may be doubled at bed-time. 



B- Zinci Oxidi, 3 j- 

Piperini, gr. xx. 

M. Fiant pil. no. xx. Sig. — One pill 
thrice daily. 



B- Tinct. Capsici, 3ss. 

Potass. Bromidi, oss. 

Vel Liq. Potass. Arsenit., . . . njl. 

Vel Tinct. Nucis Vom., 3 » j - 

Spt. Ammonia; Aromat., Siij. 

Syr. Tolutani, q. s. . . §vj. 

M. Fiat mistura. Sig. — A dessertspoon- 
ful in water four or five times daily. 



B- Tinct. Gentians Co., 5ij. 

Tinct. Calumba; Co., oij. 

Tinct. Nucis Vom., njlxxx. 

M. Sig. — A dessertsp. before each meal 
for rum-stomachs. (Loomis.) 



Alopecia. 

Cantharides, the tincture, 1 part to 8 of castor oil, well rubbed into roots of hair, 
night and morning (Wa). Arsenic, njjv of Liq. Potas. Arsenitis ter die, exercises a more 
or less powerful influence (Wa). Nitric Acid, with olive oil, makes a serviceable 
liniment (Wa). Pilocarpine, has a decided influence on the growth of the hair (B). 
Glycerin in combination with the above remedies (Wa). Sulphur Iodide, has been 
found very effectual, used internally and externally (Wa). Thyroid Extract has done 
good service in universal alopecia, as a cutaneous stimulant. Phototherapy, the 
Finsen ray has been used with benefit in bacterial alopecia, the Roentgen rays also. 
Oxygen, applied under a rubber cap fitted to the head, into which oxygen was pumped, 
with entire satisfaction, in the case of a girl who had lost nearly all her hair in consequence 
of alopecia areata (Stoker). Frequent Shaving may often save the hair in alopecia 



576 



AMAUROSIS AND AMBLYOPIA — AMENORRHEA. 



after illness. Use clean brushes with long bristles, and brush against the natural lay 
of the hair. [Compare Hair, Tinea Decalvans, Tinea Tonsurans.] 



R. Ol. Amygdalae Expres., 

Aq. Ammonias, aa 5j- 

Ol. Rosmarini, 3 i j - 

Alcoholis, 

Aq. Destillat., aa 3ij- 

Mellis Depurat. ..,. .q. s. ad 5viij. 
Sig. — Lotion fort he hair. {Wilson.) 



R. Tinct. Macis, 3 jss. 

Olei Olivae, q. s. ad Bij- 

Sig. — Lotion for baldness. (Hebra.) 



R*. Tinct. Cantharidis, 3 jss 

Tinct. Capsici, njxx. 

Glycerini 5ss. 

Spt. Odorat., ad 5vj. 

M. Sig.— Hair tonic. (Gross.) 



R. Pilocarpin. Hydrochloride . . gr. j. 

Aquas Destillat., 3j- 

M. Sig. — Ten to thirty drops twice daily, 
according to age, to improve the growth of 
the hair. (Barlholow.) 



Amaurosis and Amblyopia. 

Arnica, has long been a popular remedy for amaurosis in Germany; Mannoir 
employed it with much success (P, Wa). Rue, in minim doses night and morning, 
for dimness of vision from functional amaurotic condition; Elgajaki says it produces 
dimness of vision, and in smaller doses improves the eyesight (P). Strychnine will 
cure amblyopia from lead, tobacco, and alcohol (B); gr. T ; 5 hypodermically (Nagel); 
hypodermically in tobacco and traumatic amblyopia, and in progressive nerve atrophy 
not dependent on intercranial disease (R). Guaiac, is advised for cases of amaurosis 
occurring in persons of rheumatic diathesis (Wa). Santonin, has given very satis- 
factory results in amaurosis (Wa). Veratrine, as lotion brushed over eyelids, brows 
and temples once a day, is often useful, but should not be permitted to touch the con- 
junctiva, or great pain will result (Wa); [see formula below]. Potassium Iodide, in 
amblyopia from lead-poisoning (Wa). Opium with champagne, has caused recovery 
from tobacco amaurosis without the abandonment of the habit of smoking (Hutchinson). 
Seton, a small seton in the temple kept open for a long period, has been found effectual 
when other remedies failed (Wa). Amaurosis and Amblyopia are names formerly used 
to denote the various forms of blindness, before ocular diagnosis became as exact as 
it now is. Amblyopia is still used to designate certain impairments of vision not ac- 
counted for by organic changes visible (Roosa). 



R. Veratrinae, gr. x. 

Athens, oij- 

Alcoholis, 5 j- 

M. Sig. — Use with a brush once a 
over eyelids, eyebrows and temples. 



day 



Ri. Strychninae Sulphatis, gr. j . 

Alcoholis 3j- 

Aquae Destillatae,. . .q. s. ad 5iv. 
Sig. — A teaspoonful thrice daily before 
meals, when not used hypodermically. 



Amenorrhea. 

Aconite, in sudden suppression from cold or wet feet (R, P). Pulsatilla, in sudden 
suppression (B); often of the greatest value in the functional form (P). Iron, when 
from anemia, the most frequent cause; small doses preferred. Solution of Acetate, or 
Ferri et Ammonii Citras gr. ij, or Ferri et Strychninae Citras gr. j, also chalybeate waters; 
make a careful diagnosis before giving iron (B). Hemogallol, did good service in 
cases which could not tolerate inorganic forms of iron (Porter). Aloes, when dependent 
on anemia (B); at the periods, with hot pediluvia, friction, etc. (R, P). Potassium 
Permanganate, gr. j thrice daily increased to gr. ij, is the best of all remedies for 
bringing back the menses, having specific action on the uterine tissue (R); excellent 
in amenorrhea from cold feet, and is by far the best emmenagogue; in pill it may ex- 
plode, best in capsule with powdered elm or licorice (Parvin). Manganese Dioxide, 
in pill, gr. ij thrice daily, is a very efficient emmenagogue Mercury, the Biniodide, is 
a certain and safe emmenagogue, gr. £ in pill, four times daily. Oxalic Acid, is highly 
praised, gr. $-f in mixture, every hour (Poulet). Apiol, when from functional inac- 



\\i \;i \. 



577 



tivity; first give Iron for the blood; next aloStic purgatives, then apiol, gr. w, just 
preceding the period; or a daily dose for a week or several days before (B); the best 
emmenagogue next to Potass. Permang. (Parvin). Senega, a saturated decoction of 
the root, to extent of a pint in 24 hours, during the preceding two weeks, advantageous 
^P). Polygonum, has given excellent results when used in 3ss doses four times daily 
for a week (B). Cimicifuga, has been recommended (R); is of very great value (P). 
Arsenic, combined with Iron, when from functional inactivity of ovaries (B). Aurum 
Salts, in amenorrhea from torpor of ovaries (B). Ignatia, in suppression of hysteria 
I P). Cinnamon, causes a flow of blood to the womb (Goodell). Indigo, is considered 
very efficient in doses of from 3j to 5iv; larger doses produce nausea and vomiting. 
Nux Vomica, small doses of the extract, of benefit in some obstinate cases (Wa). 
Silver Nitrate, in substance, applied lightly to the os uteri, at time of the expected 
discharge (Wa). Colocynth, in chlorotic amenorrhea (P). Ergot, has cured when 
due to plethora (B); when anemia after use of iron (R); in chlorotic (P); njjj every 
i hour for 5 or 6 hours the day before and that of the expected flow, is very efficient 
when the cessation is not due to anemia (A. A. Smith). Senecio Aureus, will provoke 
menstruation in cases of functional amenorrhea but will not do so when there is anemia 
or advanced phthisis (M). Rue, in functional form, rrjjj— v of the oil (B, P). San- 
guinaria, is indicated for functional amenorrhea in the absence of plethora (B, P). 
Savine, general atony; ttkv-x of the fluid extract (B, R, P). Serpentaria, with anemia or 
chlorosis (B). Ammonium Chloride, for headache (R). Sitz-baths, hot, for six days 
before period; mustard may be added at period; often effectual in sudden suppression 
(B). Spinal Ice-bag, to lower dorsal and lumbar vertebrae, or cold sponging; useful 
(R). Electricity, in atony of uterus and ovaries (B). [Compare Anemia, Chlorosis.] 



R. Olei Sabinae, 

Olei Rutae, aa 3 j- 

Tinct. Polygon. Hydropip.,. %]. 

Ol. Amygdalae Expres., 

Mucil. Acacias, 

Aquae Menthae Pip., aa oij- 

Fiat mistura. Sig. — A teaspoonful two or 
three times daily. (Bartholow.) 



R. Ext. Aloes 5j- 

FerriSulph. Exsic, ij - 

Asafcetidae 3iv. 

Fiant pilulae 100. Sig. — One pill after 
each meal, gradually increased to three. 

(Goodell.) 



R. Tinct. Ferri Chloridi, 3iij- 

Tinct. Cantharidis, 3 j. 

Tinct. Guaiaci Ammon Biss. 

Tinct. Aloes, Sss. 

Syrupi, q. s. ad 3vj. 

Fiat mistura. Sig. — A tablespoonful thrice 
daily, in simple atonic amenorrhea. 

(H. C. Wood. Dewees.) 



B;. Quininae Sulphat., 3iss. 

Extr. Nucis Vom., gr. xij. 

Olei Sabinae 3ss. 

Aloes Socotrinae, gr. viij. 

Cantharidis, gr. xxiv. 

Fiant pilulae xlviij. Sig. — One pill thrice 
daily. 



Anemia. 

Nux Vomica, stimulates the blood-making organs, and is used as an adjunct to 
restorative remedies (B). Iron, astringent preparations are the best and should be 
given after meals; chalybeate waters are also useful (B). Some persons require bland 
preparations, especially when the gastric mucous membrane is irritable; a pale and 
flabby tongue indicates large doses of the chloride or sulphate (R). Hemogallol, is 
the most readily absorbed of all iron preparations (Busch); particularly valuable in 
cases of weak digestion (Lange); and in anemia due to suboxidation diseases (Porter). 
Oviferrin is more easily assimilated than the inorganic iron salts, with the best of 
which it compares favorably (M). Arsenic, as an adjunct to Iron, and when iron can- 
not be borne or fails (B). Aurum Arsenate, is highly beneficial; the solution of 
Aurum and Arsenic Bromide renders excellent service in anemia. Orchitic Extract, 
has seemed serviceable. Adrenal and Thymus Extracts have been used with benefit. 
Nuclein, has rendered good service. Bone Marrow, is highly efficient in pernicious 
anemia. Orexin, to stimulate the appetite. Cod-liver Oil, is often of great service, 
especially' in children (W). Thymol, in tropical anemia due to ankylostomiasis (see 



578 



ANESTHESIA, GENERAL. 



Worms) Cetrarin, a valuable remedy, especially when constipation is marked 
(Robert) Quinine for badly-fed town dwellers (R). Hypophosphites are useful, 
but should not be given with iron, cod-liver oil, or stimulants (R). Calcmm Phos- 
phate in anemia of growing persons, and of women weakened by rapid child-bearing 
of excessive menstruation (R) Calcium Lacto-phosphate, for nursing mothers, or 
in waste from suppuration B). Acids, added to purgative salts as tomes to he mucous 
membrane (R). Pepsin, is recommended by Hollmann. Manganese, alone not of 
muda use is best combined with Iron (B); is not, like iron, found in the feces, nor 
does it cause constipation (Wa). Pepto-mangan, is highly esteemed by, nany co^ 
petent clinicians. Galvanization, as an aid to remedies B . Cold Spongmg^, needs 
great caution, as it may lower the tone by minute degrees (R). Diet and Hygiene, of 
Prime?mportance. Nourishing, digestible food, in as large quantities as can be assum- 
K-miSc, eggs, animal broths" afterward fish, poultry, game, mutton. Moderate da, y 
out of-door exercise, in pure air, is indispensable. Bathing, especially sea-bathing aus 
restoration. Wines! often useful. Red wines are the best. [Compare Adynamia, 
Chlorosis, Convalescence, Leucocythemia, Lymphadenoma.J 

Tonic Prescriptions. 



R* . Tinct. Ferri Chloridi 5 iy . 

Ac. Phosphorici Dil., 3yj. 

Spt. Limonis, 3 i j - 

Syrupi, q.s.ad §vj. 

Misce. Sig. — A dessertspoonful in water 
after meals. To the above may be added 
3ij of the Liquor Strychninae Hydrochlo- 
ratis of the B. P. (Goodell.) 



3 



.... 5j- 



Hydrarg. Chlor. Corr., 

Liq. Acidi Arsenosi, . . 

Tinct. Ferri Chlor., 

Ac. Hydrochlor. Dil., aa giv. 

Syrupi, |iij- 

Aquae, q.s. ad ovj. 

Misce. Sig. — A dessertspoonful in a wine- 
glassful of water after each meal, as an altera- 
tive tonic. (A.H.Smith.) 



R. Ferri Sulph. Exsiccat., 

Potass. Carbonatis, aa 3ij- 

Syrupi, q- ?• 

Fiant pilulae no. xlviij. Sig.— One pill 
after each meal, gradually increased to three. 

(Bland.) 

R. Quininae Sulphatis, gr. xx. 

Ferri Sulph. Exsic, gr. xl. 

Strvchninae Sulph., gr. ss. 

Fiant pilulae xx. Sig.— One pill thrice 
daily. (Bartholou:) 

R. Massae Ferri Carbonat., 5j- 

Arseni Trioxidi, gr- J • 

Quininae Sulphatis, gr. xl. 

Fiat massa et div. in pilulas no. xl. Sig.— 
One or two pills thrice daily. 



Anesthesia, General. 
Morphine, subcutaneously before the inhalation, diminishes dan ^ r ;P d }^ ns . 
the after pain if operation is performed (Nussbaum); a preliminary injection of Mor 
Phlne lessEhe sfage of rigidSy and spasm, enables a smaller ^^^Z 
to be used with full effect, prolongs the stage of insensibility, prevents shock, ana an 
taeonizes to cardiac and respiratory depression (B). Atropme, is decidedly the best 
fmZnist to the respiratory paralysis of Ether, and should be given hypodermically 
as soln a Planning s^ptoms 9 manifest themselves (Amidon); the writer of thy took 
has S Lved S at least folr^ects oj : chloroform-narcosij ; by g^gg™ ™ *$W 
after both heart and respiration had apparently failed, btryenmne, gr. ^ n yP"" cl . 
callv repeated if necessary, the most valuable remedy in chloroform poisoning (Vance). 
SmoSa The spirit, ^xx-xxx hypodermically, of great benefit ««* , bu 
rmrertain in action (Id). Digitalis, of undoubted value to raise the blood pressui 
and strengthen the heart (Id) Adrenalin Chloride, the i to i, coo solution hypo- 
d££S^ "mtravenou injection when the emergency is great, for cardiac a£ 
respiratory failure in general anesthesia (Martin). Amyl Nitrite, is oi no 
S" blood pressure? depresses the heart and jespuaUon (Vance^ C e one, 
prevents the nausea and vomiting (Hirchman). Chloral as an aid toLmo 
surgery and obstetrics, io to 15 grams given 20 minutes before *5f„ ^Se natient over 
to intensify the effect and enable a less quantity to be used, also tiding to patient 



ANESTHESIA, LOCAL \M I RISM. 

the excited stage (Brodnax); in children a full dose of chloral In-fore anesthesia enables 
the latter to be obtained during sleep without using force (Id). Hyoscine, gi 
hypodermicallv half an hour before ether inhalation, decreases nun us and ( becks vomit- 
ing (Robertson). Alcohol, Bj-ij of whiskey or brandy before inhalation to sustain 
the heart and prolong narcosis (B); a bad stimulant as it intensities the action 
form, and lessens the fatal dose (.Dubois). Oxygen is the antagonist to chloroform 
re). Artificial Respiration and rhythmical tongue tra< iuld always he 

employed in syncope from chloroform (Boureau); should he done so that compn 
is made on the chest (Vance). Compression of the Heart by squeezing it through 
the diaphragm, successful in one case of laparotomy under ether (Lane); used in 12 
eases, without final success (Boureau). Precordial Compression by the hall of the 
thumb midway between the apex beat and the sternum, with a quick strong movement 
;,o or more times per minute, the Konig-Mass method, has been successful in many 
»ases after other methods had failed (King). [For the subject of General Anesthesia 
see the articles in Part I on Chloroform, Ether, and Coca.] 



Anesthesia, Local. 

Ether, as spray, projected upon the skin in a continuous stream, produces cold and 
local anesthesia by its rapid evaporation, and may be used for any minor operation. 
Rhigolene, a volatile petroleum product, freezes the part when sprayed thereon from 
a hand atomizer and produces local anesthesia. Guaiacol in sterilized olive oil, 1 part 
in 10 or 20, hypodermicallv, is a powerful local anesthetic [see Guaiacol.] Cocaine, 
in 1 to 4 per cent, aqueous solutions injected hypodermically or applied to mucous 
membranes, produces profound local anesthesia; in weak solution by infiltration on 
the theory that fluid infiltration of the tissues is the cause of the anesthesia produced 
by local injection of anesthetic solutions; distilled water being too painful, weak anodyne 
solutions are used for injection. (For Schleich's Solutions see under Coca.) Adre- 
nalin with Cocaine, increases the anesthetic affect of the latter and prevents its toxic 
action. Eucaine is equally effective as Cocaine and much less dangerous. Tropa- 
cocaine is less toxic than Cocaine and equally effective. Holococaine is too toxic 
for hypodermic use, but in 1 per cent, solution instilled on the eye it produces complete, 
rapid and painless anesthesia. Orthoform is too insoluble for hypodermic use, but 
is efficiently anesthetic when employed as a dusting powder or ointment for painful 
surfaces when it comes into contact with exposed nerve endings. Nirvanin in 2 to 5 
per cent, solutions, is an efficient local anesthetic and not so toxic as cocaine. Dionin 
in 4 to 7 per cent, solutions, is a good anesthetic for the eye. Phenol, in weak 
or moderately strong solutions, as a local anesthetic for the skin. [Compare the List 
of Local Anesthetics and Anodynes.] 

1$. Chloroformi, partes xij. Dissolve the camphor in the chloroform, 

Camphorae, partes ij. ' add the oil of cloves and then the tinctures. 

Tinct. Aconiti partes xij. This is credited with almost magical anes- 

Tinct. Capsici partes iv. thetic effect, used as a local application. 

Tinct. PvTethri, partes ij. (Parson's Local Anesthetic.) 

Ol. Caryophylli, partes ij. 



Aneurism. 

Potassium Iodide, in large doses (gr. xv-5ss), 3 or 4 times a day, gives great 
relief and has cured (B); combined with recumbent position and restricted diet (R). 
Veratrum Viride aids surgical expedients; also in large internal aneurisms, with 
absolute recumbence and a little Opium to relieve pain, vomiting to be avoided (B). 
Ergot, with recumbent position; favors coagulation of the blood in sac (B); Ergotin 
P). Gallic Acid and Iron, internally, have cured cases of aortic aneurism (Speer). 
Chloroform inhalation for great dyspnea (R). Lead Acetate, a valuable auxiliary 
to the more important items of rest, diet and mechanical appliances, gr. iij-v ter die 



580 ANGINA PECTORIS — ANTHRAX. 

(Wa); its use limited to the sacculated form (S). Hydrastinine, has a mild but 
enduring contractile action on the arteries, and is useful in acute and chronic aortitis 
and arterio-sclerosis, as a preventive against aneurism (Boix). Gelatin, by hypodermic 
injection to increase the coagulability of the blood; used successfully in 9 cases (O). 
Electrolysis, galvano-puncture in deep aneurisms; not very successful (B). The 
object sought is the coagulation of blood within the aneurismal sac; cures have not 
been attained by this treatment, but in many it has produced great amelioration of 
the most distressing symptoms (Petit). Aliment, milk regimen, for denutrition (B); 
a low diet, with absolute rest; Ergotin and Potassium Iodide for deep aneurisms beyond 
reach of surgical treatment (B). Rest, in recumbent posture, and light, unstimulating 
diet, are primary and essential elements in the treatment of aneurisms. Surgical 
Treatment includes ligation of the vessels, also pressure by a tourniquet or bags of 
shot, the operator's fingers, etc., applied to the main artery above the tumor, and the 
introduction of fine wire into the sac to favor coagulation. 



1^. Potassii Iodidi 3 j. 

Tinct. Veratri 5 jss. 

Tr. Cinchonas Co., 3j- 

Tr. Cardamomi Co., 3 jss. 

Tr. Gentians Co., 3 ss. 

Syrupi Simplicis, 

Alcoholis, aa 5iv. 

Aquae, q. s. ad 3 xvj. 

Misce. Sig. — Sss thrice daily. Each 



1$. Plumbi Acetatis, gr. xxxvj. 

Extract! Opii gr. iv. 

Confectionis Rosas, q. s. 

dose has gr. xv of Potassium Iodide. Ft. pil. xij. One every four hours. 



R. AcidiGallici 3j- 

Ext. Ergotas, 

Digitalis, aa gr. xx. 

Fiat massa et div. in pil. xx. 
Sig. — One ever)' two hours. 



Angina Pectoris. 

Amyl Nitrite, as inhalation, affords signal relief (R); unsafe in advanced degenera- 
tion of cerebral vessels and fatty degeneration of heart (B); gives great relief during 
paroxysms (Br). Sodium Nitrite, is less rapid in action than Amyl Nitrite, but is 
more efficient in preventing return of symptoms (Br). Nitroglycerin vs. r }m has 
been used with success (Pf, R). Chamomile, in pseudo-spasms of hysterical persons (P). 
Ether, aborts a mild attack (B); Sulphuric Ether in the nervous form, a spoonful 
immediately on commencement of attack will greatly mitigate it (Anstie). Phosphorus, 
often serviceable (R). Morphine, hypodermically, especially when cardiac dyspnea; 
strengthens the heart (R). Strychnine, in the milder forms of angina, very small 
doses (P). Turpentine applications, hot over chest, to mitigate severity of the parox- 
ysms, especially in the aged (Wa). Quinine, when intermittent (Wa); or when any 
malarial taint present (Br). Brandy, in frequent small doses, with hot bran poultice 
over heart and warmth to extremities. Cocaine, in doses of gr. $ to $ thrice daily 
for two days, proved curative in four very severe cases (Laskevitch). Cactus is efficient 
in pseudo-angina pectoris. Chloral, may be well prescribed in pseudo-angina pectoris 
(De Holstein). Crataegus Oxyacantha, the English hawthorn, a fluid extract of the 
berries, used in 40 cases of true angina with remarkably good results (Jennings). Aco- 
nite, believed by Gubler to be appropriate, and by Fleming to have been curative in 
many severe cases resisting other remedies (P) ; in cardiac disease its action is uncertain 
(Br). Arsenic, lessens or prevents paroxysms, if used in the intervals (Anstie). 



Anthrax. 

Nitric Acid strong, applied steadily, after thorough cleansing and drying, to destroy 
the diseased mass (D). Bromine, to saturate the surface (D). Nitric Acid fuming, 
is the preferable caustic (Greenfield). Quinine and Phenol, used internally, are 
indicated in all forms, also stimulants, as Ammonia, Ether, and Alcohol (Greenfield). 
Sodium Sulphite, in doses of gr. x, has been recommended. Collargolum intrave- 
nously, produces a prompt and efficient cure (Fischer). Morphine for the diarrhea 
and insomnia. Senega and other expectorants when the lungs are affected. Excision 



ANTRUM DISEASE — ANUS, FISSURED. 

and Cauterization demanded, when from direct inoculation; the two most successful 
measures (Greenfield). Phenol, a 2 or 3 per cent, solution may be injected subcuta 
ously around the pustule thrice daily, and applied on compresse 1 lution 

(Jamvosky); of 24 cases so treated 17 recovered (Matveieff). Eschar should be 
promptly destroyed, to prevent contagion. Diet, a plentiful supply of animal food, 
beef-tea, milk and eggs. 

Antrum Disease. 

Hydrogen Dioxide, the solution, 1 to 12 of water, injected through the ostium 
for diagnosis of empyema of the antrum; if pus be present it is driven out, and tills the 
nose as a white foam (Brown). Chloroform, by inhalation, small quantities frequently, 
for treatment of acute catarrh extending to the antrum, extremely efficient, both as a 
remedy therefor and as a preventive of suppuration therein (Potter). Cocaine, in 1 per 
cent, solution as nasal spray, to secure contraction of the swollen mucosa (Hickey). 
Adrenalin Chloride, in solution of 1 to 4,000, as nasal spray every 2 hours, to reduce 
the swollen mucosa about the hiatus semilunaris, and free the maxillary outlet of the 
antrum for drainage (Id). Argyrol, a 2 per cent, solution caused marked improvement 
in a long-standing case of empyema of the antrum (Fletcher). Sulphaminol, by in- 
sufflation, has been successful in diseases of the antrum and frontal sinuses. Operative 
Measures, that in most favor is to enter the antrum through the alveolus of the second 
molar tooth (Garretson); to give free drainage and enable medication of the diseased 
mucous membrane it is best to enter the antrum in its most dependent portion, through 
the upper part of the alveolus or immediately above it, between the roots of the 2d 
bicuspid and 1st molar; a gold tube then fitted to the opening, so as to project beyond 
the mucous membrane, will give free drainage, without sacrificing a sound or even dis- 
eased tooth (Brown). Boric Acid, in saturated solution, as wash to cavity twice a day, 
the after-treatment; occasionally injecting Iodine, Zinc Sulphate or Bismuth Subnitrate 
(Id). 

Anus, Fissured. 

Hydrastis, locally, promotes healing (B). Rhatany, as injection, night and morn- 
ing, after enema in the morning to move the bowels (Pf, Tr). Iodoform, improves 
and relieves pain (B). Iodo-tannin, well applied, effective (B). Belladonna, locally 
of great sen-ice for painful spasms of sphincter (P). Opium, with gall-ointment for 
fissures of anus; mild purgatives should be simultaneously employed (R). Sulphur, as 
a mild purgative, to cause soft motions (R). Ichthyol, pure, applied daily after local 
anesthesia by cocaine, is very efficient, giving complete relief in a week or two (Conitzer) ; 
10 to 20 applications cured several cases (Cheron). Tannin, oj in Glycerin oij, intro- 
duced on a tent, night and morning, with great advantage (Wa). Collodion, as pro- 
tective covering (P). Potassium Bromide, with 5 parts of Glycerin, as local applica- 
tion (R). Silver Nitrate, in solution, to the ulcer after careful cleansing and applying 
a 4 per cent, solution of Cocaine, which prevents the pain due to the silver solution; 
followed by Iodoform oint. gr. xxx to the o ; this is most efficient (Adler). Castor Oil, 
as a mild purgative (R); to keep motions soft (Br). Surgical Means, the most ef- 
ficient; forcible dilatation of sphincter or partial division in severe cases, through the 
mucous membrane and a few fibres of sphincter. Anal fissure, when uncomplicated with 
some other rectal affection, is curable in many cases by non-operative methods of treat- 
ment (Adler). Mercury, an ointment of the Oxide, 30 grains to the o , has cured many 
cases (Id). 

R Hydraig. Chlor. Mitis, gr. iv. I>. Plumbi Acetatis, 

Ext. Belladonnae, Zinci Oxidi, aa gr. x. 

Pulv. Opii, aa gr. ij. Pulv. Calamine gr. xx. 

Ung. Sambuci 5j- Adipis Benzoinat, oiv. 

M. Sig. — To be applied frequently in M. Sig. — Ointment for use in anal fissure. 

anal fissure. (Allingham.) (Al/ingham.) 



582 



APHONIA — APHTHA — APOPLEXY. 



Aphonia. 
Ignatia, in aphonia of hysterical women (P). Atropine, in hysterical aphonia and 
for fatigue of vocal cords, gr. T ^ to kt>, morning and evening (B). Ethyl Bromide, 
for rapid anesthesia, during which it was suggested to the patients to shout out loudly 
their names, count numbers, etc.; this successful in 5 cases of hysterical aphonia in 
women (Arslan). Nitric Acid, ttrv-x of the dilute acid, for hoarseness of singers, 
in fatigue of vocal cords, and when aphonia is stomachal (B). Benzoin, the tinc- 
ture by inhalation in laryngeal catarrh (Br). Oil of Rue, as inhalation in chronic 
catarrh (Br). Uranium Nitrate, as spray in very chronic catarrh (Br). Alum, 
gr. x-oj aquae, as spray, in chronic coughs and hoarseness (R). Borax, a piece 
the size of a pea allowed to dissolve in the mouth (R). Glycerite of Tannin, 
locally in chronic inflammation of the throat (R). Sulphurous Acid, by inhalation, 
spray, or fumigation, in clergyman's aphonia (R). Ipecacuanha wine, as spray, when 
congestion of vocal cords (R); in laryngeal catarrh (Br). Ammonium Chloride, as 
vapor inhaled, of great value in catarrhal aphonia (Wa). Turkish Bath, at com- 
mencement of a feverish cold (R); in acute laryngeal catarrh (Br). Galvanism, local 
ized, the best treatment for hysterical aphonia. 



R,. Acidi Nitrici Dil., 3ij- 

Tinct. Calumbae, 5j- 

Aquae, ad §iv. 

M. Sig. — A dessertsp. in a winegl. of 

water thrice daily. 



1$. Aquae Ammonias, 

Aquae, aa 5j. 

M. Sig. — A teaspoonful in a pint of hot 
water for each inhalation. 



Aphthae. 

Potassium Chlorate, the best remedy; a solution of gr. x to the 5 as wash, alone 
or with borax (Br); and gr. x to xx by the stomach (B). Borax, with honey, or as 
glycerite of borax, frequently used (R); crystals allowed to dissolve in the mouth (W). 
Sulphurous Acid, as solution, strong or diluted, locally (R), diluted as spray (B). 
Mineral Acids, formerly much used (B). Mercury, Hydr. cum Creta in small doses 
to remove the indigestion on which aphthae often depend (B); Borax being used locally 
when aphtha? exist in the mouth (Wa). Copper Sulphate, a weak solution painted 
over mucous membrane (R). Potassium Iodide, gr. j-v in oj aquae, locally (B). 
Salicylic Acid, one part dissolved in alcohol to 250 of water (R). Quinine, gr. j every 
2 or 3 hours, in infants (B), especially when consequent on diarrhea (Br). Coptis, 
the infusion has repute in New England (B). Bismuth, freely to the parts (B); as 
a local application (Br) . Glycerin, will sometimes cure (R) . Rhubarb, the compound 
powder to remove indigestion (Br); is highly useful in small doses (Wa). Limewater, 
as a mouth-wash, is much used. 



R^. Acidi Sulphurosi, 5ij- 

Aquae, q. s. ad o i j - 

M. Sig. — Mouth-wash, or may be used as 
a spray. 



R. Pulv. Rhei Co., 5ij- 

Sacch. Lactis, q. s. 

Triturat. et div. in pulv. xij. Sig. — One 
powder thrice daily. 



Apoplexy. 

Aconite, when full, strong pulse, hot, dry skin, plethoric cases, is the best remedy 
(P) ; to lower blood -pressure and prevent further hemorrhage, where the pulse is strong 
and arterial tension high (Br). Elaterium, as a purgative, a large dose (gr. ij) in 
suppository with soap; or as an injection into the large bowel (P). Croton Oil, as 
purgative, a drop may be put on the back of the tongue (Br); nj { or $ each hour (R). 
Colocynth, as a derivative purgative (Br); appears to act well (P). Cold Water, 
often harmful, though frequently used; is injurious when face pale, surface cool, circula- 
tion depressed (B). Electricity, very mild galvanic currents to promote absorption; 
caution necessary, especially if much headache and vertigo (B). Diet and Hygiene, 



U'l'l AI'U'I CIS U'l'l I I 583 

of groat importance in patients subject to apoplexy; avoid stimulating food and drink, 

vially beer, over-eating, excitement, haste, exposure to hot sun, heated ro 
At no subsequent period should a full animal diet or the use of undiluted win, 
indulged in (A). Diagnosis. Should be carefully differentiated from alcoholism, with 
which it is often confounded. [Compare Cerebra] CONGESTION.] 



IV Tinct. Aconiti, mix. 

Aqux Cinnamomi, .q. s. ad 3 ij ■ 
M. Sic;. — A teasp. every \ hour for 
hours, then every half-hour. 



T\. Ext. Colocynthidis Co., %r. xx. 

Olei Tiglii npij. 

Fiat massa el div. in pil. iv. Sig. — One 
pill as required, until free purgation. 



Appendicitis. 
Opium or Morphine, in small doses to relieve pain, but not to narcosis (Tirard); 
not in sufficient quantity to mask the symptoms, and is best avoided unless imperative 
by reason of pain and collapse (Bruce). Calomel, as a germicide and evacuant, gr. ,',-, 
every haif hour for 12 doses, followed by 5j of Magnesium Sulphate every hour until 
the bowels move several times (Mitchell); with Opium, an old practice which should 
be revived (Bruce). Purgation by Calomel and Carlsbad salts, from the beginning 
of the third day or during the active stage (Wyeth) ; should be avoided during the first 
three days (Bruce); purgation disturbs the viscera and is liable to set up general peri- 
tonitis (Tirard); in my experience no acute case has terminated fatally in which neither 
food nor cathartics were given by the mouth from the beginning of the attack (Ochsner). 
Salol, as an intestinal antiseptic, gr. x with gr. xx of bismuth subnitrate every 4 to 6 
hours (Mitchell). Ichthoform internally, to moderate the general abdominal and 
peritoneal symptoms (Polasco). Cocaine or Chlorctone, for the nausea when excessive 
(Mitchell). Boric Acid in hot saturated solution, as fomentations to the abdomen in 
the stage of invasion (Bruce). Heat by fomentations to relieve pain (Tirard). Ice- 
bag, applied over the appendix, the most efficient measure to relieve pain and control 
inflammation, and has cured many cases. Enemata, of soap and water in large quan- 
tity, after 72 hours (Bruce); should be used at the commencement to unload the colon 
(Tirard). Rest in bed is essential and should be absolute, the patient not rising to the 
sitting posture for any purpose (Id). Diet, none by the mouth for at least four days 
after pain has ceased, not even water, in order to prevent peristalsis, which increases 
the area of infection (Ochsner); 416 cases so treated with mortality of less than 4 per 
cent. (Id); other methods showing mortality of 14.6 per cent. (Deaver), 33 per cent. 
(Broca) and even 50 per cent. (Kirmisson); rectal feeding should be used exclusively, 
and the stomach emptied at once by lavage (Ochsner). Water may be taken freely 
with 5j of Hydrogen Dioxide solution in each glass (Mitchell); not by the mouth 
(Ochsner). Milk to be avoided, its casein being liable to fermentation causing gas in 
the intestines (Mitchell). Operation is indicated when there is exacerbation of symp- 
toms (Park); early removal of the appendix will prevent extension of infection to the 
peritoneum (Ochsner); in 3 years when operating on all cases my mortality was 33 
per cent., in 3 years and more of opportunist treatment it was only 10 per cent. (Broca); 
may usually be left open for decision until the fifth day or after, though demanded 
immediately in all ultra -acute cases and those in which suppuration is suspected (Treves); 
simple acute cases are generally best treated by internal medication (Wette); skilful 
medical treatment will take 95 per cent, of the cases through their first and second 
attacks safely (Mitchell). [Compare Peritonitis, Typhlitis.] 



Appetite. 

Ignatia, will correct diseased appetite (P); especially in hysterical subjects (Br). 
Anthemis, will stimulate the appetite. Cannabis Indica, produces a ravenous appe- 
tite. Bitters, to stimulate the appetite (R). Calamus chewed, is a good appetizer. 
Orexin Tannate is a powerful promoter of the appetite and efficient in the anorexia 
of many affections (Kolbl); especially valuable for children (Steiner), and in nervous 



584 ARTHRITIS DEFORMANS— ASCITES. 

anorexia (Hiifler). Condurango is efficient for the anorexia of adults, but disappointing 
in children (Steiner). Food should be savory and well cooked. Habits require ex- 
amining into, when lost appetite complained of. Fluoride of Sodium or Potassium will 
produce almost total anorexia, and may be employed with advantage in bulimia (Da C). 
[Compare Dyspepsia.] 

fy. Gentians, Quassiae, | 1$. Anthemidis, 

Cinnamomi, aa 3ij- Quassiae, aa 3j- 

Sig. — Put into a pint of boiling water, and ! Sig. — Put in a pint of boiling water, and 

when cold strain; take a winegl. thrice daily j when cold strain; take a winegl. thrice daily 
as an appetizer. before meals as an appetizer. 



Arthritis Deformans. 

Arsenic for the pain, anemia, rapid pulse, and mal-nutrition (Kolipinski); when 
referable to nervous affections (B); in large doses continued is sometimes of great 
benefit, but its action is capricious (R); is beneficial in small doses (Da C). Sodium 
Arsenite gr. § and Sodium Chloride gr. jss in oj of boiled water, hypodermically in 
the gluteal region every third day for a year in severe forms of the disease (Kolipinski). 
Antipyrine gr. v for the pain in acute attacks,' is often effective (McCrae). Iodides, 
often signally benefit, especially when due to syphilitic, mercurial, or mineral poisoning 
(B); large doses of Potassium Iodide sometimes required (R); combined with Guaiac, 
or Corrosive Sublimate, often curative in cases resisting these remedies given separately 
(Wa); Potassium Iodide should always be fairly tried (Da C). Ferrum Iodide holds 
the chief place in the treatment (Perry). Guaiacol Carbonate and Potassium Iodide 
are the most valuable drugs (Luff). Formic Acid, gtt. v. of a 2 per cent, solution, 
preceded by gtt. viij of a 1 per cent, solution of cocaine, hypodermically into the most 
painful locations, proves remarkably efficient (Couch). Aurum, the Bromide of 
Gold and Arsenic has proved curative (Wood). Remedies for articular rheumatism 
and gout are injurious in this disease. Ichthyol locally with friction, is of great benefit 
(Kolbl). Cod-liver Oil locally and internally, is of much value (R). Electricity 
by alternating currents from the induction coil, is a valuable treatment (Jones). Exer- 
cise though painful is beneficial, rest in bed aggravates the disease; self -massage of 
the joints (McCras). Massage is of great value in any form (Perry); may be used 
to ameliorate the condition in chronic and incurable cases (Da C). Dry Heat by 
hot-air baking at 350° F. for 20 to 30 minutes only, longer exposure in many cases 
injurious (McCrse). Diet should be full, with meat, the patient should take as much 
nourishment as possible (Id); desserts, fruit, and alcohol injurious. Baths, Turkish 
or sulphur; the cold douche, slightly warmed in winter, used for one or two minutes, 
then rub dry (R). Counter-irritation by the actual cautery or flying blisters to the 
affected joints, passive movements thereof, sulphurous baths, also Potassium Iodide 
intemallv in doses of to to 20 crains in the ia hours (Letulie"). 



internally in doses of 10 to 30 grains in the 24 hours (Letulie). 






Ascites. 

Digitalis, when ascites is part of a general dropsy due to cardiac or renal disease! 
is of the greatest service, except where aortic regurgitation and cardiac hypertrophy 
(P); a fresh infusion the best preparation (R); its action increased by combination 
with Squill and Mercury (Br). [See formula below.] Jalap, the most generally 
approved hydragogue purgative is compound powder of Jalap with Podophyllum (B); 
with Potassium Bitartrate, combined in form of electuary, may be persevered with daily 
though apt in some cases to cause gastric derangement (Saundby). Stillingia, in 
ascites due to hepatic changes (B). Elaterium, as hydragogue cathartic, gr. J, with 
a grain of Ext. Hyoscyami, and a drop of some aromatic oil, is the most efficient of its 
class in ascites but its action is very exhausting (W) ; cautiously in debilitated subjects, 
and is contraindicated where gastro-intestinal irritation or inflammation present (B). 
Arsenic, when ascites is due to feeble heart, and in that of old age (B); did excellent 



ASPHYXIA \\n \i'\! \. 



S8S 



service after tapping in a woman aged 82, from whom the writer removed 6j gallons 
of ascitic fluid at one tapping, when almost moribund, with the result lived 

ten years longer (Potter). Theocine, gr. iv thrice daily as a diuretic, to reduce effusion 
(Meinertz). Diuretin is often of marked benefit, especially in cases of cai 
renal origin. [See under Dropsy.] Aurum, has an ancient reputation; is efficient in 
cites due to chronic hepatic disease (Goetzner), or induration of the abdominal ore 
(Schroff). Diuretics, are of little use when the accumulation is excessive, the venous 
pressure seems to be too great for them to act (Saundby). Copaiba is an excellent 
remedy in hepatic dropsy (Br); the resin in doses of 10 to 15 grains often serviceable 
in cases of moderate effusion (Saundby). Milk-diet in an ancient remedy for asci 
and often successful, causing profuse alvine and urinary discharges (B); is sometimes 
very serviceable when the renal action is inadequate (Br). Surgical, paracentesis 
abdominis should be done in all cases where excessive effusion; laparotomy and wash- 
ing out of the peritoneal cavity, in cases of tubercular peritonitis with effusion, which 
has recently been treated successfully thereby (Saundby). [Compare Dropsy.] 



1$. Potassii Bitart., gss. 

Mellis, 3 j • 

Sig. — A teasp. every 2 hours until bowels 
are freely moved. 



1. Copaibae, 3iij- 

Alcoholis, 5 v. 

Spt. Chloroformi, 5j- 

Mucil. Acacias, 5ij. 

Aquae, q.s.ad 5*ij- 

M. Sig. — A tablesp. thrice daily. 



I}. Potassii Bitart. gss. 

Jalapaj (pulv.) ojss. 

Mellis Sj. 

Sig. — A teasp. every 2 hours until bowels 
are freely moved. 



E;. Hydrarg. Chlor. Mitis, 
Digitalis, (pulv.) 

Scillas (pulv.) aa gr vj. 

Fiat massa et div. in pil. vj. 
Sig. — One pill thrice daily, in ascites from 
hepatic changes. 



Asphyxia and Apnea. 

Of the New-Born. — Clean the mucus out of nostrils and throat; catheterize the 
trachea, and suck up the mucus. Marshall Hall's method, — by placing child on ab- 
domen, then bringing into lateral posture, repeating slowly and deliberately. Schultze's 
method, — by placing the thumbs upon the anterior surface of thorax, the indices in the 
axillae, and the other fingers along the back, the face of the child being from you; rotate 
the child, by swinging upward, so that the inferior extremities turn over toward you. 
In a moment re-rotate to the original position. Do not support head or legs in the 
forward rotation; their bending upon or toward the abdomen gives a forced expiration. 

From Foreign Bodies in Air Passages. — If the foreign bodies are round and 
smooth, invert the patient head downwards and strike upon the back. The bristle-pro- 
bang is a good instrument for the removal of fish bones, coins, etc., from the gullet; or a 
pair of curved forceps will often render good service. The writer removed a gold plate with 
three teeth attached, from the esophagus of an insane woman, by passing down a curved 
piece of stout wire, having the end bent upon itself to form a hook. After the hook 
was passed to one side of and below the obstruction, the wire was half rotated, so as to 
engage the plate, which came up on the second trial of the improvised instrument. 
Tracheotomy or Laryngotomy may be necessary, as a final resort. 

From Drowning. — Remove the person from the water as rapidly and gently as 
possible, turn the face downward for a moment and depress the tongue, in order that 
water, mucus, etc., may be removed from immediately over the entrance of the wind- 
pipe. Give the patient plenty of fresh air, fully exposing neck and chest to the breeze, 
unless that be inclement. Turn gendy on the face, one forearm being under the fore- 
head, and raise the body up that the water may have free discharge from the mouth. 
Place the patient upon die side and apply stimulants (Ammonia, etc.) near to the nos- 
trils; or the cold douche to the face and chest in order to excite respiration. 

The above measures being ineffectual, convey the body to the nearest convenient 



586 ASPHYXIA AND APNEA. 

spot, strip it carefully and dry it, and place it on a warm bed, with head and shoulders 
slightly raised, and at once employ one of the following methods: — 

Silvester's Method. — Pull the tongue forward, to prevent obstruction to entrance 
of air into the windpipe; produce expansion of the chest by drawing the arms from 
the sides of the body and upward until they almost meet over the head. Then bring 
the arms down to the sides again, causing the elbows almost to meet over the pit of 
the stomach, thus producing contraction of the chest. This imitation of the act of 
respiration should be continued at the rate of fifteen or sixteen times a minute, as in 
health. 

Marshall Hall's Method. — The person should be placed flat on the face, gentle 
intermittent pressure being made with the hands on the back, the body turned on the 
side, or a little beyond, then on the face, and the same pressure, etc., continued as at 
first. The whole body must be worked simultaneously. The same number and fre- 
quency of these artificial processes of respiration should be employed as in the other 
method. 

The Michigan Method. — Lay the body face down, the head upon the arm, and 
stand astride it; grasp it then about the shoulders and armpits, and raise the chest as 
high as you can without lifting the head quite off the arm, and hold it about three 
seconds; then replace the body upon the ground, and press the lower limbs downward 
and upward, with slowly -increasing force, for ten seconds; then suddenly let go, to 
perform the lifting process again. 

Whichever process be employed, the effort to restore the temperature of the body 
•must be maintained, the body being well rubbed in an upward direction with the hands, 
with warm flannels; bottles of hot water, hot bricks, etc., being applied to the stomach, 
the axillae, and the soles of the feet, stimulants and beef tea being judiciously adminis- 
tered when restoration is about taking place. The attempts at resuscitation must be 
persevered in for several hours, if necessary. In artificial inflation, always press the 
larynx and trachea against the vertebral column, so as to close the esophagus and thus 
prevent the air entering the stomach, Laryngotomy or Tracheotomy, with or without 
catheterization, or forced insufflations of air or oxygen, have proved successful, as also 
has electro-puncture (Garratt). 

After Long Submersion is Recovery Possible ? — According to Harley, dogs kept 
under the water i£ minutes always died, if water had entered the lungs. If it had 
not, the trachea being plugged, they survived a submersion of 4 minutes. When per- 
sons rise after sinking they usually get some air, and less speedily come into a state from 
which recovery is impossible. The greatest period between the last inspiration and 
the stoppage of the heart is 4 minutes. Some think that no recovery has been made 
after complete cessation of the heart's action. We infer that after complete submer- 
sion for 5 minutes recovery is improbable, unless the person had been previously choked 
or in a fainting state, so that no water entered the lungs. But in Anderson's case, the 
patient had been under water at least 15 minutes, and in Garratt's the time was vari- 
ously estimated at from 15 to 60 minutes. 

When is a Case Hopeless ? — If the eyes are open, the pupils dilated, the conjunc- 
tiva insensible, the countenance placid, the skin cold, frothy mucus round the nostrils 
and mouth, no attempt at respiration, and the heart's action is inaudible when the ear is 
applied to the chest, the case is hopeless (Harley). 

Signs of Death. — The following have been suggested as methods of deciding 
whether death has occurred: Tie a string firmly about the finger; if the end of the 
finger becomes swollen and red, life is not extinct. Insert a bright steel needle into the 
flesh; if it tarnishes by oxidation in the course of half an hour, life may be considered 
not extinct. Inject a few drops of Liquor Ammonia; under the skin; during life a 
deep red or purple spot is formed. Moisten the eye with Atropine; during life the pupil 
will dilate. Look at a bright light or at the sun, through the fingers held closely side 
by side; during life the color is pink; after death a dead white. After death a dark 
spot is said to form gradually on the outer side of the white of the eye, from drying of 



1THEN0PIA ASTHMA. 

the sclerotic, so that the dark choroid shows through. Putrefaction ia an absolute sign 
of death; better dela) for it than run any risk of burying alive. 



Asthenopia. 

The proper glasses; cold douche; rest of eyes. Atropine, systematically instilled, 

to prevent strain, and control spasm of the accommodation (C); cautiously in persons 

over 35 or 40 years old. Strychnine, is especially valuable in preventing the develop- 

1 of asthenopia during the strain of student-life before examinations (Musser). 

[Compare Avwrosis, Eye Diseases, Myopia.] 



Asthma. 
Potassium Iodide, when from acute bronchial catarrh, gr. xv-xx each 2, 3, or 4 
hours (R); the best medicament to suppress the asthmatic attack, in bronchial asthma, 
is Potassium Iodide and Chloral (Lazarus); is the specific in asthma, if any drug can 
be so called; should be given with Lactucarium (See). Iodipin has cured bronchial 
asthma (Frese). Belladonna, relieves paroxysm when expectoration abundant, skin 
cool and moist (B); internally in large doses, also in cigarettes (Br). Atropine, is more 
efficient, gr. ,•',, hypodermically at bedtime to abort morning paroxysm (B); large doses 
required, but very satisfactory (R); very much valued by Salter and Se"e (P). Du- 
boisine, may be used instead of Atropine. Stramonium, twenty grains of the dried 
leaves or ten of the powdered root may be smoked; Datura is sometimes better; Stra- 
monium preparations are often of bad quality, asthmatics advised to grow the drug 
themselves (R). Hyoscine, the Hydrobromate, gr. -j^, with Morphine Sulphate gr. 
H and Strychnine Sulphate gr. chi'io, the best combination for the paroxysm (S. 
Solis-Cohen). Morphine hypodermically quickly aborts the paroxysm (B); in some 
cases will induce a paroxysm (R). Apomorphine, gr. T V hypodermically has proved 
effective; or gr. T \- in camphor-water every 3 or 4 hours, with or without Morphine 
or Ipecac. Heroin, gr. y 5 hypodermically, a prompt and efficient respiratory anti- 
spasmodic (May); a valuable remedy with Potassium Iodide (Hyams). Oxy-camphor, 
the solution Oxyphor is a prompt palliative in doses of 5ss. Adrenalin Chloride, in 
1 to 1,000 solution, by spray into the fauces with full inspiration, is very effective in the 
paroxysm (Savage); Adrenal extract is useful in bronchial asthma (Solis-Cohen). 
Cocaine, hypodermically, is used with the best results, even where other remedies 
failed to relieve (Mosler); the leaves of the coca-plant make the best cigarettes for 
asthma (Nachtigal). Chloroform, inhaled from warm water; anesthetics relieve, 
but increasing doses required, leading to habit (R). Ether, in full dose, may avert 
mild attack (B). Amyl Nitrite, inhaled, quickly checks spasmodic asthma (R). 
Tetranitrin gr. ss, to reduce the high arterial tension (Huchard). Chloral, is highly 
efficient in spasmodic asthma; may arrest a paroxysm (R). Paraldehyde, irijxlv-5j, 
used in 30 cases of asthma with rapid and complete relief in most and lessening of dis- 
tress in the others (Hearder). Nux Vomica, in nervous subjects (B); often of great 
benefit in spasmodic asthma (P); the tincture in drop doses every five minutes has 
rendered extraordinary results in both cardiac and bronchial asthma, and in asthma 
of peripheral reflex origin, as from phimosis (Macfarlan). Antipyrine, is successfully 
employed in bronchial asthma. Aconite, in spasmodic (P); often averts the attack, 
if given at commencement; useful also in the asthma following coryza and sneezing 
in children (R). Ipecacuanha, the wine as spray to the fauces, sometimes useful in 
severe bronchial asthma, but not of much service in genuine asthma (R); nauseant and 
emetic doses in the spasmodic form (B). Lobelia, gtt. x of the tincture every J hour 
during paroxysm; tijx ter die, with additional doses at night, in bronchitic asthma 
when worse at night; cautiously if heart disease (R); often gives permanent relief (B). 
Pilocarpine Hydrochloride, gr. £ in water, at bedtime, promptly and effectively 
relieves, in cases of bronchitic asthma with hypertrophic rhinitis; in some of nine 
years' standing it apparently gave permanent relief (Wyss). Grindelia, gives relief 



5 88 



ASTHMA. 



in spasmodic form (B); three grains of extract thrice daily, to prevent attacks, or 
njjxx-xxx of fluidextract every half-hour or hourly from the onset of paroxysm (R). 
Arsenic, as cigarettes, as well as by internal administration (B); ttjjj of liquor arseni- 
calis ter die, in attacks from bronchitis, local irritation, etc., allied to hay fever (R). 
Ethyl Iodide, very valuable in spasmodic form, and lessens liability to subsequent 
attacks; ttjjv-xx thrice daily by inhalation (B). Cannabis Indica, has been useful 
(R). Sulphurous Acid, by inhalation, spray, or fumigation (R). Mustard, as a 
counterirritant over the vagus, from beneath the right ear to the right sterno-clavicular 
articulation (Waugh). 

Euphorbia Pilulifera, 3ss-j of the fluidextract thrice daily, used with excellent 
results in asthma and asthmatic bronchitis (Dujardin-Beaumetz). Bromides, relieve 
but soon lose effect (R). Eucalyptus, smoked with Stramonium, Belladonna, Tobacco 
(B). Quinine, after acute symptoms subside, as antipyretic to succeeding fever and 
restorative tonic (B). Potassium Nitrate, the inhalation of fumes of burnt nitre 
paper will sometimes avert a paroxysm; different methods of preparation useful for 
different cases (R). Silver Nitrate, sometimes injected into trachea (R). Chamo- 
mile Oil, has been found very serviceable (P). Sanguinaria, is very useful in humid 
asthma, and occasionally so in the spasmodic form (R). Antimony, in an affection of 
children like asthma, dissolve a grain of Tartar Emetic in half a pint of water, and give 
a teaspoonful of this every \ hour for the first hour, then hourly; if vomiting induced, 
lessen the dose (R). Coffee, a small cup of very strong coffee often useful in a parox- 
ysm (R); asthmatics should not use it as a beverage (P). Tobacco, smoking, some- 
times relieves (R). Pyridine, the fumes are highly efficient (See). Asafoetida, has 
been recommended (R); palliative only (P). Colchicum, in gouty subjects (R). 
Oxygen inhalations are serviceable, but should not be used if heart disease is present 
(R). Carbonic Acid, in 5 to 10 per cent, solution, by inhalation, is well borne and 
renders good service (P). Carburetted Hydrogen, the inhalation of ordinary illu- 
minating gas for 3 minutes never failed to abort a paroxysm in a lady who had sought 
professional assistance in vain (White). Galvanism, of pneumogastric often relieves, 
+ pole beneath mastoid process, — pole to epigastrium; Faradism of no use (B). Proph- 
ylaxis, avoidance of exciting causes, especially indigestible food, wet, damp, and 
sudden changes of temperature. Attention to the stomach will do most for many 
asthmatic patients. An important point is to take the heaviest meal early in the day, 
and very little solid food after 2 p. M. Shower-bath and out-of-door exercise, not how- 
ever to a fatiguing extent (R). In special cases of reflex origin from exposed nerve- 
filaments, operative treatment of the nose and naso-pharynx, by galvanic cautery or 
otherwise is required (Lazarus). [Compare Dyspnea.] 



I). Ammonii Bromidi, gr. clx. 

Ammonii Chloridi, gr. xc. 

Tinct. Lobelia, 3iij- 

Spt. iEtheris Comp 5j- 

Syrupi Acaciae, q. s. ad 5iv. 

M. Sig. — A dessertspoonful in water, 
every hour or two, for the paroxysm. 

{Pepper.) 



3- 



M. 



Fluidextr. Grindeliae, §ss. 

Fluidextr. Lobeliae, 3ij- 

Fluidextr. Belladonnas, 3j- 

Potassii Iodidi, 3uj. 

Glycerini, giij. 

Sig. — A dessertspoonful as required. 



1^. Ext. Stramonii, gr. ij. 

Potassii Iodidi, 3 jss. 

Ammonii Carbonatis, 3 j- 

Tinct. Lobeliae, 3 jss. 

Aquae Chloroformi,.q. s. ad Sviij. 
Ft. mistura. Sig. — A tablespoonful every 
four to six hours. 



Arsenical Cigarettes. 

]$. Sodii Arsenatis, 3ss-j. 

Aquas Destillatae, 5 j- 

Moisten unsized white paper, and roll into 
cigarettes, each containing gr. J to gr. j of the 
salt. Two or three of these to be inhaled 
daily. (Bartholow.) 

R<. Belladonnse Fob, 3j- 

Stramonii Fol., 

Hyoscyami, aa 3ss. 

Extracti Opii, gr. iij. 

Aquae Laurocerasi, q. s. 

Dissolve the opium in the water, and 
moisten the leaves therewith. When dry, 
roll into twelve cigarettes. Smoke two to 
four daily. (Trousseau.) 



I}. Spt. ^Etheris Compos., 
Liq. Morph. Sulph., 

(gr.jad 5j), aa 5j- 

M. Sig. — A teaspoonful every half-hour 
or hour during the paroxysm. 



vsnr.M \ i ism hi n SORES. 589 



Astigmatism. 
Atropine, a weak solution to aid examination of the eye by dilating pupil and par 
alyzing accommodation (B). Duboisine, as substitute for atropine, has move rapid 
action, with shorter duration of effects and less conjunctival irritation. Glasses, of 
suitable form, cylindrical in simple astigmatism, bi-cylindrical in mixed astigmatism. 
Pray's Test Letters, to determine degree and direction of the defect (O. [Compare 
Eye Diseases, Myopia.] 

Atheroma. 

Phosphorus, in minute doses, with cod-liver oil (B). Arsenic, often of great 
value in atheroma, especially where imperfect action of kidneys (Br); indicated when 
there are puffy eyes, drowsiness, intellectual torpor (B). Lemon-juice, daily used, 
is said to retard atheromatous degeneration of the vessels. Aurum and Arsenic 
Bromide is very efficient in atheroma and calcareous degeneration of the arteries 
(Barclay). Quinine, gr. iij-x daily, in atheroma, is used with advantage (B). Am- 
monium Bromide, to promote absorption of deposit (Wa). Digitalis, may be useful 
in general capillary atheroma if employed cautiously (W). Tetranitrin, in dose of gr. ss, 
to reduce high arterial tension in arterio-sclerosis (Huchard). Hydrastinine is an 
excellent agent in acute and chronic aortitis and arterio-sclerosis, by reason of its mild 
and enduring action on the vessels (Boix). Cod-liver Oil, with Phosphates, Hypo- 
phosphites, or Calcium Lactophosphate, in combination (B). [Compare Aneurism.] 

Atrophy. 

Cod-liver Oil, has proved beneficial (Wa). Olive Oil, by inunction, every 12, 6, 
or 4 hours, successfully employed (Wa). Arsenic, has had remarkable success in 
muscular atrophy (Tr). Electricity, in progressive muscular atrophy, the induced 
current very strong at first, then weaker as improvement; interrupted currents from 
vertebral column and plexuses to nerves of affected muscles; in more extended forms, 
the constant current to the nerves, the induced to the muscles (Ros). Massage, 
removes the waste products and restores the muscular power (Br). [Compare Emacia- 
tion - , Locomotor Ataxia.] 

Balanitis. 

Mercury, Hydr. Chlor. Corr. gr. j to 5jss Aquae Calcis, as lotion, if not much in- 
flammation (Br). Oil, on linen, to inflamed part beneath foreskin, which must be again 
drawn forward; strict cleanliness. Astringent Lotions, of Alum or Zinc Sulphate, 
with warm water injections (Br). Lime-water, the best lotion if much inflammation 
(D). Tannin, in alcohol, equal parts, as dressing after washing with a weak solution 
of common salt. Phenol, a 5 per cent, solution, on cotton rag after washing, thrice 
daily, is generally sufficient. [Compare Phimosis, Gonorrhea.] 

Bed-sores. 
Alcohol, Brandy, or Eau-de-Cologne, to harden skin of parts exposed to pressure 
(R); as wash to parts threatened (B). Glycerin, or glycerin cream, rubbed over the 
parts exposed to pressure, after washing, morning and evening, is one of the best pre- 
ventives (R). Alum, oss, whites of four eggs, Tinct. Camphors; oij, an excellent 
application (B). Thymol Iodide dusted over the part, an excellent application. Zinc 
Stearate with Tannic Acid, is very efficient. Zinol, in 3 per 1,000 aqueous solution, 
an excellent application (Giinther). Charcoal sprinkled over the black slough, which 
then should be covered with a poultice (R). Galvanic Couplet, of zinc and silver, 
connected by a copper wire; one element on sore, the other on the adjacent part (B). 
Silver Nitrate, a solution (gr. xx ad 3j) to be painted on the threatened but unbroken 



59° BERIBERI — BILIOUSNESS. 

skin, as soon as it becomes red, will prevent sores; if Nitrous Ether solution be used, 
gr. v to the 5 is enough (R). Iodoform, dusted over sores (R). Linen, air-dried 
better than that which is ironed or mangled, by reason of its greater softness. 

Beriberi. 

Methylene Blue, caused rapid amelioration of all the symptoms in eleven cases 
(Thur). Digitalis or Strophanthus, small doses seem to do good in the cardiac cases 
(Mn). Nitroglycerin, full doses, trjiij-v of the one per cent, solution every i or J hour, 
when signs of acute cardiac distress appear (Simon). Amyl Nitrite, by inhalation in 
sudden cardiac attacks, pending the action of nitroglycerin (Mn). Bleeding from the 
arm or external jugular, 8 or 10 ounces, if signs of cardiac distress or failure persist and 
increase, in spite of the above-mentioned drugs (Id). Oxygen inhalations, are worth 
trying in cardiac cases. Magnesium or Sodium Sulphate, in small and repeated doses 
from the outset, to counteract constipation and drain the tissues of fluid (Mn). Potas- 
sium Bromide and Aconite, with anodyne liniments, for cramps and excessive muscu- 
lar hyperesthesia (Id). Strychnine, Arsenic and Silver Nitrate, as tonics for the 
nervous and muscular complications. Medication should be purely symptomatic, no 
drug known has any specific influence on the disease (Mn) ; the symptoms are treated as 
in other forms of neuritis (Ty). Faradization and Massage, are of great service for 
the muscular atrophy and cutaneous anesthesia; but should not be employed until the 
muscular hyperesthesia has subsided (Mn). Diet, should be nutritious but not bulky, 
animal food in reasonable amount, milk, eggs, wheaten flour, oatmeal, beans, are all 
indicated. Rice is a bad food for beriberics, being too bulky (Mn); withdraw suspected 
food or drinking water (Ty). Rest in bed for the worst cases, especially those showing 
cardiac complications; the milder cases should be up and out in the open air. Removal 
from the infected house or district (Ty), is essential to recovery; a dry locality best, 
the room sunny, thoroughly ventilated and in an upper story (Mn). A sea -voyage 
has often a marvelously restorative effect (Id). Watercress is reported to have been 
found curative in New Caledonia (Id). 



Biliousness. 

Podophyllum acts as a cathartic (B); corrects deficient secretion of bile, especially 
in children and infants; gr. -£$ to xjj, every six hours, to correct white or clayey stools; 
also in general hepatic derangement (P). Aconite, in occasional doses, improves the 
effect of Podophyllum (R). Mercurial Cathartics, act only as purgatives; Calomel 
gr. j-x, or Pil. Hydrarg. gr. v-x; Mercury as purgative restricted to cases where there 
is excess or deficiency of bile (B); frequent small doses of gray powder for deficiency 
(R); Calomel, gr. iij, followed by 3ij each of Rochelle and Epsom Salts, when the 
tongue is heavily coated and furred (Gross). Mercury, Yellow Oxide, in doses of 
gr. /o to Ju, in trituration with sugar of milk, exceedingly efficient in many disordered 
conditions of the alimentary canal and its appendages (Schaffer). Bryonia, is worthy 
of commendation in the ordinary bilious headache with vomiting, and in the general 
hepatic derangement known as sluggish liver (P). Hydrastis, gtt. v-xv of fluidex- 
tract daily before meals, for biliousness with chronic gastric catarrh and dyspepsia (B). 
Mineral Acids, before meals, Hydrochloric Acid and Pepsin after meals, in atonic 
dyspepsia (B). Stillingia, when deficient biliary secretion (B); may be used in place 
of Mercury (Br). Ammonium Iodide, gr. j-iij in water each 2, 3 or 4 hours, for 
catarrh of duodenum and biliary ducts (B). Ammonium Chloride, is much em- 
ployed in Germany for hepatic derangements, and with success. Apocynum Andro- 
saemifolium is an ideal cholagogue, and is almost specific in the so-called bilious con- 
dition (Chalmers). Euonymus, is considered a very efficient remedy by many practi- 
tioners in cases of hepatic dyspepsia, or "bilious attacks," so called. Manganese, for 
gouty subjects. Rhubarb, as a cholagogue. Aloes, in biliousness with constipation. 
Angostura, is suitable in the worst forms of bilious fevers (P). Calumba, is of benefit 
in many forms (P). Alkalies, and their laxative salts, in the bilious state, with uric 



Bl \niM K, [RR] r \ l : 1 E 1:1 EPH IRITIS. 



SOI 



acid diathesis (B). Milk-cure, in obstinate cases; buttermilk or skimmed milk often 
agrees best (B). [Compare Dyspepsia, Hepatic Congestion, Duodenal Catarrh.] 



II. Fluidextr. Stillingiae 5v. 

Tinct. Aloes, 5'j- 

Tinct. Nucis Vom 3j- 

M. Sig. — Twenty drops in water thrice 

dairy. (B.) 

H. Ext. Euonymi 3ss. 

Ext. Hyoscyami gr. xv. 

Ext. Gentianse, gr. vj. 

Fiat massa et div. in pil. xij. Sig. — One 
pill every other day. 



l^. Hydrarg. Oxidi Flavi, K'j- 

Sacch. Lactis, q. a. 

Triturat. et <liv. in chart, xlviij. 

Sig. — One powder dry on the tongue twice 
daily. 

1$. Massae Hydrargyri, 

Ext. Colocynthidis Co.,..aa gr. iij. 

M. et div. in pil. ij. 

Sig. — Take at once, and follow it in a few 
hours with a saline cathartic. 



Bladder, Irritable. 

Belladonna, in nocturnal incontinence, due to relaxation of sphincter, or irritable 
mucous membrane (B); gtt. v-xx of tincture every 3 or 4 hours give gradual but sure 
relief (P). Cantharis, in women, without acute inflammation (B); incontinence on 
coughing (R). Benzoic Acid, when from enlarged prostate, removes fetor of urine; 
also renders phosphatic or alkaline urine acid (P). Ammonium Benzoate, may 
be used instead of Benzoic Acid (Br). Gelsemium, the best remedy for irritable 
bladder of women of hysterical type, with constant desire to urinate (B). Cubeb, is 
often successful in women, but Cantharis generally better (B); is of especial value when 
vesical catarrh present (P). Cannabis Indica, in spasm of the bladder and in irritable 
conditions of that organ, is generally useful. Eucalyptol, is often very efficient, but 
frequently fails, irjjij on sugar two or three times a day. Carbonic Acid, by injection 
through a catheter, after washing out the bladder, may be employed in almost all forms 
of irritability of the bladder, unless acute inflammation be present (P). Antipyrine, 
20 grains in solution, by rectal or vesical injection, powerfully lessens irritability of the 
bladder (Chastelet). Ichthargan, in 1 to 2,000 solution by irrigation, relieved the 
irritability in tuberculosis of the bladder (Lohnstein). Aquapuncture has been em- 
ployed with considerable success (B). [Compare Cystitis, Dysuria, Enuresis, 
Lithiasis, Calculi, Urinary Disorders.] 

R;. Tinct. Gelsemii, °3ss. 

Sodii Bromidi 3 iij - Sig. — A teaspoonful in water every four 

Fluidextr. Tritici, §iss hours, for irritable bladder. 



Bladder, Paralysis of. 

Cannabis Indica, in retention from spinal disease (R). Ergot, in paralytic dysuria, 
especially when sensation of bladder being only partially emptied (P) ; when incontinence 
from paralytic sphincter, and in paralysis from over-distention (Wa). Arnica, has 
proved curative (P). Strychnine, gr. ff V to J 6 , is useful (B). Cantharis, often given 
with excellent effect, when bladder atonic (Wa). Galvanism, may greatly benefit (B); 
electro-magnetic current from the bladder to the spine, of great use (Wa). 



Blepharitis. 
Pulsatilla, internally and externally (P). Mercury, after detaching crusts, rub in 
brown citrine ointment (B); should be diluted with vaselin or simple ointment (Br). 
Tannin, powdered, or tannic acid solution, gr. j-x to the 5 (B). Alum, after acute 
symptoms subside (B); a solution, gr. viij to oj aquae, every i or i hour, an excellent 
application (R). Hydrastis, as lotion, very serviceable (P). Bismuth, equal parts 
of the Subnitrate and Glycerin, to the inflamed surface, in ciliary and glandular bleph • 
aritis (Wa). Ergot, the fluidextract locally, gives excellent results (B). Ichthyol, 
useful in the obstinate strumous form (Darier). Argyrol, a 25 per cent, solution, or 



592 



BOILS. 



weaker if used by the patient, is painless and very effective (Id). Cuprol, a 10 per 
cent, solution painted over the lids, reduces the inflammation rapidly and relieves the 
pain and itching (Burnet). 



B;. Aluminis, gr. x. 

Aquae Rosae, 5 ij • 

M. Sig. — Lotion for the eyelids. (B.) 



B- Unguent. Hydrarg. Nitrat.,. 3j- 

Petrolati, 3iij- 

Sig. — Ointment for margins of lids. 



Boils. 

Hydrated Chloral, is probably the best local application; the boil should be kept 
covered with a tampon of cotton soaked in a solution of Hydrated Chloral 3ijss in Glyc- 
erin and Water, aa 3v (Spehn). Salicylic Acid, locally, to destroy'the staphylococcus 
pyogenes [see formula below]; a 2 per cent, solution in alcohol, washed over small boils, 
or in plaster of 50 per cent, strength, changed 4 or 5 times daily, to hasten the necrotic 
process in a well-formed boil; a 2\ per cent, ointment in vaselin rubbed over daily 
after bathing the part with warm water, in general furunculosis (Philipson). Calcium 
Chloride, in solution, externally as a fomentation, will hasten maturation; or Lime- 
water on compress covered with oiled silk, promotes suppuration more quickly than 
ordinary poultices (P). Sulphides, in small doses, gr. ^ to \ of Cabt Sulphurata 
every hour or two, or Sulphurous Mineral Waters, will abort or mature, and aid to 
expel pus (R); of no use in the boils of diabetes (R). Ichthyol, as a thick ointment, 
is an excellent application (Hodara) ; a 25 per cent, solution applied every 2 to 4 hours, 
reduces the size of the base, and if commenced early will often abort the boil (McLean). 
Sodium Bicarbonate in solution on compresses, relieves the pain in furunculosis 
(Br). Glycerin, as the official Cataplasm of Kaolin, is an excellent application. 
Belladonna, as plaster, to subdue inflammation, or lint wetted with Atropine, gr. iv, 
Rose-water, 5j (B); with Glycerin locally, to allay pain; internally often successful 
(R, Wa). Aromatic Sulphuric Acid, for the tendency, gtt. x-xv, in plenty of water 
thrice daily. Silver Nitrate, gr. v-xx to Bj of Nitrous Ether, painted over adjacent 
part, to abort; specific if used early (R). Boric Acid, gr. xij daily, in 2 wafers; also 
a 4 per cent, aqueous solution warm, externally by gentle friction, 4 or 5 times a day, 
and on compresses to the parts — will abort furuncles yet in the commencement of 
development, rapidly cure those matured, and prevent new ones (Alison). Arsenic, 
long-continued for succession of boils (B); to lessen tendency to recurrence (Br). 
Opium, a thick extract locally (R). Alcohol, pure, or containing 5 per cent, of tinc- 
ture of Benzoin, applied thrice daily to arrest minute boils (Philipson); Camphorated 
Alcohol, smeared over boils in early stage, then when the skin is dry smear with cam- 
phorated oil, to abort them (R). Sodium Phosphate, the best remedy for the 
systemic condition which produces boils (R). Phenol, undiluted, on a thread 
passed through center of boil while recent, will- abort it; a phenol solution (5 per 
cent.) on dressings after opening a boil, will prevent a second crop, due as is often the 
case to migration of cocci into the skin from the original boil. Counter-irritation, 
by blisters or Iodine around the boil (R). Collodion, at papular or pustular stage 
(R). Hydrarg. Biniodide, the ointment locally, with Calcium Sulphide, gr. j daily 
in divided doses internally, leaves little to be desired so far as treatment is concerned. 
Corrosive Sublimate, the B. P. solution, 1 in 875, dropped into the ear twice daily, in 
furunculosis of the ear, also on cotton wool in the canal, gives satisfactory results and 
prevents return; as lotion, 1 in 1000, to frequently cleanse the part, then powder with 
Boric Acid and Starch, and cover with a clean and dry antiseptic dressing (Mn). Io- 
dine, the tincture, locally to the initial papule, may often abort a threatening boil (Id). 
Aluminum Acetate, a solution in water, 1 to 4, causes the speedy abortion of boils in 
the external auditory canal (Grosch). Poultices to assist maturation and allay pain, 
may be smeared over with Belladonna or Opium (R); should never be used, except in 
exceptional cases, as they sodden the adjacent area and are prone to be followed by 
more boils therein (Mn). Mangos are frequently blamed for boils in tropical countries. 
[Compare Acne', Carbuncle.] 



BONE DISEASES BRIGHT'S DISEASE, v i 11 



\\U is Sulphurat., u;r. iij 

I actis q. s. 

Triturat. et «.li\- . in chartas xxx. 
Si>4 One powder every j hours. 



593 



.Willi Salicylic] ."iij. 

Emplast. Saponis .". 

Emplast. Plumbi., ?> ]. 

'i in in, in foi boils. (/ Iritziiittnn.) 



Bone Diseases. 

Iodine, in scrofulous affections of bones, should be used locally, with Ferrous 

[odide or Cod-liver Oil internally, nutritious diet, wine, out-door exercise (W'a). Cod- 
liver Oil, in scrofulous affections, may be relied on if perseveringly used and accom- 
panied by good hygienic conditions (Wa). [Compare Castes, Exostosis, Nodes, 
Periostitis, Rachitis, Spina Bifida, etc. ] 



Breath, Fetid. 

Potassium Permang., gr. j to 3j aquas rosae, as a wash for the mouth (B). Chlo- 
rine, as solution of chlorinated lime to remove fetor (B). Phenol, a dilute 
solution, as wash for the mouth (W). Camphor, is used as a corrective (R). Thymol, 
in solution, as a mouth-wash is very efficient in removing the odor of tobacco from the 
breath. Look for bad teeth, disordered digestion, and in very offensive cases for gan- 
grenous lungs; cleanliness of teeth is essential. 



U. Calcis Chlorat., 3 iij - 

Aqua; Destillatae, 

Alcoholis, aa o i j - 

Olei Rosas, njjiv. 

M. Sig. — A teaspoonful in a glassful of 

water as a lotion for the mouth. (B.) 



R. Acidi Salicylic!, 5j- 

Liq. Ammonii Acetatis, 5nj- 

Glycerini, 5 j. 

Aqua;, q. s. ad 5vj. 

M. Sig. — A tablespoonful every six hours. 
(Robinson.) 



Bright's Disease, Acute. 

Aconite, should be given immediately on the appearance of the nephritis in scarla- 
tina (R); as a diuretic, advocated (P). Strontium Lactate, is highly efficient and is 
much more useful in acute nephritis than in chronic (Da C). Pilocarpus, is much 
used (Da C); large doses very depressant to the heart, but njv-x of the fluid extract 
every half-hour or hour will produce sweating; may be combined with tincture of Digi- 
talis (Smith); or Pilocarpine Nitrate, to excite skin when symptoms urgent, gr. ,V to J 
for adult (B); the dose should be small at first; it is not a suitable drug for children 
(Y); I have latterly resumed its use, often with benefit (O). Turpentine, in drop or 
half-drop doses every 2 to 4 hours, controls the dropsy in a remarkable manner (P); 
hot turpentine epithems are serviceable but may increase the action of the kidneys (Wa). 
Picric Acid gr. J in oviij of water, of which oij every 3 hours, has proved remarkably 
efficient in bad cases (Couch). Belladonna, has often proved useful (P); may be used 
with benefit (Wa). Hyoscyamus, may be used instead of Belladonna (Wa); is useful 
in irritable kidneys (P). Cantharis, after subsidence of the acute stage, one-minim dose 
every three hours will stop the hematuria (R). Digitalis, infusion Bss, the best remedy 
in renal dropsy from acute desquamative nephritis (B) ; is diuretic only as long as dropsy 
lasts (R). Cannabis Indica, as diuretic; is especially useful when bloody urine (R). 
Eucalyptus, sometimes effective; cautiously, or it will aggravate symptoms (B). 
Jalap, the compound powder is the most generally useful purgative, used in the early 
morning to produce free watery evacuations when uremic symptoms supervene (B). 
Gallic Acid, checks albuminuria (B). [See Albuminuria, for formula.] Juniper, as 
diuretic; often aggravates (P). Diuretics, the stimulating ones, which act on the secre- 
ting cells of the kidneys, are contraindicated; but this is not the case with those which 
simply favor the flow of water through the kidneys, and of such diuretics Water is the 
best (Y). Alkaline Salts, as Potassium Citrate, Sodium Berizoate, or Sodium Bicarbon- 
ate, may be usefully added to the water (O). Diluents, as milk, and Potassium Bitar- 
trate in solution, should be used freely to relieve the congestion and remove obstructions 

39 



594 



bright's disease, chronic. 



from the tubules (B). Iron, after the acute symptoms have subsided, as a tonic, the 
most suitable preparation being Basham's mixture (the now official Liquor Ferri et 
Ammonii Acetatis) in 5ss doses thrice daily (Da C). Poultices, large, of linseed meal, 
made light and soft as possible, beneficial (Wa). Cupping, in lumbar region, amelio- 
rates acute desquamative nephritis, and congestion of the kidney (B); cupping or 
leeches over the loins, with opiates freely, diluents, and demulcents, with rest and 
antiphlogistic regimen, often suffice (Wa). Vapor-bath or Warm Pack, to increase 
the action of the skin. [Compare Albuminuria, Hematuria, Scarlet Fever, Uremia.] 



1$. Fluidextr. Pilocarpi, 3ss. 

Vini Ipecac, 5 jss. 

Mucil. Acacise, 3j- 

Aq. Cinnamomi, ad 5ij. 

M. Sig. — A teasp. every four hours until 

free diaphoresis. 



R<. Pulv. Jalapae Comp., 3iv. 

Div. in chartulas no. iv. 

Sig. — One in water before breakfast. 



1$. Potassii Acetatis, oijss. 

Infusi Digitalis, Siij- 

Infusi Juniperi, q. s. ad 5vj. 

M. Sig. — A tablesp. every 2 to 4 hours as 

a diuretic. 



B- Liq. Ferri et Ammonii 

Acetatis (U. S. P.), 3 viij. 

Sig. — A tablesp. thrice daily, as soon as 
hematuria disappears. 



Bright's Disease, Chronic. 

Lead, diminishes the albumin (R). Gallic Acid, to lessen albuminuria (A). 
Hydrastis lessens the excretion of albumin (B). Nitroglycerin, to dilate the peripheral 
vessels, relieves the heart, diminishes renal congestion and the excretion of albumin (B). 
Tetranitrin in dose of gr. ss, is very efficient to reduce the high arterial tension of 
interstitial nephritis (Huchard). Fuchsin, in doses of gr. vij-xv daily, used with 
considerable success in different stages of the disorder, and was well borne (Riess). 
Oleum Erigerontis, lessens albumin, lowers vascular tension, improves general con- 
dition, and favorably influences the headache, nausea, and other uremic symptoms (B). 
Cod-liver Oil, is very useful (R). Cannabis Indica, as diuretic when bloody urine 
(R). Turpentine, sometimes given in very small doses as a diuretic, and to check 
hematuria (R); half-drop or drop doses every 2 to 4 hours very successful in dropsy 
with albuminous urine depending on non-desquamative disease of the kidneys. Jabo- 
randi, is very satisfactory in uremia (B) ; large doses very depressant to the heart (Smith); 
ttjxx of the fluidextract ter in die if the urine decreases much (Da C). Iron, to im- 
prove digestion and correct anemia; the tincture of the Chloride or Tinct. Ferri Acetatis 
preferred (B); in chronic tubular nephritis with cardiac hypertrophy the Liq. Ferri 
et Ammonii Acetatis, 3ss ter in die, with an occasional vapor-bath (Da C). Chima- 
phila, has power over various forms of nephritic disease, especially when albuminuria 
present (P). Eucalyptus, in chronic desquamative nephritis, cautiously used, will 
improve (B). Elaterium, for the dropsy, as a derivative cathartic; must be cautiously 
used (R). Theocine, gr. iv thrice daily, powerfully diuretic in dropsy from renal 
disease (Meinertz). Potassium Bitartrate, to prevent dangerous accumulations 
in cellular tissue or important cavities, also to draw off effete matters; care must be 
used, as it is a brisk purgative and is weakening (R); in form of cream-of -tartar lemon- 
ade an agreeable diuretic (B). Jalap, the compound powder occasionally as derivative 
cathartic, to relieve the kidneys (Da C). Bromides are useful in the convulsions (I 
Potassium Iodide, has improved some cases, which were possibly due to syphilis (R). 
Aurum, the Chloride in pill gr. ^ to -^ ter in die, persistently, in chronic interstitial 
nephritis, to arrest hyperplasia of the connective tissue; may be combined with Arsenic, 
which has a similar influence (B). Mercuric Chloride, acts in the same manner, 
gr. yjj bis die (Da C). Milk-cure, has been very successful; skim-milk alone for 
some time, then gradual addition of other diet (B). Water, in large draughts as diuretic, 
when excretion of solids is deficient (Br); hot fomentations to lumbar region (B). 
Baths, warm and Turkish, when uremic symptoms and dropsy; discretion needful, 
as baths may weaken (R). Mineral Waters, especially the Buffalo Lithia Water, 
of Virginia, which has many advocates. Food should be nourishing; milk, eggs, and 



BRONCHIECTASIS — BRONCHITIS, ACUTE. COB 

rare beef are particularly suitable (Da C). Peanuts are an excellent article of food 

for subjects of kidney disease, by whom foods rich in animal albumin are to be avoided 
(Furbringer). Decapsulation of the kidneys, done in 51 cases, with 9 cures, .•.• im 
proved satisfactorily, 7 deaths (Edebohls); these results are nut corroborated, tin- 
mortality has been high, and when recovery from the operation has occurred the disease 
was not cured. [Compare Dropsy, Uremia.] 

U. Strychninse Sulphatis, gr. J. I fy Spiritus Glycerylis Nitratis, 3j. 

Tinct. Ferri Chloridi oss. Sig. — One drop, gradually increased to 

\cidi Acetici, 5 jss. I five, four times daily," on sugar. (B.) 

Curacoae 3 j. 

Liq. Ammonii Acetat. ,...<;</ Jvj. ; If. Auri et Sodii Chloridi, gr. jss. 

M. Sig.— A tablesp. every 6 hours, fol- Aquae Destillatse giv. 

lowed by a glass of water. For the anemia. Solve. Sig. — A teasp. ter in die. 

Bronchiectasis. 
Quinine, the most useful remedy as a tonic (B). Phosphates, are undoubtedly 
useful, so also are the Hypophosphites (B). Chlorine, in solution as a stimulant and 
deodorizer, or as inhalation to lessen fetor (Br). Palliation of the cough and expecto- 
ration, with care of the general health of the patient, is all that can be accomplished. 
[Compare Emphysema.] 

Bronchitis, Acute. 

Acetanilide, in dose of gr. iv every two hours, has often arrested the attack within 
24 hours. Aconite, gtt. ss-j every hour (B); in catarrh and bronchitis of measles (R). 
Tartar Emetic, in the first stage, gr. J,, to \\,, especially if cough is violent (B); gr. j 
to a quart of water, a teasp. of this every hour for the wheezing and cough of slight 
bronchitis in children (Smith); gr. J to £ every 2 or 3 hours (R). Ipecacuanha, as 
wine, when expectoration profuse and difficult to expel (R); in dry stage (P); when 
secretion is scanty and dry, but use Squill when the secretion, though copious, is difficult 
to expel (Br). Lobelia, as expectorant (B); for paroxysmal dyspnea (R). Am- 
monium Chloride, when an expectorant is indicated; with the compound Mixture 
of Glycyrrhiza, an old and good remedy. Ammonium Benzoate gives good results 
in many cases, especially those of the lithemic diathesis (Coston). Ammonium 
Carbonate, when expectoration is profuse, and the condition low (R). Ammonium 
Acetate, from its sudorific action, is always indicated, especially in children (Dessau). 
[See formula below.] Opium, Morphine and Quinine combined, or Dover's powder, 
to abort an attack; also with expectorants to allay cough (B); in frequent and violent 
coughs, without obstructed oxidation; also to check excessive secretion (R); as sudorific, 
gr. x of Dover's powder very useful (P). Apomorphine, the Hydrochloride internally 
in doses of gr. ^ every 3 hours, is the best of all expectorants. Heroin, given with 
Ipecac, is particularly effective (Hyams); especially for the cough and dyspnea, proved 
effective in 99 per cent, of 700 cases (Grinewitsch). Dionin, as a cough remedy. 
Phenol, a 5 per cent, solution used with steam atomizer as spray, is promptly efficient 
in relieving the symptoms. Camphor, in oil by hypodermic injection in bronchitis 
from cold; the first injection acts like an expectorant, and after the fourth the expectora- 
tion ceases completely, even in the most serious cases (Alexander) ; has but slight value 
in the bronchitis of the emphysematous. Sanguinaria, after subsidence of acute 
symptoms, as expectorant (B); very successful (P). Quinine, to reduce temperature 
(R). Adrenal Extract, has given good results. Colchicum, useful when gouty 
diathesis (P). Cimicifuga, an excellent expectorant, and useful when acute symp- 
toms have subsided (B). Nitric Acid, ttrx of the dilute acid relieves (B). Asafcetida 
or Ammoniacum, the last best, in bronchitis with wheezing of old people (R). Asa- 
fcetida, is an excellent stimulant of respiration, especially when the capillaries have 
become clogged with the products of inflammation, and suffocation seems imminent; 
here also the Cold Bath is a means of enabling the patient to expel the mucus, the 



596 



BRONCHITIS, CAPILLARY— LOBULAR PNEUMONIA. 



equal of which has not been yet advanced; it may be used for even very young infants 
and should be but momentary for them (W). Turpentine, 3] of the od to oiv of 
boiling water, the vapor of which as an irritant inhalation to provoke coughing and 
expulsion of mucus in cases so exhausted that expectorants fail (Murray). Cubeb, 
very useful, especially when secretion copious and system relaxed (P). Copaiba, alter 
subsidence of the fever, the most servicable expectorant, but nauseous (B). Counter- 
irritants, mustard as large poultice, with linseed or oatmeal, or both, very useful (K). 
Iron Lead, Zinc Oxide, to check profuse secretion (R). Heat to chest by linseed 
poultices, of great service. Diet, should be light and in liquid form Temperature 
of atmosphere in room should be about 8o° F., and the air moistened by steam. [Com- 
pare Cough.] 

R<. Tinct. Sanguinariae, 

Tinct. Lobeliae, aa 3j ; 

Vini Ipecac, 3 ij - 

Syrupi Tolutani, q.s. ad 3iv. 

M. Sig. — A teaspoonful every 3 hours. 
( B -) 

R. Apomorph. Hydrochlor., . . . gr. \. 

Ac. Hydrochlor. Dil., m\\). 

Syrupi Senegae, 3y- 

Aquae Destillat., 3j- 

M. Sig. — A teaspoonful every 2 hours, 
for a child of 3 years as expectorant. Should 
be put up in a blue bottle. 



R. Antim. et Potassii Tart., ... gr. ij. 

Liq. Ammonii Acetatis, 5iv. 

Spt. Athens Nitrosi, 5j- 

Tinct. Aconiti, 5ss. 

Syr. Simplicis, q. s. ad 3vj. 

M. Sig. — A teaspoonful every 2 
hours. In first stage. 



or 3 



R.. Liq. Ammon. Acetatis 3iv. 

Spt. Athens Nitrosi, 

Syr. Ipecac, aa 3 jss. 

Syr. Senegae, 3j- 

Syr. Limonis, 5 j • 

M Sig. — A teaspoonful every 3 hours for 
children. (Dessau.) 

R. Fluidextr. Cimicifugae., 5ss. 

Tinct. Opii Deodorat., 3 j- 

Syr. Tolutani, q.s. ad gij. 

M Sig. — A teaspoonful every 4 hours. 

(B.) 



I*. 



Vini Ipecac, 3 i j - 

Liq. Potassii Citratis, 3iv. 

Tinct. Opii Camphorat., 

Syr. Acaciae, aa 3j- 

M. Sig. — Tablesp. ter die. In first stage 
of ordinary acute bronchitis. (Da Costa.) 



Bronchitis, Capillary— Lobular Pneumonia. 

Ipecacuanha, as emetic, preferred to tartar emetic in capillary bronchitis of very 
young or very old (B); as wine, when expectoration P™^.^.^^^^^' 
in very young infants should be used in place of antimony M & P). Squill, as ex 
pectorant, may be used with benefit (Wa). Antimony Sulphurated, gr. „ in com- 
bination with Dover's powder, every 2 or 3 hours, when the temperature very high 
and pulse full and strong; must be stopped as soon as nausea and vomiting begir 
(M & P) Lobelia, for paroxysmal dyspnea (R). Ammonium Carbonate, when 
expectoration profuse and strength diminishing; in severe bronchitis or broncho- 
perumonia of children, especially "when prostrate and livid (R); has probably . speafc 
action on the diseased tissue and its products (Clymer). Ammonium Iod de, 1 .mil 
rapid doses, often gives great relief to the catarrhal process (Da C), often gnes th 
most astonishing relief (B). Ammonium Chloride, gr. ij every 2 hours «th er atone 
or with Potassium Chlorate (Clymer). Serpentina in capillary bronchiti > J^hJdren 
crives excellent results (B). Turpentine, one of the best stimulants when vital powers 
fre depre ed and peripheral circulation feeble (B). Camphor, to allay cough and 
promoTe expectoratL ?B). Hydrocyanic Acid, for coug h and tende ncy to »pe m. 
Hydrargyrum Subsulphate, is effective as emetic (B). Mustard as poult.c or 
bath useful (R); the most important part of the treatment (M & P). Poult. 
to encircle the whole chest in children (R); followed by a jacket of cotton wool around 
the chest Steam, by inhalation, may be impregnated with sedatives, or f 
s of great importance "(M & P). Quinine in that form of capil L«y brcmch^s ccu, 
ring in tropical climates, and where marked debility (M & P). S *™ u ^f ' f " 
often necessary, especially in the suffocative form, and where marked prostrat, 



r.Kowm ns, chronic. 



597 



\1 & P). Emetics arc necessary when suffocative symptoms become prominent. 
[Compare Cough.] 



H \mmonii Iodidi 5j-ij. 

uit 5ij-iij. 

Syr. Glycyrrhizse, 

Syr. Tolutani aa 3ij. 

M. Sig. — A teasp. every 2 or 3 hours. 



K. Quinin.r Sulphatis, gr. vj. 

Ac. Sulphurici Dil npxij. 

Syr. Simplicis, oss. 

Aquae, 5 ijss. 

M. Sig. — A teasp. every 2 hours to child 
of 2 or 3 years; older children require more 
quinine. (M. & P.) 



I! Liq. Vmmonii Vce1 ,Vs. 

Syr. [pecac 

M . .1 ; .lii n.i- Sulph., gr. ,',. 

Syr. Acacia 3j- 

Vquse, 

M. Sig. A teasp. hours for a 

child 2 years old. When surface pair and 
expression languid, skin cool. (M. & I' - 



R. Fluidextr. Serpentarise, .... ,^ss. 

Ammonii Carbonat., 3ij- 

Syr. Tolutani g JSS. 

A teasp. every 2, 3, or 4 hours. 



Bronchitis, Chronic. 

Antimony, when expectoration copious and difficult to expel (R). Ammonium 
Chloride, with stimulating expectorants, such as Serpentaria, Sanguinaria or Eucalyp- 
tus (B); when secretion is thick and abundant the salt may be applied by an atomizer 
(R). Ammonium Benzoate is of signal service (Coston). Ammonium Iodide 
and other Iodides, with expectorants are very serviceable (B). Ammonia by inhala- 
tion, to lessen expectoration (R). Ethyl Iodide, by inhalation, is very valuable by 
reason of its local influence, itjv-xx thrice daily (B). Grindelia, an excellent expec- 
torant, especially when cough is troublesome (B). Strychnine, as a respiratory 
stimulant and to check the reflex vomiting (B); the Syrup of the Phosphates of Iron, 
Quinine, and Strychnine. Squill, in chronic forms with tenacious sputa, but not 
when fever or acute inflammation (R). Opium, with expectorants, to allay cough 
(B); when cough frequent and violent without any signs of obstructed oxidation, also 
to check excessive secretion (R). Codeine, gr. J every 3 to 6 hours, when other opiates 
are not well borne (P). Morphine, gr. I with 5 grains of Dover's powder at bed-time, 
followed by whiskey on the next morning, used in more than 200 cases with excellent 
results (English). Apomorphine, small doses by the mouth as an expectorant (Br). 
Heroin with Potassium Iodide, a valuable combination (Hyams). Dionin is an 
excellent remedy for the cough. Myrtol is of great value in fetid bronchitis (Gubler); 
is very satisfactory in subacute and chronic affections of the respiratory tract (Solis- 
Cohen). Ichthyol, in pill or mixture, up to gr. xv daily, gives marvellous results 
iBrun). Sulphur in severe cases with abundant discharge, especially in cases of con- 
stitutional debility (R). Sulphurous Acid Gas, inhalations, or the acid in form of 
spray, sometimes beneficial (R). Hydrogen Dioxide, the solution internally, doses 
of 5j-iij, diluted with 3 to 4 of water, gives great relief in chronic bronchitis with dysp- 
nea. Lobelia, for paroxysmal dyspnea (R). Thiocol, is efficient in chronic bronchial 
catarrh and in fetid bronchitis, a 10 per cent, sweetened solution (Frieser); in chronic 
bronchitis of non-tuberculous origin (Braun). Adrenal Extract has given good results. 
Euphorbia Pilulifera, is very successful in asthmatic, chronic and advanced or suba- 
cute bronchitis (Dujardin-Beaumetz) ; 3ss-j of the fluidextract thrice daily. Tar, 
diminishes the secretion and allays the cough (P); gr. ij in pill every 3 or 4 hours in 
chronic paroxysmal winter cough (R). Digitalis, when interstitial pneumonia and 
general anasarca (B). Eucalyptus, valuable in chronic cases of broncho-pulmonary 
catarrh (B). Chekan, a fluid extract of the leaves is said to be highly efficient (M). 
Carbonic Acid, diluted, may be inhaled with benefit (P). Formalin, in dilute solu- 
tion administered as spray. Nuclein, has been administered with benefit, as a general 
tonic. Gallic Acid, is useful in some forms of chronic broncho-pulmonary catarrh 
(B). Iron, with free expectoration, Mistura Ferri Composita; or better, the Phosphate 
of Iron, Quinine, and Strychnine (B); to check profuse bronchial secretion (R). Col- 
chicum, in gouty subjects (R). Balsam of Peru, and that of Tolu, when three is 



59» 



BRONXHORRHEA. 



copious secretion of pus (R). Phenol, by inhalation of the ^ jpray , J :j££ ,^~ 
of water; may be combined with ^^en^ l^y ^\n^y (B); of great 

SX^S^?!^^^ fe assets?. 

Snary^^^ 

Benzoin, 5j of the ^^^^JiSVIto^tSn (B). Phosphate's, 

and lessens expectoration (R , 1S so ™f™^ s pupate (R) Serpentaria, as stimu- 
for the resulting cachexia (B); the Calcium Phospha te (Kh : £ u n soluti 
lant. Alum, powdered, dusted over surface (g)- Stiver mtrat^ e o y ^ 

gr. v-xx to the 5, on sponge probang (B). Camphor to aiiay c g p 

Expectoration (B). Sumbul has decided efficacy gy^^JZJ 0US (B) . 
secretion (R); for profuse secretion tne best o all "P^^ (B) . Terpill 

Cubeb, when profuse expectoration, has ™^ J™^ 
Hydrate, gave immediate and curative results m cases ot long stanamg 

bronchitis, "which had resisted all ^"/-^ 

solutio, Syr. Lactucam, q. s. ad Si], of which a teasp. ^^i"^ 
Terebene, is very valuable; requires an equal w«g ht of lgJ«Jg«S™ n . 

to suspend it. Koomiss-cure, possesses grea value (B). ^1 >* (R) 

[Compare Cough, Emphysema.] 



R. Fluidextr. Eucalypti 5 J- 

Ammonii Chloridi, OJ : 

Ext. Glycyrrhizffi, OiJ. 

Syrupi Tolutani, onj. 

M Sig.— A teasp. 4 to 6 times daily. 



R. Tinct. Sanguinariae, 3j- 

Ammonii Chloridi, 5] ; 

Syrupi Tolutani, OiJ- 

Spt. jEtheris Nitrosi, Sss- 

Aquse, Sujss. 

M. Sig.— Tablesp. p. r. n. 



R. Syrupi Scillae Sss. 

Tinct. OpiiCamph., OU- 

Ammoniaci 3ss. 

Syrupi Tolutani, 5*. 

M. Sig-— A teasp. p. r. n. 

R<. Ammonii Chloridi, 3iij. 

Svrupi Picis Liquidae, 3 v] . 

M ' Sig.— A tablesp. 4 times daily. 



R. Ammonii Carbonat., ¥■' 

Infusi Serpentariae, Oiv. 

M. Sig.— A teasp. every 3 hours. 



Bronchorrhea. 

Ammonium Iodide, of.eo \r^**%^'2^& ££Z 
CR} Ammonium Benzoate is very efficient in agect cases wuu ici F cooious 

Uot """^J^g*^ To.'e^n^oTiSAn ,o,p«o<in=, i» d« 
S° m e ri-Jdl" EoVSemaUy (mi), and by spray (gr. v ad I 3, M« ; 
of gr. x xx aaii) , Benzoin bv inhalation, for its local influence. J»yno 

often of great utility (Da C). Benz0 ™'.° y a 1 ~; * va i ua bl e agent in bronchorrhea and 
is largely eliminated by the lungs, and is a most valuab le a 8 ent in D •• ■ ^^ 
fetid bronchitis, acting as . stimulant and antisepU (Gub r) dose ^ ^ ^ 

improves (B?. Lead Acetate, as astri ngent tc . restran ^^^^ fJ^raSn 



BRUISES Ul BO Bl NION. 



599 



over front and back of chest (R). Spinal Ice-bag, to restrain excessive Becretion (R). 
Quinine, and the Phosphates, also Cod-liver Oil, as restoratives W it. [Com- 
pare Bronchitis, Chronic, also Cough.] 



K Copaibas, 

Bus. Tolutan , 

PuK Acacias aa 5ss. 

Ac. Sulph. Arom.it., 5ss. 

Aquas Destillat 3vj. 

M. Sig. — A tablespoonful thrice or four 
times daily. 



ty. Potassii Ioiliili 3j- 

Ac. Nitrici I>il 5iij. 

Tinct. Belladonna Fol.,. 

\i . S.ilii vlici 3 i- 

Aquse Camphors, . .q. a. ad 3iv. 
M Sig Dessertsp. in water 3 

times daily, for fetid bronchitis. 



or 4 



Bruises. 
Arnica, the infusion very useful as an external application for bruises and cuts; 
also an excellent internal remedy for internal bruises, shake, falls, blows, or shock; 
miv x every 2 or 3 hours (P); in bruises, sprains, etc. (Wa). Aconite, the liniment 
locally to painful sprains and bruises (Wa). Capsicum, a strong tincture applied with 
gum, said to act like a charm on discolored bruises (R). Ichthyol, in 30 per cent, 
alcoholic-ethereal solution, applied twice daily, gives most satisfactory results (Charles); 
a 20 per cent, ointment remarkably anodyne in severe contusion of the ankle (Acker- 
man). Sulphurous Acid, a solution constantly applied (R). Oil of Bay, as stimu- 
lating liniment (P). Opium, the tincture 5j with Linimentum Saponis 5 j diligently 
rubbed in two or three times a day, affords great relief (Wa). [Compare Sprains.] 

Bubo. 

Mercury, necessary in the indurated buboes diagnostic of syphilis (Ricord); Calo- 
mel locally applied for indolent buboes refusing to heal after opening (H). Sulphides, 
are less useful in maturating buboes than in the case of ordinary boils or abscesses (R); 
to check suppuration (St). Iodoform, locally, has proved useful (Wa). Iodine, 
applied to produce vesication around a bubo, relieves inflammation (R); freely every 
day, with rest and compression, to cause absorption (St). Silver Nitrate, lightly 
to surface, to stimulate indolent buboes (Wa). Potassio-tartrate of Iron, 30 parts 
to 250 aquae destil., three tablesp. daily, also as lotion to sore (Ricord); in phagedena 
(St). Tartar Emetic, gr. j every two hours, reduces inflammation in many cases 
(Wa). Nitric Acid, locally for indolent and broken bubo (R). Phenol, a 2 per 
cent, solution, by injection, used in 150 cases of buboes and other enlarged glands, 
with uniform success (Taylor). Ichthyol mixed with mercurial ointment, to stimulate 
granulation after operation, and remove lymphatic hypertrophies (Fuller). Hydrated 
Chloral in 10 per cent, solution, as a stimulant and antiseptic application (W). Pres- 
sure, by compressed sponge under a spica bandage, or by a shot bag, the best local 
treatment for indolent bubo (Keyes); in all cases cleanliness, rest in the recumbent 
posture, emollient poultices. Ice over the bubo greatly relieves (B). Surgical. 
Open freely when suppuration; if the pus is virulent the opened bubo is a chancroid 
and should be treated as such (Keyes); enucleation and.curettement give good results 
as to rapid healing of the wound. Diet, should be generous with cod-liver oil in 
phagedenic bubo. Treatment of syphilitic bubo is that of general syphilis, local 
measures are useless and no treatment is called for until the general eruption appears 
(Keyes). [Compare Chancroid, Syphilis.] 



Bunion. 
Iodine, as paint, or Emplastrum Hydrargyri, for indolent form, thick but not 
tender (D). Phenol in 2 per cent, solution by injection once in 2 or 3 days, 
very successful (Hueter). Silver Nitrate, 5j to the 5 locally when simple thickening 
and effusion. Lead-water and Laudanum, when inflamed. Benzoin, the com- 
pound tincture, when ulceration, as a stimulant application. Mechanical contri- 



600 BURNS AND SCALDS — BURSITIS. 

vances, to draw the phalanges inward, may be needed if simple treatment proves in- 
sufficient. Rest, fomentations and anti-arthritic remedies for thickened bunion; burst 
it by pressure if recent and sac thin (D). [Compare Bursitis.] 



Burns and Scalds. 
Phenol, i part to 30 of Linim. Calcis, or 1 part to 6 of Olive Oil; the latter 
speedily relieves pain, and promotes healing without suppuration (\Va); 1 part to 10 
of Olive Oil, applied on layers of cotton batting, the best application for bums of all 
degrees: applied in full strength by brush over the burned surface, very successful 
in over 100 cases (Brodnax); the strong acid less dangerous than solutions. Lime- 
water and Linseed Oil, equal parts, as in the Carron Oil; or with Olive Oil con- 
taining 10 per cent, of Oil of Eucalyptus (Caird); a favorite and efficient application 
(P). Picric Acid, a saturated solution, Picric Acid 5, dissolved in Alcohol 80, then 
add Distilled Water 1000, applied on strips of sterilized gauze, gives better results than 
any other treatment (Power); in solutions of i to 5 per cent., the most reliable applica- 
tion (Maddock). Sodium Bicarbonate or the Carbonate, a strong solution applied 
on compress, quickly relieves the pain and promotes healing. Boracic Acid, a satu- 
rated watery solution, used with great success (Lister). Lead Carbonate, as white 
lead paint, an excellent application to burns of small extent (B). Salicylic Acid, 
3j to oviij 01. Olivae, is an efficient local application (B). Collodion, flexible, to burns 
of first degree (R). Phytolacca, relieves pain (B). Normal Salt Solution, applied 
on cotton, gives great satisfaction (Keen). Thymol Iodide, j, Olive Oil, ij, Vaselin 
viij, as ointment for extensive burns (Walton). Acetanilide, powdered and dusted over 
the surface is an excellent application. Rhus Toxicodendron, the tincture externally, 
5j to the pint of water, in superficial but extensive burns (P). Cantharis, the tincture 
diluted with 40 of water, and applied on lint, is an excellent application. Ichthyol, 
a 6 per cent, ointment will often prove the most comfortable dressing (Bulkley); a 1 per 
cent, salve of Ichthyol with Vaselin, or a 2 to 10 per cent, aqueous solution in severe 
cases, speedily relieves the pain and promotes cicatrization (Lorenz); a 50 to 80 per 
cent, solution in all cases, gives most satisfactory results (Schutze). Resorcinol, a 1 or 
2 per cent, solution hastens formation of epithelium (Hebra). Iodoform, as gauze or 
pomade, after cutting the bullae and washing with a weak salt solution, the best treat- 
ment (Congress of Dermatology, 1889). Zinc Stearate with Acetanilide or Boric Acid, 
makes an excellent dressing. Unguentum Cetacei of the Br. Phar. with the benzoin 
omitted, makes an excellent bland dressing during healing. Pinus Canadensis, 
the concentrated extract, painted on freely, effectually relieves the pain, Turpentine, 
in dangerous cases, where great constitutional depression (P); as wash to severe burns, 
then locally Basilicon Ointment mixed with Turpentine (B). Cotton-wool, to allay 
pain and exclude air (P). Warm Bath, immerse for some days (R); exclusion of 
air the main indication (H). 



R. Ichthyolis, o j ■ 

Zinci Oxidi, o ij • 

Cretae Preparatae, 5 ii_l . 

Amyli, Olei Lini, aji oiij- 

Aquae Calcis, oiv. 

M. Sig. — Apply on lint to burns of 2nd 
degree. 



Py. Olei Eucalypti, § jss. 

Olei Olivae, 5 xivss. 

Aquae Calcis Oj. 

M. Sig. — Apply on lint and cover with 
oiled silk. An improved Carron Oil. 



Bursitis. 
Iodine, painted on outside, after removal of fluid by the aspirator (D); after blister- 
ing (Wa). Blisters, in rheumatic enlargement of bursae, are almost indispensable for 
a rapid cure (Wa). Fomentations, with rest, to relieve pain and swelling; if un- 
availing, a crucial incision into the bursa, care being taken not to open the capsule of 
the knee (D). Excision, when chronic, tumor hard, resisting other measures (C). 
[Compare Bunion.] 



(Weill \l l CA1 i l ll, r.li l VRY. 



Cachexiae. 
Calcium Phosphate, in scrofulous affections and anemia (Wa); in phthisis an, I 
affections marked In- mal nutrition (B), Iron, in splenic, syphilitic ami strumous, 

an. I especially in all anemic states; also in the malarial ami phthisical; chalybeate 
waters (B); the Ammonio-citrate is the best tonic in the cachexia ol gastric uli 

daily in chlorotic females (Wa). Arsenic, a prompt remedy in the malarial 
cachexia; also of real value in the cancerous (Wa). Hydrastine, in paludal and 
splenic cachexia-, stands in high esteem (B). Nitric Acid, is adapted to the cachexia 
following acute diseases or intemperance; also as an alterative after a Long COUrsi 
Mercury (Wa). Potassium Iodide, in constitutional syphilis and resulting affections 
of bones and skin (Wa). Mercury, in the syphilitic, but its utility much questiot 
(Wa). Aurum, in cancerous, mercurial, and syphilitic cachexia', especially when 
bones, glands, and oculo-nasal mucous membrane affected. Phosphates, in 1 
diseases, wasting, bronchitic, leucorrheic cachexia- (15). Arnica, in very developed 
cachexia:, has excitant action on the nervous system (Wa). Eucalyptus, a serviceable 
tonic and stimulant in cachectic states generally (B). Manganese, the Syrup of 
Ferrous and Manganese Iodide, in anemic, syphilitic, strumous, malarial, cancerous 
cachexia; (B). Grape-cure, often modifies most happily many cachectic conditions (P). 
Air, in good condition, an important element (B). Water, the Turkish bath and wet 
pack as aids to remedial action, in plumbic, mercurial and paludal cachexia- (B). Oils 
and Fats, to promote constructive metamorphosis in many cachexia;, especially cod- 
liver oil (B); the latter a most valuable remedy in scrofula, phthisis, atrophy, tubercular 
and jail cachexia;, anemia (Wa). Massage, has been productive of remarkable results 
in many forms of cachexia (B). Aliment, of prime importance (B). [Compare 
Anemia, Scrofula, Syphilis, etc., and the Formuhe for Tonics under Adynamia 
\\n Anemia.] 

Calculi, Biliary. 

Chloroform, in 20- to 60-drop doses every 3 or 4 hours, is by some supposed to 
act as a solvent of gall-stones; it cannot so act but undoubtedly affords some relief (B); 
as an inhalation it may be used to relieve the pain of the paroxysm (Br). Ether and 
Turpentine, equal parts of each, 5j once daily for a year, is Durande's solvent remedy; 
is not solvent, and as an anodyne is inferior to morphine or chloral (B). Morphine, 
gr. J with Atropine, gr. T l^, hypodermically, the best anodyne for the pain and vomit- 
ing during the paroxysm (Br). Chloral sometimes relieves the pain (R). Counter- 
irritants, as mustard poultices to relieve the pain during the paroxysm (Br). Olive 
Oil, 5ij at night, followed next morning by 3 or 4 seidlitz powders an hour apart, 
efficient in facilitating the expulsion of accumulated gall-stones; this treatment is 
based on rational principles, as gall-stones placed in Olive Oil undergo solution, losing 
nearly 70 per cent, of their weight in 10 days (Brockbank); oiv-viij per diem between 
the attacks the best prophylactic (Id). Sapo Animalis, of the Br. Ph., is still more 
efficient for their solution and breaking up (Id). Nitro-muriatic Acid, as bath, 
found useful in India to relieve the pain and promote expulsion of the calculus, 5iij 
of the acid to a gallon of water (Scott). Glycerin, is a good remedy for biliary lithiasis 
iFerrand). Sodium Phosphate, in 5-dose before each meal for several months, to 
prevent recurrence (B); should be given in plenty of water (B). Sodium Salicylate, 
increases the secretion of bile and renders it more watery; it is therefore indicated in 
cases where there is a tendency to the formation of gall-stones (Br). Succinate of 
the Peroxide of Iron, hydrated, contains a large proportion of nascent oxygen, and 
is given in teaspoonful doses after meals for several months, and resumed at intervals 
afterwards to prevent reformation of the calculi (Buckler). Diet, is important; with- 
hold all starches, sugars, and fats, also malt liquors and spirits; moderate exercise out 
of doors, lean meats, eggs, fish, fruits and succulent vegetables to be used freely. Min- 
eral Waters, the alkaline are useful, especially Vichy, which is deemed of great benefit. 
[Compare Colic, Jaundice.] 



6o2 CALCULI, RENAL AND VESICAL. 



1$. Ferri Peroxidi Succinat. 

Hydrat., §iss. 

Aquas, 5 vjss. 

M. Sig. — Teasp. after each meal for sev- 
eral months. 



R. Spt. /Etheris Comp., oij- 

Liq. Magendie, ngxxx. 

Syr. Zingiberis, q.s.ad %\. 

M. Sig. — Teasp. doses, an hour apart, 

until pain is relieved. 



Calculi, Renal and Vesical. 

Alkalies, especially Potassium salts, if long continued, will effect solution of uric 
acid calculi (R); Sodium salts should not be used (B). Calcium Carbonate, in doses 
of gr. xv-xx thrice daily in plenty of pure water (Croftan); as much as 5ss have been 
given daily for months without bad effects (Von Noorden); acts against uratic calculi 
by binding the phosphates of the food and blood. Lime-water has been used with 
benefit, internally and injected into the bladder (P). Potassium Citrate, in large 
doses for bloody urine containing uric acid crystals (R); the Citrate and Carbonate 
are the most desirable solvents for uric acid gravel (Sir H. Thompson). Potassium 
Tartra-borate, if long used, is very efficient as a solvent for uric acid calculi (B). 
Potassium Salts, are much more efficient than those of Lithium as solvents for uric 
acid (Rogers). Alkaline Mineral Waters, those rich in Potassium preferred, espe- 
cially Vichy (B). Ammonium Benzoate, long continued, will dissolve phosphatic 
calculi (B). Ammonium Biborate, will prevent attacks of colic where uric acid 
calculi, in 20-grain doses every two hours until free urination, then gr. xv thrice daily in 
a glass of flaxseed tea. Magnesium Boro-citrate is a good solvent of uric acid calculi 
(Madsen). Lithium Citrate, to promote oxidation (Da C). Piperazin, as a solvent 
for uric acid and urate concretions, is far superior to other agents. Olive Oil, internally, 
is of excellent service in renal as well as in hepatic calculi, controlling the crises of the 
disorder with undoubted effect ( Aussilloux) . Hydrangea, in decoction, used by the 
Cherokees in all calculous affections with uniform success (Butler). Lead Acetate, 
gr. \ to the 5 of distilled water, injected into the bladder to prevent formation of phos- 
phatic calculi, or a solution of Dilute HC1 Acid, mjij-iij to the § (Sir H. Thompson). 
Nitric Acid, very dilute, as injection for phosphatic calculi (R); gtt. j to the 5, as 
injection into the bladder in chronic cystitis and phosphatic deposits (B). Cotton- 
root, in decoction, as a demulcent for strangury and gravel (P). Castor Oil, of value 
as a purgative (P). Calumba, to relieve the vomiting (P). Counter-irritants, as 
mustard-poultices, or turpentine stupes, to relieve the pain of the paroxysm (R). Anes- 
thetics, for the same purpose (B). Antipyrine gr. xxiv, Laudanum gtt. x, Water 3iij, 
injected into the rectum f hour before beginning lithotrity, rendered the crushing and 
evacuation of the stone absolutely painless, the bladder seeming non -sensitive to touch 
or tension (Chastelet). Morphine, hypodermically, as an anodyne and to relieve 
the vomiting (B). Hot Fomentations, to alleviate spasm and pain while calculus 
is passing. Diet, restrict the use of sugar in any form or combination, also fats and 
alcoholic beverages. Fresh, green vegetables may be used freely, also skimmed milk 
or buttermilk. Mineral waters, preferably Vichy, Friedrichshall and Carlsbad. Fre- 
quent abstinence from animal food. Lemon-juice and soft water in large draughts, 
are useful. Surgical Measures. Lithotomy or Lithotrity for removal of a stone 
from the bladder. Solvents are of no use except for a very small calculus, and even 
then a considerable time must be occupied in the process. No operation in surgery 
more certainly safe, rapid, and successful than lithotrity (Sir H. Thompson). [Com- 
pare Colic, Lithiasis, Oxaltjria, etc.] 



Magnesium Boro-citrate. 

R. Magnesii Carbonat., 3j- 

Sodii Biborat., 

Acidi Citrici, aa 5ij- 

Aquae Bullientis, 5 viij. 

M. Sig. — Tablespoonful 3 or 4 times 



Potassium Tartra-borate. 

R>. Potassii Bitartratis, partes iv. 

Ac. Borici, partem j. 

Aquae, partes x. 

By heating the above together, the salt is 
obtained as a powder, of which gr. xx in a 



daily. (B.) | large draught of water 3 or 4 times daily. 



CAN! I K. 603 



Cancer. 
Opium, stands first on the list of palliatives, allaying pain and quieting irritation 
(Wa); as powder applied to cancerous sores; also Morphine, dissolved in glycerin, 
and spread on lint, very useful where there is much pain; Opium is also used in cancer 
of the stomach (R); Codeine, gr. ,'.-, to ,'„, a good hypnotic (P). Arsenic, internallj 
in cancer of the stomach, diminishes pain and checks vomiting. Arsenous Acid, pure 
or with starch, as a caustic; enough should be used to set up active inflammation (R); 
may cause arsenical poisoning by absorption. Sodium Cacodylate, the salt of an 
organic arsenical compound, is a valuable palliative in carcinoma, arrests progress and 
improves the general condition of the patient (Payne). Belladonna, the extract locally 
and internally, of great benefit as a palliative for the severe pain (P). Conium inter- 
nally and as poultice, to relieve pain (R); is particularly efficient against the pain of 
cancer (P). Hydrastis, as a local alterative and antiseptic to cancerous sores, has a 
renewed interest (Pf). Phenol, undiluted, to the sore, and injected beneath it, 
limits and retards (B); pure, as anesthetic, before applying caustics; with glycerin 
as application to fetid cancers (R). Mercuric Chloride, in small doses, long con- 
tinued, will retard the growth of gastric cancer (Da C). Citric Acid, 3j to 5viij 
aquae, useful in allaying pain of cancerous ulcerations (Wa). Acetic Acid, 1 to 3 
aquae, ihjxxx injected into the tumor, has been used with varying success (Wa). Chloral, 
in 10-grain doses, 3 times a day, has relieved the most severe pain of cancer (R). Chlo- 
roform, as vapor to raw surface (R). Pyoctanin (Methyl Violet) in solution, by 
injection into the neoplasm, to bring about shrivelling up and final disappearance of 
carcinoma (Mosetig). Hyoscyamus, bruised leaves, locally (P). Bismuth, relieves 
pain and vomiting of gastric cancer (B). Aurum, the Arsenate was extensively em- 
ployed internally by Massart with benefit. Iodoform, applied to diseased surface, 
relieves pain and removes fetid odor (P). Resorcinol, 15 parts to 20 of Vaselin as an 
ointment twice daily after washing with a solution of Pot. Permanganate, has success- 
fully stopped epithelioma (Antonio). Potassium Chlorate, in impalpable powder, 
dusted on epithelioma, said to be curative (B). Pepsin, injections into tumor (B). 
Salicylic Acid, pure, applied in powder (B). Zinc Chloride, the most efficient and 
safe escharotic; parts j-ij to v of flour, as caustic arrows inserted at base of the tumor 
(B). Potassa Fusa, as escharotic (B). Zinc Sulphate, dusted over, dry, an excel- 
canlent caustic; remove the eschar by poultice (B). Bromine, for destruction of uterine 
cer, is preferred by some (B). Chromic Trioxide, a powerful escharotic (B). Caus- 
tics have never cured true mammary cancer, but many breasts are thereby destroyed 
for innocent swellings which could have been removed by a single incision (McGraw). 
Viola Cucullata, an infusion and a poultice of the leaves have been used with some 
reported success. Formalin by injection, cured sarcoma of the naso-pharynx (Thomp- 
son). Condurango was formerly esteemed as a remedy for gastric cancer, is only 
palliative. Calcium Carbonate, as calcined oyster-shell, very efficient in arresting 
growth of cancerous tumors, and in alleviating the pain thereof (Hood). Rumex 
Acetosa, an excellent local application; has a popular reputation. Iron and Man- 
ganese, the Syrup of the Iodide, for resulting cachectic state (B). Toxins, the erysipe- 
las and prodigiosus toxins have proved more efficient in sarcoma than in carcinoma 
(Coley); do not effect even temporary improvement (Senn). Alcohol by injection 
around the circumference of the growth to obliterate vessels and lymphatics; cured 
35 cases of mammary cancer (Hasse); cured primary cancer of the naso-pharynx 
(Kuh); is especially indicated in recurrence after operation (Id). Chlorine in the 
body should be reinforced by a special diet enabling large quantities of sodium chloride 
to be absorbed, as the saccharomycetes will not develop in the presence of chlorine (Rost). 
Roentgen Rays are preferable to all other methods of treatment in superficial carcinoma 
involving a considerable area (Hyde); cured 36 cases of epithelioma (Pusey); a com- 
bination of these rays and the Finsen rays promises well in deep-seated cancer, the 
former being penetrating and germicidal, the latter curative (Hopkins). Radium 
Rays are reported as curative in a case of recurrent carcinoma of the lip and palate, 
in the clinic of Prof. Gussenbauer; also in a case of melano-sarcoma, and in other 



604 CANCRUM ORIS — CARBUNCLE. 

cases. Ozone, locally applied as an antiseptic and anodyne agent in cancer of the tongue 
and throat, is highly efficient; was used on Sir John Millais with great benefit during the 
last three months of his life and kept him comfortable without narcotics. Poultices, of 
starch, applied cold (R); or poultices of bread, sprinkled with charcoal or freshly ground 
coffee, as deodorizers to open cancers. Water Enemata, to relieve pain and straining 
in intestinal cancer (R). Electrolysis, has been of great service in many cases, relieving 
the pain and diminishing the tumor. In any case in which operative interference is con- 
sidered necessary, electrolysis is the preferable method, and in others is advisable 
(Butler). In 18 cases of epithelioma treated by electrolysis, 13 were cured, 2 improved, 
in 2 there were no results, and 1 ended fatally (Groh). [Compare Uterine Cancer.] 

Cancrum Oris. 

Arsenic, in medicinal doses is an efficient remedy (R). Boric Acid or Borax, 
in solution as a mouth -wash. Nitric Acid is the best caustic for the worst forms of 
the disease (Wa). Potassium Chlorate, gr. xx-xl in 24 hours, has been strongly 
recommended (D). Quinine, made into a syrup, or as enema, to support the strength 
(Wa). [Compare Aphthae, Stomatitis.] 

Carbuncle. 

Boric Acid, administered internally and externally as for Boils (which see) ; equally 
efficacious in carbuncle, diminishing pain, redness and hardness; numerous apertures 
rapidly form for the elimination of the core; the fever falls, excitation and insomnia 
abate, and the carbuncle heals, in the majority of cases without surgical interference 
(Alison). Mercury, Corrosive Sublimate, injected into tumor at several points, in 
doses of 2 drachms of a ^ts P er cent, solution dividedly, has produced good results; 
these injections were often repeated, in broken doses likewise, on the following days 
(Casson). Belladonna, with Glycerin, as local application to relieve pain (P). Am- 
monium Acetate, to support the system (Cezard). Phenol, on lint, with 
Glycerin or Oil, into discharging sinuses (R); or hypodermically into the sloughing 
tissues. Caustic Potash, applied before an opening occurs, or small pieces inserted 
into openings made by scalpel, to cause the rapid separation of the slough. The result- 
ing ulcer should be treated on general principles. Ichthyol ojss, with Camphorated 
Cerate oj, applied thickly twice daily, rapidly lessens the pain and inflammation, 
favors elimination of the core, and hastens cicatrization (Felix). Silver Nitrate, the 
tip of a pencil of lunar caustic introduced into all the white spots of suppuration (Id). 
Galbanum and Opium as plaster to relieve pain, the core then separating painlessly 
(Hill). Iodine, to produce vesication around carbuncle; reduces inflammation (R); 
part j of the tincture to iij aquae locally, has most striking effect (Wa); may be used 
with benefit internally or hypodermically (Cezard). Calcium Sulphide, gr. /,, 
hourly or even 7 two hours, of great service (R). Opium, a thick extract, locally (R). 
Potassium Chlorate, highly recommended, also Quinine and Iron freely, to support 
the system and counteract the carbuncular poison. Poultices, the inflamed surface 
having been previously smeared with Belladonna and Glycerin (R); long-continued 
poulticing is thought to create a tendency to a fresh crop. Strapping, with plaster, 
concentrically from the border inward, leaving the centre free, will sometimes arrest 
extension (R). Collodion, as protective covering (P); as zone around base, leaving the 
centre exposed (Wa); Collodium Cantharidatum in a broad zone painted around the 
carbuncle, to relieve the tension (Ag). Ice, or Ice-hags or iced water on cloths in 
early stage, changing to warm fomentations as soon as suppuration has begun (Hebra). 
Excision of the entire mass down to the deep fascia and laterally into healthy skin 
(Keen). Curettement of every necrotic pocket, after a free crucial incision, followed 
by trimming away the overlying skin, and applying a firm dressing. Crucial In- 
cisions are not so frequently made now as formerly; they relieve tension but often 
give rise to severe hemorrhage. Diet should be very supporting, and stimulants may 
be used freely when the patient is debilitated; Saline purges occasionally (Hill). [Com- 
pare Axteirax, Boils.] 



CARIES CATALEPSY CATARACT CATARRH. 605 



E) Calcis Sulphurat gr. iij. 

Sacchari Lactis q. s. 

Triturat. et div. in chart, xxx. 

Sig. One powder every 2 hours, to 



i; 1 <", 1 Ferri Chloridi Si. 

Potass. Chlorat 7> i i j . 

Liq. Ammonii Vcetat., Jiii, 

Syrupi et \.quse,. . Rviij, 



taken dry on the tongue. I M. Si^. Dessert sp. every 1 

Caries. 
Aurum, in syphiloma of bones (B). Calcium Chloride, when' strumous cachexia 
\B). Phosphoric Acid, with 8 parts water, locally applied, has been of benefit (Wa). 
Phosphates, the best is Syrup of Calcium Lacto-phosphate, or Parrish's phosphates 
(R). Villate's Solution, injected through the sinuses to dissolve the carious bone, 
has cured many cases (B). Sarsaparilla, a very useful medicine 1 1'). Iodine, Locally, 
with Iron or Cod-liver Oil internally (Wa). [See Bonk.] Potassium Iodide, in 
syphilitic caries, holds the first place (Wa). Cod-liver Oil, to promote constructive 
metamorphosis (R); is almost specific in caries due to tuberculosis (W). Mechanical 
Contrivances, are necessary in most cases; Sayrc's plaster jacket, Agnew's jacket of 
leather and steel, Taylor's apparatus, etc., are used in spinal caries to separate the 
diseased bones, and extend the spinal column. [Compare Necrosis.] 

Catalepsy. 

Turpentine, in enemas, and embrocations along the spine, affords the best chance 
of stopping the paroxysms (Wa). Treatment must be essentially tonic and restora- 
tive (H); no constant line can be stated (A); external stimulation to arouse conscious- 
ness, by Ammonia, cold douches, Faradism, etc. Apomorphine, gr. ■,-'„- to t '.t, in the 
paroxysm; with the onset of nausea, consciousness returns and spasm ceases; in the 
intervals between the attacks the treatment should be that of hysteria (Gowers). 

Cataract. 

Galvanism, has been successfully employed in the incipient stage (Wa). Mydri- 
atics, Atropine, Duboisine, etc., to secure full dilatation of pupil, as a means of ascer- 
taining when the operation should be made, which is when the cataract is mature and 
there is no vision even with dilated pupil (Wa). Diet and Regimen, may do much 
to retard degeneration of the lens in cases due to diabetes, or to malassimilation in 
gouty or rheumatic persons (C). Iridectomy, made early and effectually may post- 
pone the progress of lenticular opacity, if due to increased intraocular tension (C); 
in partial cataracts which have become stationary, iridectomy for artificial pupil may 
be done to expose the clear portion of the lens (Roosa). Phosphorus, with Oil, by 
frictions to the forehead, and instillation of the same into the eye, may cause absorption 
of the lens or capsule (Wa). Codeine, in diabetic cases (Br). Sodium Sulphate, 
a solution suggested as injection into anterior chamber, in hope to dissolve the nebula 
(Wa). Medicine, accomplishes nothing except to improve the general health and so 
delay the progress of the opacity. Removal may be performed by one of several oper- 
ations (Roosa). 

Catarrh, Acute Nasal. 

Menthol, 1 or 2 parts dissolved in 20 of chloroform, of which a few drops in the 
hollow of the hand, the hands then rubbed together and placed before the face, the 
remedy being inhaled alternately through the nose and the mouth, will arrest the prog- 
ress of a cold in its initial stages (Wunsche). Chloroform, by inhalation in small 
quantities, is an excellent nasal antiseptic, and is of great value in acute nasal catarrh. 
Sodium Salicylate, to abort a cold, gr. x bis die. Potassium Chlorate, in doses 
of eight or ten lozenges a day, will abort many a cold (R); a very good remedy in ordi- 
nary catarrh (P). Quinine, gr. x, with Morphine, gr. ,'., at incipiency, will often abort 
an acute coryza (B). Opium, at night, if taken early in the case, will often abort an 



606 CATARRH. 

attack of coryza; a glass of hot grog assists its action (R); Dover's powder in a full 
dose at the onset may abort (B). Codeine, is useful in common colds, as palliative (B). 
Ammonia, may be inhaled in the early stage (R). Camphor, as inhalation, the 
spirit in form of vapor (R); with Opium and Ammonium Carbonate as powder (see 
formula below), to break up or modify a cold (Beard). Tartar Emetic, gr. 7 x n to fa 
in the first stage (B); in acute catarrh of children often accompanied by vomiting and 
diarrhea (R). Pilocarpus, the fluidextract in doses of ttj;x to xxx, every half hour 
until profuse diaphoresis sets in, is one of the best modes of aborting a cold; or Pilo- 
carpine Hydrochloride, gr. & in water at bed-time, will give prompt relief and cure 
in a few days (Wyss). Iodine, by inhalation in daily attacks with itching nose (R); 
3ij of the tincture with oj of Phenol inhaled from a sponge in the bottom of a wide- 
mouthed bottle placed in hot water (B). Iodides, are unquestionably serviceable, 
their action being local and substitutive; Ammonium Iodide, gr. j every two hours, 
the best mode of using them (B). Sodium Iodide, gr. x ter die, with Pil. Ferri Iodidi 
in catarrhs of specific origin (B). Potassium Iodide, gr. x at bedtime at the onset, 
to cut short an acute cold in the head; also useful in chronic colds (Ro). Arsenous 
Iodide is very efficient as a remedy for an acute cold, coryza, and similar affections, 
especially when accompanied by a sore throat resembling that of diphtheria; gr. iij 
triturated with gr. xx of sugar of milk, one-half of which may be dissolved in 5iv of 
water, and a teasp. given every hour or so. Arsenic, when sneezing, itching of nostrils 
and frontal headache (R) ; as cigarettes (B). [See under Asthma, for formula.] Vera- 
trum Viride, if Arsenic fails (R). Potassium Dichromate, in small doses, gr. T J C 
in trituration, is very efficient, especially when the nasal discharge is thick, stringy, 
and glutinous. Ipecacuanha, for acute nasal and bronchial catarrh, and ordinary 
colds in children (B). Cimicifuga, when headache, stiff muscles, dull aches, bone- 
pains, etc. (R); an excellent expectorant (B); rheumatic colds; neuralgic pains in jaw 
(P). Ichthyol, a i to 10 per cent, ointment with Vaselin (Lorenz); is especially appli- 
cable to catarrh of mucous membranes (Hoffman); by inhalation from hot water for 
ten minutes often aborts a beginning coryza (Unna). Phenol, solutions of i to 5 per 
cent, in doses of 5j every 2 hours for children (Dessau); a 5 per cent, solution with the 
steam atomizer by inhalation, an efficient remedy in acute coryza. Zinc Stearate 
with Menthol, a very good insufflation in rhinitis. 

Aconite, in severe coryza with much chilliness, aching limbs, hot and dry skin, 
and quick pulse; also in catarrhs of children and that accompanying measles (R); in 
acute coryza (P); with Belladonna in ordinary colds with sore throat and high fever 
(B); in doses of ttjjJ every J hour very useful for a commencing cold in the head (Smith). 
Belladonna, in acute nasal catarrh with profuse watery secretion, njv of tincture, 
then njj each hour (B). Nux Vomica, has great effect upon a dry cold in the head 
(P). Euphrasia, is of decided utility in coryza (P). Pulsatilla, a warm lotion, 
5j-ij in oiv aquae, syringed into the nasal passages in subacute coryza with muco- 
purulent secretion (P); acts similarly to Aconite, but is contraindicated if much gas- 
tric or intestinal irritation exists (B). Cocaine, a 4 or 5 per cent, solution locally as 
spray, to empty the engorged venous sinuses of the nasal mucous membrane by their 
contraction, which it induces; the fluid extract of Coca diluted with water is equally 
efficient if enough be used (Cohen). Resorcinol, the best of all applications. (See 
under Catarrh, Chronic.) Chloral, 20 grains in 5j of Castor Oil, applied with 
a soft mop, when the Schneiderian membrane is very irritable, checks the secretion 
of mucus and lulls the irritation and the head pains (Brodnax). Ammonium Chloride 
or Cubeb, in the dry, congestive stage of a cold in the head; Cubeb cigarettes may 
be smoked as a temporary palliative with great relief. Sulphurous Acid, in coryza, 
by inhalation, spray, or fumigation, is very efficient (R). Oil Inunctions, daily to 
the whole body, in cases of undue susceptibility to taking cold, will prevent the fre- 
quency of the attack (B). Baths, a warm foot-bath before going to bed; Turkish 
bath, at onset in coryza, may prove abortive, also useful later on; cold sponge-bath in 
cases of extreme susceptibility, supplemented by occasional Turkish baths (R). [Com- 
pare Cough, Hay-Fever, Influenza.! 



I \ I \KKII. 



607 



11. Quininse Sulphatis 

Liq. Vrsenicalis (B P.), - 

1 iq. \tropinffi(B. P.) 

I \i. Gentians 

I'ulv. Acacia- 

Ft. pil. no. xij. Sig. — One 
6 hours, for acute colds. 



gr. xvuj. 
nil xij. 

. . gr. \\. 
-• q-s. 
every 5, 4, < 
{Whalen.) 



amphorae, gr. I. 

Ktheris q. s. 

Dissolve to creamy consistence, 
then add — 

Ammonii Carbonat., gr. xl. 

Pulv. Opii gr. x. 

Divide into thirty papers. 
One or two powders, according to age, 
twice or thrice daily. (Beard.) 



U l'!i lis gr. Kw. 

Ucoholis 

\> 1 \'iim, mi e noLocx. 

^QUtB 5i 

M. Sig. A Few drops a- an inhalation 
front a blotting paper. (Brand.) 



1$. Morph. Vcetatis 

Bism. Subnitrat., 

'l'ah i a9 

Ft. 1 hartulas no. xxx. 

Sig.- Use a< snufi in acute rhinitis. 

(Sajous.) 



gr. iv. 



.»i 



gr. ij. 



R<. Morph. Hydro< hlor.,.. 

Bismuthi Subnit. ovj. 

Pulv. Acacia-, ,~ij- 

M. Sig. — Use as snuff, | to I the above 
in 24 hours. (Ferrier's Snuff.) 



Catarrh, Chronic Nasal. 

Sanguinaria, the tincture in 10-drop doses thrice daily or gr. ^ of the alkaloid 
internally, and the powder in small quantity locally to the mucous membrane, is suc- 

uil treatment for chronic nasal catarrh (B). Glycozone, frequently applied, is 
of benefit (Edson). Hydrastis, is of value in chronic coryza, also in ulceration of 
the septum or any other part of the nasal fossae, gtt. v of the tincture thrice daily inter- 
nally, and 5j to 5viij of water locally by syringe (P). Pulsatilla, is excellent in sub- 
acute inflammation of nasal passages, with offensive muco-purulent discharge, oj- 
ij to oiv of water, as wash (P). Potassium Dichromate, is an excellent local applica- 
tion in a solution of gr. j-x to 5iv water (B); small doses, gr. r }, u in trituration inter- 
nally, a most efficient remedy, especially when the discharge is tough and stringy, and 
the nose tender. Cocaine, is much used, but is only of temporary benefit; danger 
of inducing the cocaine habit. Resorcinol, the best of all applications; after cleansing 
the nose with Dobell's solution, use a 2 to 10 per cent, ointment in vaselin, also a spray 
every other day, of a 2 to 4 per cent, solution: it gives the same results as cocaine, but 
is slower in action and more lasting, and does not suppress the normal function of the 
mucous membrane, as the latter does. Zinc Stearate, makes an excellent insufflating 
powder, 15 parts with 5 of Europhen in atrophic rhinitis (Gibb). Myrtol is very 
satisfactory in subacute and chronic affections of the respiratory tract (Solis-Cohen). 
Argyrol in 10 to 20 per cent, solution, is a valuable application (Holmes). Ichthyol, 
a 10 to 20 per cent, aqueous solution on pledget of cotton for 15 to 30 minutes, followed 
by a salve of the same, gives good results in atrophic rhinitis (Douglass). Eucalyptus, 
has been employed with benefit (Wa). Bismuth, in powder with acacia, as in Ferrier's 
snuff (see formula above), or with tannin, calomel, etc., used by insufflation daily (Rob- 
inson). Iodoform and Tannin, 1 of the former to 2 or 3 of the latter, carefully trit- 
urated and applied by an insufflator every other day only, is the very best of all ap- 
plications (B). Sodium Chloride or Phosphate, a teasp. to the pint of warm water 
as cleansing solution, or the Bicarbonate, in the same proportion; a sea-water gargle 
in the naso-pharyngeal space, has been used with success (Mosler) ; Wei de Meyer's 
Catarrh Cure is simple Sodium Bicarbonate and a little pink coloring matter (Robin- 
son). Potassium Permanganate, gr. j-x to the pint of warm water, as a deodorant 
solution when necessary. Ammonia, by inhalation, when painful inflammation ot 
nasal mucous membrane and frontal bones (R). Phenol, in a 1 per cent, solution 
as spray, or inhalations of the vapor with that of Iodine from a bottle in hot water, 
vajiorized by the warmth of the hand (B). Salicylic Acid, in weak solution, 1 to 500 of 
water, as a disinfectant and astringent injection, used with a retropharyngeal syringe, 
and followed by applications of powdered Calomel through a speculum upon the ulcer- 
ated parts of the mucous membrane (Massei). Cubeb, finely powdered and blown 



6o8 



CEREBRAL ANEMIA — CEREBRAL CONCUSSION. 



into the nares by an insufflator (B); may be smoked, and administered internally in 
teasp. doses (Wa); in freshly ground powder as a confection, in follicular disease 
of the naso-pharyngeal space (Robinson). Ammoniacum, in the same condition, 
small doses, gr. j-iij, with Ipecac or Ammonium Carbonate, will lessen the amount 
of secretion (Robinson). Aurum Chloride, in mercurialized and syphilitic subjects, 
with offensive discharge, depressed spirits, and soreness of the nasal bones. Iodides, 
of Iron and Sodium, in catarrh of specific origin (B). Silver Nitrate, in powder, 
as alterative application, gr. x-xv to the 5 of menstruum, is often a useful adjunct to 
treatment, used once every 4 or 5 days (Robinson). Cod-liver Oil should be used 
in strumous subjects (R). Alum, in powder, dusted over the affected surface, is a 
useful application (B). Bromine, the vapor may greatly benefit, but must be used 
with caution (B). Senega, has been found serviceable (Wa). Douche is dangerous, 
being likely to cause extension of the catarrh to the Eustachian tube and the middle 
ear; it has been very generally abandoned. Sprays by hand-ball atomizers, or com- 
pressed air apparatus, of warm solutions, Vaselin, etc., are used with considerable 
success (Cohen); the Hank's atomizing tubes, with a 2-ball rubber syringe, are very 
serviceable for office use, and for the application of Rumbold's hot Vaselin spray. [See 
formula below.] Sulphur Waters, internally, of great benefit in follicular disease 
(Robinson). [Compare Ozena.] 



B;. Phenolis, itjx. 

Glycerini, 5 v j ■ 

Petrolati, 5 ij - 

M. Sig. — Warm and use as a spray every 
4 hours. (Rumbold.) 

1$. Ichthyolis, njxl. 

Mentholis, gr. v. 

Petrolati, 5j- 

M. Sig. — Salve for the nose in atrophic 
rhinitis. (Douglass.) 

Ip. Sodii Salicylatis, 5ij- 

Sodii Boratis, oiij- 

Glycerini, Bss. 

Aquae, q. s. ad ovj. 

M. Sig. — A dessertspoonful into a pint of 
warm water; snuff it from the hollow of the 
hand thrice daily. (Sajous.) 



R. Pulv. Argenti Nitrat., gr. vij. 

Pulv. Acaciae, 5j. 

Bismuthi Subnitrat off)- 

Triturat. Sig. — Apply with insufflator 
once in 4 or 5 days (Robinson.) 



R-. Phenolis, (cryst)., gr. xij. 

Sodii Bicarbonatis, 

Sodii Boratis, aa 3j- 

Glycerini, 3ij- 

Aquae, q. s. ad 5viij. 

M. Sig. — Use with nasal sprayer once or 

twice daily. (Dobell.) 

1$. Ext. Pini Canaden., njxx. 

Glycerini, ttjxxx. 

Aquas, q. s. ad Oj. 

M. Sig. — Use with post-nasal syringe. 



Cerebral Anemia. 

Iron, the tincture of the Chloride, or mild chalybeate waters, in chronic cases from 
general anemia (B). Amyl Nitrite, in vaso-motor spasm; affords relief in sudden 
attacks (B). Chloral, in small doses with stimulants and warm baths (Ros). Cam- 
phor, or other cerebral excitants, as Asafcetida, Valerian, Serpentaria (B); the Mono- 
bromide in one- to five-grain doses (Hammond). Nitroglycerin, njj of a 1 per cent, 
solution (P). Phosphorus, supplies the needed material for healthy brain action 
(B). Strychnine, stimulates the circulation generally; with Iron preparations as a 
tonic. Galvanism, a mild current transversely through the head, gives excellent 
results in the confusion of mind, vertigo, etc., due to imperfect nutrition of the brain 
from atheroma of the cerebral vessels (B). Arsenic, is highly efficient in some hypo- 
chondriacal cases (B). Aurum, is of great utility in vertigo and melancholia, when 
due to or accompanied by cerebral anemia (B). [Compare Insomnia.] 

Cerebral Concussion. 

Arnica, when concussion is due to a fall, cannot be too highly spoken of (P). 
Warmth, to extremities, rest, expectant treatment, will suffice in mild cases (Ag). 
The indications are: to recover from insensibility and collapse; to prevent inflammation; 
to restore impaired faculties (D). Stimulants or Venesection, cannot be too strongly 

reprobated (Ag). 



i 1 REBRA] ( ONG] STION CB VN« ROID. 



Cerebral Congestion. 
Aconite, in the ac live form, renders important service i B); is much the besl remedy 
in this condition (P). Belladonna, one of the best remedies in all hyperemic condi- 
tions of the brain or spinal cord (P). Gelsemium, njjv of the fluidextract every two 
hours, very useful (B). Bromides, are very useful (B); must be used in full do 
Colocynth, as a counter-irritant, appears to art well (P). Cathartics, lessen bio 
pressure (B). Colchicum, in plethoric subjects (P). Galvanism, of the brain ami 
cervical sympathetic (B). Chloral, when temperature high (B). Arsenic, sluggish 
venous circulation, torpor (B). Hydrocyanic Acid, njij v of the dilute acid (B). 
Venesection, will prevent injury to brain; not to be adopted as a matter of course; 
is contraindicated when anemia, aortic valvular disease, or in cases commencing with 
syncope I \). Water, cold douche to head, feet in warm water; ice and hot water 
alternately to head and nape of neck, often more effective than ice alone (B); hot water 
to head on flannels, mustard and hot water packing for 20 to 30 minutes around legs, 
when active congestion; protect bowels well (R). Diet, should be low, but not too 
low, until all fear of relapse is past; full animal diet should be avoided, also undiluted 
wines (A). [Compare Apoplexy, Coma.] 

Cerebral Softening. 

Venesection, and antiphlogistic treatment generally, are most beneficial in red 
softening the result of inflammation; require wise discretion, and should be used early; 
not to be thought of in the yellow form, arising from want of nutrition, wherein restora- 
tives and food are needed, perhaps wine (A). Phosphorus, in threatened softening 
of the brain; is the only drug which affects the nerve centers (W). 

Chancre. 
Mercury, small doses steadily, but ptyalism must not be induced; black-wash or 
yellow-wash on lint, to erosions and ulcerated indurations (B); Calomel alone as dry 
dressing; the internal use of Mercury is best postponed until secondary symptoms 
appear (St). Phenol, as wet dressing, gr. ij of crystals in 5iv of water applied 
thrice daily (St). Iodoform, heads the list of dry dressings; with Lycopodium, equal 
parts, or 1 to 2 of Zinc Oxide; 2 to 1 of Calomel (St). Hydrogen Dioxide, said to 
destroy the specific character; wash lesions thrice daily, and apply lint soaked in it (R). 
Caustics, should never be used unless chancre is attacked by phagedena (St). Caustic 
Alkalies, to hard edges (R). Bromine, Chromic Trioxide, the best escharotics (B). 
Dressings, are effective as far as the local trouble is concerned in the majority of cases,, 
sometimes a piece of lint on the erosion will suffice (St). Cleanliness if absolute is 
the best treatment, the use of corrosives only delays the healing process (Clark); of 
great importance; tepid water locally frequently suffices for the local treatment of 
infecting chancre [Compare Chancroid, Syphilis.] 

Chancroid. 

Mercury, the Acid Nitrate one of the best caustics; apply with a glass rod (B). 
Nitric Acid, fuming, as caustic (R); 5j to oviij aqua? is an excellent dressing (St). 
Phenol, injected into the sore (B); 5ij-v to Oj aqua? locally in phagedena (St); 
the pure acid as cautery to thoroughly destroy the germs, followed by Iodoform or 
other antiseptic drying powder (Ruggles). Ferri et Potassii Tartras is the specific 
enemy of phagedema (Ricord); oj to ovj aqua?, internally, teasp. doses thrice daily; 
also locally (St). Ferrous Iodide, in sloughing phagedena, or simple chancroid in 
debilitated constitutions (B). Iodoform, powdered and dusted over the sore, allays 
pain, changes morbid action, and is antiseptic (R); 1 part to 2 of Lycopodium, or one 
of Tannic Acid; as stimulant and alterative (St); does no good except to relieve pain 
>ssV Potassium Chlorate, is impalpable powder, is better than Iodoform (B) 
40 



6io 



CHAPPED HANDS AND LIPS — CHILBLAINS. 



Chloral, gr. iij ad oj aquae, the best local application to relieve pain (Gross). Caustics, 
in severe cases, the white-hot iron, strong Sulphuric Acid, pure Nitric Acid, pure 
Phenol, are effective in the order named (St). [Compare Bubo, Chancre.] 



Chapped Hands and Lips. 
Sulphurous Acid, as solution or by fumigation, will speedily cure (R). Glycerin, 
diluted, or better still, Glycerite of Starch, or with £ the quantity of Eau de Cologne 
(R). Benzoin, the comp. tinct. i part to 4 of Glycerin; an admirable application 
(P). Hydrastis, on compress as lotion (P). Collodion is usefully employed (P). 
Phenol, 1 part to 2 of Glycerin, locally; one application is generally sufficient. 
Unguentum Aquae Rosee alone, is often efficient; may be combined with Zinc Oxide. 
Menthol, with Salol, etc. (see below), is said to alleviate the pain of chapped hands 
on the first application. Picric Acid, a 1 per cent, solution locally (Maddock). 

3- 



1$. Mentholis, gr. xv. 

Salolis, gr. xxx. 

Ol. Olivae, 5ss. 

Adipis Lana?, ojss. 

M. Ft. unguentum. 



Cetacei, 3j- 

Glycerini 5 i j ■ 

Cerae Albas, gr. xv. 

Ol. Amygd. Amarae, IRnj- 

M. Ft. unguentum. 



Chest-pains. 

Belladonna, as ointment, when tenderness is in the skin (R). Iodine, as oint. 
when pain is in muscles (myalgia) of chest, they being tender on pressure, while the 
skin may be pinched without pain (R). Strychnine, affords relief in functional 
irritability of the nervous system, manifested by wandering neuralgic pains (B). Arnica 
internally for a stitch in the side. Bryonia, when painful catching of breath. Cim- 
icifuga, for intercostal rheumatism and pains under the breasts in women. [Com- 
pare Myalgia, Neuralgia, Pleuritis, Pleurodynia, Pneumonia.] 



Chilblains. 

Digitalis, internally and locally, to improve the circulation, and combat the arterial 
hypo-tension and peripheral vaso -dilatation which are always present in those subject 
to chilblains (Pilatte). Caffeine and Kola may sometimes be substituted for Digitalis. 
Iodine, as ointment, the best application (R); the tincture lightly painted over the 
surface every 3 or 4 days, is particularly serviceable for the itching. Arnica, is a useful 
application (Wa). Phenol, with Iodine, as an ointment, is a very efficient appli- 
cation for chilblains. Benzoin, the tincture in Glycerin, applied after thorough wash- 
ing in soap and water and drying, the best application. Sulphurous Acid, an efficient 
application; 3j to 3iij each of water and glycerin (B); as solution or fumigation (D). 
Balsam of Peru, in ointment for broken chilblains (R). Capsicum, the tincture 
painted over unbroken chilblains (R). Cajuput Oil, applied locally (R). Turpen- 
tine, as wash, then apply Basilicon Ointment mixed with Turpentine (B). Ichthyol, 
a 10 per cent, ointment with Lanolin or Vaselin as the base, relieves promptly and 
cures (Macpherson) ; a 20 per cent, ointment with Lanolin (Kopp); equal part with 
Oil of Turpentine gives excellent results (Klonk); 33 per cent, ointment gives the best 
results in frost-bite, quickly relieving pain and subduing inflammation (Hermance). 
Picric Acid, a 1 per cent, solution locally is specific (Maddock). Hydrogen Dioxide 
diluted with warm boiled water, for immersion of foot (Courtin). Thiol, the dry form, 
as a dusting powder, is used efficiently. Alcohol, as Eau de Cologne, or camphorated, 
with friction, after careful drying of the hands and feet. Vaselin and other fatty sub- 
stances should never be applied (Pilatte). 



R;. Tinct. Digitalis, ojss. 

Thymolis (cryst.) gr. xlv. 

Alcoholis (70 C), 

Glycerini, aa 5 xv. 

M. Sig. — For local use. {Pilatte.) 



1$. Phenolis, 3j- 

Tincturas Iodi, 3ij- 

Acidi Tannici, 3 j- 

Cerati Simplicis, Si v. 

Misce bene, ft. unguentum. (Morrow.') 



CHLOROSIS CHOKING— CHOLERA VSIATICA. 



6n 



Chlorosis. 
Iron, combined with Arsenic or Strychnine, also occasional purgation and active 
exercise (R); the [odide, when much torpor of the system, is often speedily efficacious 
(Wa); Iron is not a specific in chlorosis, and acts best in the purest types (Tr). Hem- 
ogallol benefits cases which cannot tolerate inorganic iron (Porter). Manganese, 
the saccharated carbonate of iron and maganese I B); Pepto-mangan is a good prepara- 
tion. Arsenic, if Iron fails or disagrees (B). Aurum Arsenate, has rendered | 
service. Ergot, in chlorotic amenorrhea (P). Nux Vomica, stimulates the blood- 
making organs, and may be combined with Iron; a very generally useful preparation 
is the syrup or elixir of Iron, Quinine, and Strychnine (B). Cocculus Indicus, when 
amenorrhea and exhausting leucorrhea (P). Hypophosphites, of Calcium or Sodium 
R). Benzoin, has been used with advantage (P). Pepsin, benefits, especially 
where digestive derangement (B). Sulphur, of great benefit in cases where Iron is 
of no effect; also to prepare the system for benefit from Iron (Schulz). Bone Marrow, 
has been used with benefit. Thymus Extract, has apparently been of service. Nu- 
clein, is employed with success in some cases. . Orexin, the Tannate is remarkably 
efficient for the anorexia (Kolbl). Quinine Salicylate, as a gastro-intestinal anti- 
septic and disinfectant, preventing auto-toxemia upon which the disease so largely 
depends (Moore). Kumyss, is a valuable nutrient (Brush). Purgation, is very 
important, to prevent auto-infection from putrid intestinal decomposition, which is 
the true cause of this disease (Duclos); absorption of such products tending to impover- 
ish the blood, and produce a "fecal anemia" (Sir A. Clark). Oils and Fats, as inunc- 
tions, after baths, of great benefit (B). Galvanization, will aid the action of the 
remedies (B). [Compare Anemia, Amenorrhea.! 



K. Ferri Arsenatis, gr. ij. 

Extract! Cinchonae, gr. xij. 

Fiant pil. xij. Sig. — One pill after each 
meal. (B.) 

B- Ferri Sulph. Exsiccat., gr. xl. 

Quinina: Sulphatis, gr. xx. 

Strychninae Sulphat., gr. ss. 

Ft. pil. xx. Sig. — One thrice daily. 



B • Aloes, gr. v. 

Ferri Sulph. Exsiccat., gr. xv. 

Ol. Tanaceti, vel 

Ol. Sabinae, gtt. xxx. 

Croci, 
Myrrhae, 

Cantharidis, aa gr. xxx. 

Ft. pil. lx. Sig. — Two thrice daily, gradu- 
ally increased to four. {Wallace.) 



Choking. 

Potassium Bromide, benefits a curious affection, sometimes found in children 
who from their birth can swallow solids with ease, but choke at drinks (B). Oil of 
Cajuput, in one case of persistent choking sensation in the throat, a few doses removed 
the symptom which had lasted several weeks (Hale). 



Cholera Asiatica. 

Camphor, is to some extent an efficient remedy, checking intestinal secretion and 
allaying pain and spasm (W); a drop or two of the saturated tincture, or gtt. v-x of the 
spirit with a little Opium every half-hour (B) ; gtt. iv-vj of strong spirit every ten minutes 
until symptoms abate, then hourly (R) ; the combination of camphor, opium, etc., known 
as Squibb's Cholera Mixture (see next page for formula) is an efficient remedy at the 
inception. Opium with astringents, to control the diarrhea as early as possible (Tirard) ; 
Morphine hypodermically in the preliminary diarrhea (P); is of the greatest value 
even in collapse (R); dangerous when renal complications exist (P); is the principal 
ingredient in Chlorodyne, a remedy commonly used in India. Atropine as a sedative 
to the gastro-enteric branches of the vagus, which are greatly excited by the toxins of 
the disease (Harkin); used often with satisfaction (Waugh). Chloroform, a few 
drops frequently repeated, of great value (B); has proved a very efficient remedy. 
Chloral hypodermically in the algid stage (Hall); with Morphine by hypodermic 



6l2 



CHOLERA ASIATICA. 



injection, is most effective treatment (B); causes pain and induration but not suppura- 
tion (B); is of doubtful value (W). Sulphuric Acid, has been used with advantage 
(W); with Opium, is very effective (B); two parts of the aromatic acid with one of 
Laudanum, of which njjv-xxx according to age, is one of the best prophylactics (Mc- 
Clellan); as lemonade, proved an efficient prophylactic in the insane department of the 
Philadelphia almshouse (Curtin); is a most rational remedy, being injurious to the 
spirilla and also astringent. Quinine, by the mouth or by enteroclysis if vomited, but 
not by venous or hypodermic injection, inhibits the spirilla and disinfects the intestinal 
canal; gr. x of the sulphate in acid solution or as powder every hour for 4 hours, then 
a less amount at longer intervals (Fullerton); used in Russia in the Botkin's Cholera 
Drops (see formula below). Calomel in small, repeated doses with Opium, has given 
satisfaction; as an intestinal antiseptic from the first onset of the disease (Tirard); 
some authorities recommend a laxative at the start to clear out the bowels, followed 
by small doses of Calomel and Opium every 2 hours: Calomel in large doses was used 
successfully by army surgeons, at southern military posts during the epidemic of 1873. 
Arsenic, in epidemic cholera, for the vomiting and collapse (R); some cases of arsenic 
poisoning are not distinguishable from cholera (B). Salol, has done excellent service 
as an intestinal antiseptic, and prevents anuria (Hueppe); is peculiarly antagonistic 
to the comma bacillus (Lowenthal). Guaiacol, the Carbonate as an intestinal anti- 
septic has been used with benefit. Paracotoin, in doses of gr. iij hypodermically, 
has been used with success. Ammonia, njjxv-xxx of the stronger solution diluted 
with 4 volumes of water, by intravenous injection for sudden collapse, may be repeated 
in 15 minutes if necessary (W). Strychnine as a prophylactic during the preliminary 
diarrhea, and as a stimulant when nearing collapse (B). Alcohol, small doses of 
iced brandy for vomiting (B). Spinal Ice-bag, for cramps (R). Saline Injections, 
into the veins, have been successful in the collapse (B); Sodium Chloride, Sodium 
Carbonate, aa 3j, Boiled Water quart j, makes a suitable injection, of which one to 
three quarts at ioo° F. may be slowly injected into a vein by gravitation, the effect 
being carefully watched (Mn). Milk, by transfusion, in the collapse (B). Irrigation 
of the intestines with hot water and soap, using 1 to 3 gallons at a time twice daily, also 
Hydrogen Peroxide with hot water to cleanse the stomach; the method used by me 
in Russia and at Hamburg, during the epidemic of 1892 (Elmer Lee): enteroclysis by 2 
quarts of fluid 'thrown high into the bowel and repeated every two hours, containing 
Sodium Chloride oj to the pint, or Tannic Acid, 5j-3j to the pint, have proved very 
satisfactory. Hypodermoclysis by a normal salt solution delivered slowly into the 
subcutaneous tissues, may be used conjointly with enteroclysis; it replaces lost fluid, 
stimulates in shock, and aids the elimination of the toxin (Kemp). Heat to the body 
is very essential. Absolute Rest, recumbent position, no food, ice freely, enemata 
of warm milk, fresh air, friction and heat to abdomen, legs, and feet; no alcoholic 
stimulants, they are worse than useless. Cholera Toxin, as inoculated by Haffkine 
for immunization, has been used on a large scale in India with a measure of success 
(W); a toxin for prophylaxis and an antitoxin for therapeutic treatment, were used by 
the official physicians in Japan during 1902, with a reported mortality of about 35 per 
cent., against one of 70 per cent, at the same time in the Philippine Islands. Treat- 
ment, a purely symptomatic and expectant treatment is the only one of any proved 
value (Mn). 



3. 



M. 



Chloroformi, 5 j- 

Tinct. Opii, 
Spt. Camphorse, 

Tinct. Capsici, aa iij - 

Alcoholis, q. s. ad oij- 

Sig. — 30 to 60 drops in water. 

{Squibb' s Cholera Mixture.) 



R. Phenolis, gr. viij. 

Bismuthi Subnit., oij- 

Mucil. Acacias, 

Aquae Laurocerasi, aa oj- 

M. Sig. — Teasp. ever)' hour or two, for 
the vomiting and diarrhea. 



S 



Ol. Menthae Piperita?, partem j. 

Tinct. Opii, partes iv. 

Ac. Hydrochlor. Dil., partes ij. 

Quininae Hydrochlor., partes iv. 

Tinct. Cinchona; Comp., 

Spt. ^itheris Comp., aa partes xv. 

M. Sig. — 15 drops every 2 hours. 

{Botkin's Cholera Drops.) 



R. Chlorali Hydrati, 5iij. 

Morphina; Sulph., gr. iv. 

Aqua; Laurocerasi, 5 j- 

M. Sig. — Fifteen to twenty drops as in- 
jection hypodermically. (B.) 



CHOLERA INKWIIM CHOLERA SIMPLEX. 613 



Cholera Infantum. 
Bismuth Subnitrate, in hourly doses of 3 to 6 grains, is regarded by many as 
almost a specific. Ipecacuanha, greenish stools with mucus and often blood B) 
Arsenic, for vomiting and collapse (R). Mercury, gr. i of gray powder hourl] 

great service in infantile cholera with incessant sickness, profuse, almost continuous 
diarrhea, offensive and nearly colorless stools; a Starch injection, with a minute quan- 
tity of Laudanum, assists the gray powder, and should be given in urgent cases (R). 
Calomel, gr. iij-v dry on the tongue, for its antifermentive action in the small intestine.-, 
which are inaccessible to irrigation (Visanska). Atropine as a sedative to the gastro- 
enteric branches of the vagus which are greatly excited by the toxin of the disease 
(Harkin); gr. -.',,, hypodermically is very effective, especially as a stimulant in the col- 
lapse (Waugh). Zinc Phenolsulphonate, gr. J-j, with a grain of Bismuth Subnitrate 
and one of saccharated pepsin or other digestive ferment, every } hour until the danger 
is past; proved very effective in cases resisting other treatment (Id). Zinc Oxide, 
with Bismuth and Pepsin, is very useful (B). Camphor, 5j of the spirit in §iv of 
milk, very servicable (B); an admirable remedy for summer and choleraic diarrhea 

R . Opium is generally necessary; enemata of Starch and Laudanum [see above 
under Mercury], Morphine, hypodermically, in doses of gr. ._,,',„ to ^according to 
age, the latter dose for a child of one year, with 5 or 6 drops of Etner, to be re- 
peated in an hour, the most efficient treatment (E. Smith). Copper Sulphate is often 
very successful (B). Phenol, with Bismuth, may arrest the disorder promptly 
(Br). Lead Acetate, is one of the most useful astringents in this complaint (Br). 
Potassium Bromide, when due to nervous irritation or cerebral congestion (B). 
Tannic Acid, oss to the pint of cold water, as intestinal injection after lavage, to 
precipitate proteid toxins (Visanska). Tannalbin is an efficient remedy (Rey). Mag- 
nesium Sulphate, gr. v, with m; i of laudanum, in solution every 2 hours for a child 
one year old (Visanska). Silver Nitrate, is beneficial after the acute symptoms have 
passed (B). Caffeine, when due to nervous irritation (R). Coto Bark, the tinct. gtt. 
j-iij, is highly recommended by Rohrer for choleraic diarrhea in children. Alcohol, 
in grave cases, with tendency to collapse, gtt. x-xx of brandy with milk every 30 to 60 
minutes. Diet, farinaceous food a common cause; no food, not even milk, in the acute 
stage when the digestion is inactive. Kumyss is the best food (Brush); milk and 
lime-water (R); no starches or fats (B); drinks freely to keep the vessels filled and 
prevent paralysis of the heart (Meinert). Milk in any form should be absolutely 
prohibited in infantile summer diarrhea, it being the best medium to favor the growth 
of the bacteria (Hoag). Lavage of the stomach and colon with normal salt solution, 
should be done at once (Visanska). Spice Poultice, composed of Cloves, Ginger 
and Cinnamon, mixed with brandy or whiskey, applied to the abdomen. Mustard 
Bath in collapse, also as mustard plaster over the heart, and ether hvpodermically 

Smith). 

K. Phenolis, gr. xxiv. , R<. Plumbi Acetat., gr. xxiv. 

Spt. \'ini Gallici gtt. xxiv. Opii Pulveris, gr. xij. 

Aquae Menth. Pip., 5jss. Camphorae oss. 

Mucil. Acacias, 5vj. Sacch. Lactis, q. s. 

Syr. Papaveris, ovj. Triturat. et div. in chart, xij. 

Tinct. Opii Deod., gtt. x. Sig. — One powder every hour. (B.) 



M. Sig. — A teasp. every 2 hours. 



R. Hydrarg. Chlor. Mitis, gr. 

Bismuthi Subnitrat., gr. ij-v. 

In powder even.' half hour for the vomiting ! Ft. pulv. no. j. Repeat every half-hour or 



R. Hydrarg. Chlor. Mitis, gr. 

Plumb. Acetatis, gr. 

Opii Pulveris, gr. ,'„- 



and purging. hour for the acute gastric symptoms. 

Cholera Simplex. 

Camphor, an admirable remedy (R). Salol, is highly efficient. Salophen, is 
equally so. Veratrum Album, for the vomiting (R). Copper Salts, have been 



614 



CHORDEE — CHOREA. 



given (R). Arsenic, for vomiting; also for collapse in later stages (R). Chloral, 
hypodermically with Morphine, is the most efficient treatment (B). [See C. Asiatica 
for formula]; for the cramps Chloral Bj in Linim. Saponis oiv to vj, applied to the 
abdomen with friction (Da C). Opium, gr. J to £ every 2, 4, or 6 hours, in the early 
stage (P). Morphine, gr. J to £ hypodermically, is very useful (B). Phenol, with 
Bismuth is very effective (B). Lead, the Acetate in the early stages (R). Calumba, 
as anti-emetic, of great value (P). Ipecacuanha, has been used with much ad- 
vantage (Wa). Sumbul, said to have proved successful (P). Mustard, as an emetic 
in collapse, to stimulate a failing heart (P). Cajuput Oil, much used in India for 
choleraic affections (P). Alcohol, as iced brandy in small doses for vomiting (B); 
the value of stimulants is justly doubted; if given, should be largely diluted (Wa). 
[Compare Cholera Asiatica and Infantum.] 



Chordee. 

Aconite, gtt. j of the tincture hourly, will relieve chordee (R). Belladonna, 
combined with Camphor or Opium, gives the best results of remedies administered 
internally (St). Camphor, 3j doses of the spirit will relieve (R). Cantharis, gtt. j 
of tinct. ter die, will prevent (R). Cannabis Indica or Cannabis Sativa (P). Lu- 
pulin, valuable (P); said to prevent (B). Morphine, hypodermically, the one sure 
remedy; should be injected into the perineum at bedtime (St). Cocaine, a few 
drops of a 4 per cent, solution, locally to the glans; or injected into the urethra, promptly 
relieves chordee. Diet, should be plain, even low, no stimulants; copious draughts 
of barley-water, or linseed tea. 



1$. Liq. Morph. Magendie, 3iv. 

Atropinae Sulphat., gr. j . 

Acidi Acetici, q.s. 

Aqua Destillat. q. s. ad oj- 

M. Sig. — v— TfJiviij hypodermically at bed- 
time. (Sturgis.) 



J$. Opii Pulveris, gr. xij. 

Camphors, gr. xxiv. 

Sacch. Alb., q. s. 

Fiant capsular xij. 

Sig. — One at bedtime, to be repeated in 
2 hours if required. (Slurgis.) 



Chorea. 

Antipyrine, is the only medicine from which cures may confidently be anticipated 
(McCall Anderson); is successfully used to combat excitability of the motor nerve 
centres (W); may be given in 2 grain doses every 3 hours to very young children 
(Whitla). Acetanilide, used with benefit, in both mild and grave forms of chorea (Id). 
Exalgin, with Citrate of Iron and Quinine after. meals (Dana); is believed by many 
to have specific power over chorea, given in doses of 2 grains thrice daily and gradually 
increased to 3 grains five times a day. Arsenic, is one of the most certain remedies, 
but large doses are required and are well borne (B); irjfiij of Fowler's solution thrice 
daily for a child of 7 years, gradually increased to irjx thrice daily, and may be continued 
for several weeks (Whitla); is very successful in uncomplicated cases (R). Sodium 
Cacodylate, the salt of an arsenical compound, in daily doses of gr. J-f (Lannois). 
Cannabis Indica, mjij-viij of the tincture as per age, every 3 or 4 hours, has a rapid 
sedative effect on the convulsive movements (Burton). Zinc Sulphate, in doses of 
2 or 3 grains gradually increased to 8 grains, is next in value to arsenic (Whitla); in 
large and increasing doses is very useful (R); has action similar to that of Arsenic, 
but is inferior (B). Hyoscyamine, .jJu grain thrice daily, gradually increased, has 
cured cases which have resisted all other remedies (Da C). Duboisine is equally effi- 
cient; the Solanaceae are very suitable for nervous, delicate children. Trional gives 
prompt relief (Meade). Aspirin is an excellent remedy (Gorges). Quinine, as a 
stimulant to the inhibitory centre which controls motor discharge from the spinal cells, 
and which is weakened in chorea to a greater degree than the discharge power (W). 
Aurum Bromide, in daily doses of gr. & to £, continued until its characteristic head- 
ache is produced (Goubert); the Bromides in full doses have proved useful. Chloral, 
contributes to cure by inducing quiet sleep (R); in gradually increasing doses is of 



CHOROID] riS CHYLl R] \. (,i e 

the greatest service, as it has an almost absolute power to suspend or control spasm 
during its deep hypnotic action (Gairdner). Chloralformamide, may be pushed with 
greater safety, and excellent results have followed its use (Whitla). Physostigma, 

is recommended (R); is of doubtful benefit (B); cures the disease in 5 or 6 days with 
doses of ,',, grain of Phvsostigmine twice daily hypodermically (Reiss). Calcium 
Chloride, has done good in strumous subjects (B). ' Cocaine, is of the highest value, 
and lias cured cases repeatedly in which all the ordinary remedies had been used in 
vain; the whole amount given daily has rarely exceeded } grain (15). Cimicifuga; 
is a very valuable remedy in cases due to menstrual derangement (P); when there is 
a rheumatic history (R). Strychnine, in doses gradually increasing to the toxic (Tr); 
minute doses, gr. S ' M to ,',,, have been highly useful when chorea is due to fright or 
commencing puberty (B). Cuprum Ammoniatum, has been used successfully (B). 
Iron, large doses of the Subcarbonate in anemic cases, about the time of puberty (B). 
Chalybeate waters often relieve or cure. Arsenic generally belter, unless anemia 
coexists (R). Veratrum Viride, has been employed (R). Cocculus, or Picroto.xin, 
large doses (P). Conium, in large doses, to quiet muscular agitation (B); is only 
palliative (R); evidence contradictory as to its value (P). Valerian, said to restrain 
the movements (R); useful when from worms (P). Chloroform, inhalations often 
of great service in severe cases (R). Morphine, with Chloral, hypodermically in 
large doses for severe cases (Tr); when the movements prevent sleep (R). Musk, 
has been given (R). Cod-liver Oil, when nutrition is low (R). Water, by cold 
affusion to head and spine, cold baths are important (B); tepid water first, cold should 
not be used if rheumatism or fever or pain in the joints (R). Electricity, static, is 
useful in some forms (B); the constant current used in 20 cases, all recovering (Bene- 
dict); a galvanic chain around the neck and down the back, is reported serviceable. 
Rest in bed is essential (Perry). 

I!. Chlorali Hydrati 5iv. Py. Tinct. Ferri Chloridi, 5j 



Tinct. Hyoscyami, 

Syr. Limonis, aa o j. 

Aquae Cinnamomi, o iv. 

M. Sig. — A teasp. 3 or 4 times daily, 
according to age. 

1>. Zinci Oxidi gr. iij-vj. 

Sacchari Albi, gr. l.xxv. 

M. et div. in pulv. no. vj. 
Sig. — One powder thrice daily. 

(Bamberger.) 



Liq. Aeidi Arsenosi, ~>ij. 

Syr. Limonis, o jss. 

Aquae q. s. ad 5 viij. 

M. Sig. — A teasp. thrice daily after 
meals, gradually increased and effects 
watched. 



1$. Arscni Trio.xidi gr. ■'„ .',■,. 

Ferri Reducti, gr. j-iij. 

Quininoe Sulph., gr. ij-v. 

In pill or capsule, thrice daily. (Sachs.) 



Choroiditis. 

Mercury, as in iritis; cannot be borne to the same extent as in the latter disease 
(A). Opiates, necessary externally and internally to overcome pain (A). Treat- 
ment, is generally the same as in corresponding forms of iritis, but when atrophic 
spots appear on the choroid, no treatment can repair the damage (A); rest of eyes 
and protection from light by blue glasses; in suppurative form (panophthalmitis) use 
Atropine, in strong solution, with ice compresses and leeches in early stage; Para- 
centesis repeatedly to relieve tension and give exit to pus; Canthoplasty of outer canthus 
to relieve the pressure of the lids (Roosa). 

Chyluria. 

Thymol, in doses of 1 grain, gradually increased to 5 grains, cured two cases of 
chyluria due to filariae in the blood (Laurie). Hypophosphites, the syrup in emul- 
sion with Cod-liver Oil, caused the entire disappearance of chyluria in a woman who 
had been a life-long sufferer therefrom (Barnes). Sodium Benzoate, in doses of 
5j thrice daily, gave promising results, but the after-history of the cases was not ob- 
tained (Mackenzie). Potassium Iodide, in large doses, has checked the discharge 



6l6 CLIMACTERIC DISORDERS — COLIC. 

for a time in several cases (Lewis). Gallic Acid, in doses of 5j-ij, always affords some 
benefit (Id). Ferric Chloride, large doses of the tincture do some good (Id). Treat- 
ment, is unsatisfactory; no remedy appears to possess any constant effect (Whitla); 
drugs have no influence whatever in stopping the lymphorrhagia, the best results are 
obtained by absolute rest in bed, elevating the pelvis, restricting the amount of food 
and fluid — especially fatty food, and gentle purgation (Mn). 



Climacteric Disorders. 

Aconite, for nervous palpitations, and restlessness or "fidgets"; gtt. j hourly (R). 
Cimicifuga, for distressed headache (R). Amyl Nitrite, in small doses when the 
"heats" predominate, followed by cold, clammy, pale skin (R). Ergot, for the flood- 
ing, gr. ij of Squibb's extract in fresh pill ever} 7 hour until relieved; Cannabis Indica 
may be well combined with it. Cannabis Indica, is used in the headaches of the 
menopause, with uniformly good results. Picrotoxin is a valuable remedy for the 
vasomotor disorders. Iron, for flutterings of the heart, with fullness of head, heat 
and weight on the vertex, frequent flushings, and hot and cold perspirations; large 
doses of the Chloride thrice daily (R). Nux Vomica, Opium and Belladonna, 
when the symptoms described above under Iron are limited to the head and face (R). 
Ammonia, Raspail's sedative lotion to painful part of the head in climacteric head- 
aches (R). Potassium Bromide, for the despondency, with sleeplessness and irri- 
tability, often also with heats, flushings, perspirations (R). Physostigma, the extract 
gr. 37j every \ hour for 7 or 8 doses, for flatulence and a sensation of fluttering at the 
pit of the stomach (Smith). Camphor, for drowsiness and headache; Eau-de-cologne, 
saturated with Camphor, rubbed on the head (R). Zinc Valerate, for hysterical 
symptoms (R). Change of air and scene, when other treatment only partially success- 
ful (R). Warm Bath, to promote free perspiration; at 90 to 95 F. for an hour, 
once a week, will correct many of the symptoms (R). [Compare Menorrhagia, 
Metrorrhagia.] 

Coccygodynia. 

Chloroform, injected as deeply as possible about the seat of greatest pain (B). 
Electricity, has cured one severe case of 12 years' standing, and helped others. Sur- 
gical treatment the only resource in rebellious and painful cases (Ros). Nott extir- 
pated the coccyx; Simpson performed subcutaneous section of muscles and ligaments; 
Goodell removed the bone, after first treating the case as the local expression of a gen- 
eral neurosis. 

Coldness. 

Strychnine, for cold hands and feet (R). Cold Baths, with friction to the skin, 
nightly for cold feet (R). Chloral, in small doses daily, will counteract the coldness of 
the feet and hands in certain cases of anemia, hysteria, etc. (Cherchevsky). Spinal Ice- 
bag, is often efficiently employed in general coldness of the surface, and persistent cold- 
ness of the hands and feet (R). Cocaine or Atropine, will raise the body -temperature. 

Colic, Intestinal. 
Nux Vomica, quickly subdues abdominal cramps and spasms (P). Belladonna, 
especially in children (R). Chamomile Oil, njjiv-vj, in colicky attacks of hysterical 
women (P). Cocculus, of great value, especially during pregnancy (P). Chloral, 
sometimes relieves (R). Chloroform, effective in flatulent colic; also useful in hepatic 
and saturnine (B); often used combined with Opium (D). Potassium Bromide 
in a peculiar form of colic in young children (R); given in Anise- or Peppermint-water 
is of greater efficacy for the colic of infants than the opium preparations in general use, 
and perfectly safe (B). Asafoetida, no better remedy in flatulent colic of infants; 
teasp. doses of the emulsion (B). Dioscorea, is used successfully in so-called bilious 



CO] tc 



617 



colic, im'w \w of the fluid extract. Morphine, gr. ' 1 hypodermically, repeated 
in 15 minutes, gives more relief than any other remedj in all forms ol colii 
quent small doses (P). Arsenic, will cure in a surprising manner when enteralgia 
is idiopathic (B). Essential Oils, especially those of Cloves and Cinnamon 
of Anise, Cardamom, etc.; Oil of Rue in flatulent colic of children (P), Magnesium, 
the Carbonate with Opium and Asafcetida, as in Dewees's Carminative, tin- dose 
being itR.xx for an infant 2 to 4 weeks old. Tobacco, as enema, is dangerousl (B); 
lyster, or by stomach (R). Ammonia, in spasm of intestinal canal and in 1 
hildren or infants from had feeding (R). Lime Water, for young children who 
- milk in lumpy masses, with colic and flatulence (R). Water/hot fomentations to 
pain (R); a copious enema of warm water often gives immediate relief. 

K. Ext. Gentians, 1>. Camphors, 

Rhei aa oj- | <su i, 

Ft. pil. xx. Sig. — One or two pills thrice Zingiberis aa.gr.ij. 

daily for tendency to colic. Ft. pil. xij. Sig. -One pill as required. 

Colic, Lead. 

Alum, singularly, is the best remedy (B); gr. x hourly (R); converts the poisonous 
salt oi lead in the system into a comparatively innocuous sulphate; ojss-iv daily with 
njxl-1 Tinct. Opii, and an occasional close of Castor or Croton Oil to procure one or 
two motions daily (Wa). Opium, gives more relief than any other remedy, gr. £ to 
\ of Morphine hypodermically (B); gr. ij-iv of Opium, with a moderate dose of Castor 
Oil (P . Sulphuric Acid, diluted well, as a prophylactic, and is useful in the treat 
ment of the disease (B); considered remarkably efficient when used in association 
with repeated Sulphur baths (Wa). Calomel, a full dose, with or without Opium, 
followed in a few hours by Castor Oil and a Turpentine enema, often affords speed) 
and marked relief (Wa). Tobacco, may control, but is dangerous (B). Croton Oil, 
in half-drop doses, with sufficient Opium to relieve the pain, repeated every 3 or 4 
hours until free evacuations are produced; proves effectual when other remedies fail 
(Wa). Magnesium Sulphate, for the constipation, and to remove the poison from 
the system; should be combined with Potassium Iodide, oj of the former thrice 
daily and about two hours after having given gr. v-x of the Iodide; this treatment 
Ives the lead in the tissues, causes its elimination by the intestinal mucus, renders 
it insoluble after it has entered the intestinal canal, and quickly removes it from the 
body (Br). Atropine, gr. ,',„, with Potassium Iodide, gr. v, gives excellent results 
in the treatment of lead-poisoning, the former relieving the colic and pain in the head in 
the most rapid manner, keeping the bowels open freely, assisting in the return of the 
bodily powers, and aiding in the removal of the lead by the Iodide (Humphreys). [Com- 
pare POISOXTNG BY LEAD.] 



I!. Aluminis, oij- 

Ac. Sulphurici Dil., 5i- 

Syr. Limonis, § j. 

Aquae, 5iij. 

M. Sig. — Tablesp. every hour or two for 



R. Magnesii Sulphatis, oj. 

Ac. Sulphurici Dil., !"> j. 

Aquas, oiv. 

M. Sig. — Tablesp. every 3 hours (B); or 
thrice daily, each time preceded I" a 5- to 



■•lie. (B.) 10-grain dose of Potassium Iodide. (Br.) 

Colic, Renal and Hepatic. 
Ether, inhaled in paroxysms of hepatic colic (R). Chloroform, by inhalation in 
renal and biliary colic, inferior only to Morphine injection, superior to Opium, warm 
baths, etc.; two or three administrations will be required (R). [See also Cone, Intes- 
tinal.] Counter-irritation, flying blisters for renal colic (R). Opium, small doses 
with Spt. Chloroformi every five or ten minutes until the pain gives way, or Morphine 
hypodermically (R). Turpentine, has been given with benefit in biliary colic (R). 
Olive Oil, in full dose during an attack of colic, frequently gives relief (Brockbank); 
stops the spasm of the ureters, and acts in nephritic colic precisely as it does in hepatic 



6l8 COLLAPSE — COMA — CONDYLOMATA. 

colic (Aussilloux). Glycerin, in doses of ov-vij in hepatic colic brings the attacks 
to an end; doses of 5j-iv daily, in a little alkaline water, prevented recurrences (Fer- 
rand). Water, warm baths to ease the pain (R). Aliment, withhold all starches and 
fats; Alkaline mineral waters are useful (B). [Compare Calculi, Biliary.] 

Collapse. 

Camphor, 5j of a 10 per cent, solution in oil, hypodermically into each forearm, 
in the collapse of pneumonia (Schilling); hypodermic injections of camphor are used 
tor the purpose of excitation in collapse. Ether, by mouth, inhalation, or hypodermi- 
cally, is of great sen-ice. Ammonia, the water diluted, by intravenous injection, in 
cases of fracture and laceration accompanied with collapse (P); in desperate cases 
when the hypodermic method is the only available route (Whitla). Brandy, or other 
alcoholic stimulant, by mouth if the patient can swallow, if not then by the bowel or 
hypodermically (Id). Digitalis, the tincture as a cardiac stimulant, but being slow 
of action it should be preceded by Ammonia or Alcohol. Strychnine, or Nux Vomica, 
for impending cardiac failure, is very efficient. [Compare the articles on Heart Af- 
fections and Syncope.] Caffeine has a good effect in many cases of failing circula- 
tion. Atropine is of great value in sudden collapse with subnormal temperature, loss 
of arterial tension and copious sweating (W). Adrenalin hypodermically, for the 
vaso-motor collapse of cocaine or chloroform poisoning (Miles). Musk of good quality. 
is an efficient cardiac stimulant. Electricity to the phrenic nerve, or an interrupted 
current through the upper extremities (Whitla). Beef Extract, Liebig's in large doses 
with hot water, is a rapidly acting stimulant (Id). Transfusion, or a warm saline 
solution by subcutaneous injection, when collapse is associated with extensive hem- 
orrhage; or an Esmarch bandage to the limbs, or the tourniquet to the femoral artery, 
to keep the blood out of the lower extremities (Id). Heat to the surface and over the 
cardiac region. Counter-irritation, by mustard to the spine, nape of the neck, and 
calves of the legs. Affusion, of cold water alternating with hot (P). [Compare 
Exhaustion, Shock, Syncope.] 

Coma. 

Alkalies are antagonistic to the acid toxins of diabetes, and should be given at 
once in enormous doses when the prodromes of coma appear (Elliot); Sodium Bicar- 
bonate, ioo grains in a pint of milk 3 or 4 times daily, or 200 grains at one subcutaneous 
injection (White). Croton Oil, as a purgative, ttj>J or J every hour, mixed with a 
little butter or lard and conveyed to the back of the tongue (R). Oxygen, by inhala- 
tion, is generally applicable in coma. Potassium Bitartrate, free purging therewith, 
often removes coma, convulsions, and other symptoms due to poisoned blood (R). 
Blisters, in the comatose condition, large blisters or mustard poultices should be ap- 
plied in quick succession to different parts of the body — chest, abdomen, thighs, and 
calves; often very valuable in the critical condition near the end of an acute illness (R I. 
Cold Douche, for stupor of drunkenness or of opium poisoning; may have to be 
repeated if relapses occur; it should be kept up for a long time if pulse and breathing 
improve or are no worse (R). Mustard, as poultice to the feet and ankles in the coma 
of narcotic poisoning (P). Saline Solution, the normal salt solution by injection, 
will sometimes relieve diabetic coma temporarily (Fagge). Exercise, in coma from 
opium-poisoning the patient should be persistently walked about. [Compare Cere- 
bral Congestion, Uremia, and Poisoning by Narcotics.] 

Condylomata. 

Nitric Acid, o j in Oj aquae, as wash, frequently used (R). Thuja, locally a strong 
tincture, also ttjjv internally, night and morning, for warts with narrow base and pen- 
dulous body; warts about anus or pudenda of either sex, whether syphilitic or not, 
are often rapidly cured by Thuja (P); in non-syphilitic warts of penis or vulva, I have 
employed it with satisfaction (Pf). Mercury, Calomel dusted over, after washing 
with a solution of Chlorinated Soda (Ricord) ; the Nitrate locally, or a 20 per cent, oleate 



CONJUN< I T\ IT] 6lQ 

(R). Zinc, tin' Chloride, [odidc or Nitrate as local applications (R). Arsenic 
Trioxide, as a caustic (R). Phenol, as a mild escharotic (B). Chromic Trioxide, 
gr, i' in 5j aqua' dost.; a good local application (B). [Compare Syphili ., \\ u its.] 

Conjunctivitis, Catarrhal. 

Zinc, a weak solution of the sulphate or acetate as astringent collyrium (B); gr. 
j ij in 5j aqua- destil. as mild astringent lotion every few hours, with ice locally in the 
earlier stage (Roosa). Sodium Borate, gr. v in 5j aqua- dest. a good and mild astiin 

lor ordinary eases. Boric Acid, gr. vj in 5j each of aqua- camph. and aq. destil., 
a- collyrium (Fox). Boro-glyceride, in dilute solution, 5ss to the 5, is an efficient 
application. Mercury, Calomel finely levigated and dusted from a camel'sdiair brush 
over the palpebral conjunctiva in severe cases (B); is a most efficient application in the 
conjunctivitis of children showing minute ulcers; the Oleate of Mercury and Morphine 
applied to the outside of the lids in palpebral conjunctivitis (R); the Red Oxide as 
ointment, 10 grains to the 3 of Vaselin (Bader); the Yellow Oxide, 8 to io grains to 
the 5 of Vaselin (Seely) ; i grain in 5ij of Vaselin is strong enough. Phenol, in 
a ; per cent, solution applied every two hours by spray of steam atomizer, which dilutes 
it one-half, an extremely efficient application, relieving the pain and contracting the 

. Is. Cocaine, the Hydrochloride, in 3 to 5 per cent, solution or oleate, applied to 
the palpebral conjunctiva, is a very efficient palliative, especially where much pain and 
photophobia (Roller). Alum, Potassa Alum after acute symptoms subside (Br); 
gr. iij-v ad oij aq. destil. brushed over the conjunctiva twice daily. Pulsatilla, 
5j-ij of tincture to oiv aquae, as wash several times daily, also nuj-x internally every 
3 or 4 hours (P). Opium, the wine dropped into the eye relieves pain and improves 
the condition of the conjunctiva (R); Morphine, gr. j-ij ad oj, is often used in collyria 
with Zinc Salts or Alum, but is irritant. Cadmium, as collyrium, gr. ij of the sulphate 
to 5j aquae rosae (B). Tannin, in Glycerin, oj ad oj, every second day in chronic 
catarrhal conjunctivitis, presenting diffused injection of vessels with edema (Hansell). 
Silver Nitrate, solutions of gr. j-iv to the 5, applied by physician to conjunctiva 
(R); should not be given to patient; Zinc and Copper Salts are preferred (B). Copper, 
the Sulphate crystal in chronic cases where great swelling or hypertrophy of the papil- 
lary layer; is too irritating to be entrusted to the patient. Lead salts should never be 
used lest deposits occur in slight abrasions or ulcerations of the cornea. Sulphates, 
of Zinc, Copper, and Iron, with Alum, aa gr. j to oj of aq. destil. as collyria, extremely 
efficient; in severe cases may be used in saturated solution by the physician (Holmes). 
Castor Oil, a drop placed in the eye often allays the pain and photophobia caused 
by an irritant (R). Belladonna, locally and internally (B). Atropine in strong 
solution, gr. iv to the 5, is one of the best local applications where mydriasis is not 
objectionable. Euphrasia, as a mild astringent (P). Blisters, behind the ears in 
bad cases (R). Ergot, the fluidextract locally gives excellent results in acute con- 
junctivitis (B). Staphisagria, especially in tarsal ophthalmia (P). Colchicum, 
when gouty diathesis (A). Spigelia, in rheumatic form (P). Lithium Carbonate, 
a 1 to 500 solution makes an efficient wash for the eyes in gouty conjunctivitis (Duch£). 
Ichthyol in 3 per cent, solution or ointment, a serviceable astringent and antiseptic 
(Gould). Ichthargan, a 2 per cent, solution is effective (Eberson). Argyrol in 2 
to 5 per cent, solution gives good results (Holmes). Cuprol, a 10 per cent, solution 
is of great benefit (Burnet). 

r». Zinci Sulphatis, ' R. Hydrarg. Oxidi Rub., gr. x. 

Morphinae Sulph., aa gr. j. Atropinae Sulph., gr. j. 

Atropine Sulph., gr. ss. Petrolati, oj- 



Aquae Rosae, 5j. 

M. Sig. — Eye-water. 

R. Liq. Plumbi Subacetat oj. 

Aquae Destillatae, oiij- 

M. Sig. — For local use. To be brushed 



M. Sig. — A minute portion as an oint- 
ment for the eye. (Bader ) 

R. Ung. Hydrarg. Nitrat gr. xx. 

Cocainae Hydrochloridi, gr. v. 

Petrolati Albi, a ij ■ 



over conjunctiva of everted lids by the sur- Use a fresh ointment, triturate thoroughly, 

geon and washed off with water. (Buller.) ' and label "Ointment for the eye." 



620 CONJUNCTIVITIS. 



Conjunctivitis, Diphtheritic. 

Zinc Chloride, gr. ij-iv to the 5, as collyrium, has succeeded admirably (Wa). 
Atropine, locally throughout the disease; not very effectual (Roosa); is, for severe 
cases, powerless; cornea sure to be attacked and liable to slough (Xoyes). Boric Acid, 
a 4 per cent, solution, as antiseptic, the best application, with Quinine internally in 
full doses (Noyes). Iron, the Pyrophosphate for children, oj in 5iij of simple syrup, 
of which a teasp. thrice daily after meals, with Quinine in i- to 3-grain doses thrice 
daily and good food (Derby). Cold by compresses as in purulent ophthalmia, in 
early stages. Silver Nitrate, in 10 grains to the 5 solution locally, or the mitigated 
stick in the second stage. Tannin, gr. xx to the 5 of Glycerin, later on, applied every 
day, with hot water lotions if corneal complications are present. 

Conjunctivitis, Gonorrheal. 

Zinc Chloride, gr. j-ij ad oj aquae, as collyrium, used with marked benefit (Wa). 
Silver Nitrate, a 2-grain to the o solution, after syringing out the eye with warm 
water, followed by ice compresses, in hope to abort the attack, if seen early (Roosa). 
Collargol, as ointment into the conjunctival sac ever}' hour, cured in 4 days a severe 
case which had resisted other treatment (Wolffberg). Argyrol in 5-10 per cent, solu- 
tion, is a valuable application. Cold, by ice or wet compresses, essential in the early 
stages (C). Atropine, may be used from the beginning, as corneal complications 
begin very early. Treatment, is generally the same as for Purulent Conjunctivitis; 
isolation and cleanliness are of prime importance. 

Conjunctivitis, Granular. 

Silver Nitrate, the diluted stick applied lightly and quickly (C); strong solutions 
to granular lids, gr. xx to the cautiously when corneal ulcers exist (B); mild solu- 
tions better, gr. v to the daily in the papillary form; in miliary trachoma it should 
not be stronger than gr. ij to the 5 (Xoyes) ; applications lose their effect after a time, 
and should be changed (Roosa). Copper Sulphate, the solid crystal lightly touched 
to the membrane once a day, the favorite astringent and caustic in all forms of trachoma 
(Roosa) ; when the membrane is torpid to other stimulation and when lymphoid sub- 
stance is predominant; as ointment gr. v-x to the 5 of Vaselin, when for use by patient 
(Noyes). Alum, a smooth crystal is a useful daily application (Xoyes). Phenol, 
in a 5 per cent, solution applied once a week at each angle of the upturned eyelid. 
Dionin, a 4 to 7 per cent, solution as a prompt analgesic. Ichthyol in 3 per cent, 
ointment or solution, gives excellent results (Travis). Ichthargan in 2 per cent, solu- 
tion, applied with a hair pencil, is very efficient (Eberson). Argyrol, a 20 per cent, 
solution, alternating with other applications, has proved valuable (Holmes). Tannin, 
gr. x-xxx to the 5 of Glycerin, an application to change to from others (Roosa). Bis- 
muth is one of the numerous applications in chronic conjunctivitis and granular lids 
(B). Phytolacca internally, is undoubtedly efficient in granular conjunctivitis (W). 
Jequirity, to excite substitutive inflammation. Atropine, gr. ij to the 5, thrice daily, 
is often advisable, when moderate irritation and haziness of the cornea (Xoyes). Hy- 
gienic Measures, are of great value; protection by blue or smoked glasses; rest of 
eyes, best secured by using Atropine collyria; hot or cold water as local bath frequently. 
Tobacco, must be avoided, also all locations contaminated by impure air. Canthop- 
lasty, of outer commissure when the lids press on the globe. Roentgen Rays have 
proved very successful in trachoma, and cause no serious injury to the eyeball (Mayou). 

Conjunctivitis, Phlyctenular. 
Mercury, Calomel finely levigated and dusted from a camel's-hair pencil over the 
membrane in phlyctenular ophthalmia, an excellent application, but should never b 
used when Iodine is being taken; in more obstinate cases a small bit the size of a pin- 
head of Pagenstecker's ointment (Hydrarg. Oxidi Flaw gr. j-iij, Vaselini 3j), placed 



COH [UNCTIV] [IS CONSTIPA1 [ON. 

between the !ii!s (Noyes). Ergot, the fluidextract applied undiluted gives excellent 
results in the phlyctenular ophthalmia of children (B). Antimony, Tartar Emetic 
; or i linns daily in strumous ophthalmia, with sharp pu | the 

outset (R). Belladonna, or Atropine, locally in strumous ophthalmia, of greal service 
in relieving pain ; constitutional treatment also required (Wa). Arsenic, invaluable 
in inveterate cases o\ strumous ophthalmia, especially when compli* ated with cutaneous 
eruptions (Wa). Ichthyol, in 3 per cent, solution or ointment, a serviceable astringent 
and antiseptic (Gould); in 1 to 2 per cent, solution conjointly with hot stupes, very 
efficient in phlyctenular affections of the eye (Reber). Dionin in 4 to 7 per rent, solu 
lion as a prompt analgesic. Tannin, finely powdered and dusted over the everted 
ltd, gives remarkably good results in this and other forms of conjunctivitis, causing 
very little pain and no inflammatory reaction (l>). Carbonic Acid Gas, applied to 
the eye is said to relieve the pain and photophobia of strumous ophthalmia (R). Hy- 
drastis, as lotion is serviceable when Meibomian follicles are implicated, causing 
adhesion of lids in the morning (P). Physostigmine, locally, to reduce the pupil and 
shut out the light (P). Iodine, is employed locally in strumous ophthalmia, for its 
alterative stimulation (W). Zinc Chloride, gr. ij iv to the T>, as collyrium, has suc- 
led admirably in pustular ophthalmia (Wa). Zinc Sulphate, gr. j -iv to the 5, 
is verv serviceable; the addition of Liquor Plumbi improves its efficacy (Wa). Rhu- 
barb, the Mistura Rhei et Soda; when much disturbance of digestion present. Tonics, 
may be given later, as preparations of Cinchona and Iron. Cod-liver Oil, in strumous 
subjects, tends to remove the manifestations of the disease (R). 

Conjunctivitis, Purulent. 

Boric Acid, a 4 per cent, solution, as antiseptic, is all that is necessary in mild 
cases; in others it is the proper fluid for cleansing the eye (Noyes). Atropine, when 
the cornea becomes invaded and shows haziness, a solution gr. ij to the 5 must be 
instilled every 3 hours (R). Silver Nitrate, gr. iij-x ad oj aquae destil., rarely so 
strong as gr. x to the o, applied by brush once daily to everted lids in purulent ophthal- 
mia of infants iXoyes); solution gr. f to the o twice daily under lids (Meigs); by 
many considered needless and injurious (Roosa). Protargol, a 30 per cent, solution 
tHartridge). Zinc Chloride, gr. ij to the o, the best remedy for purulent ophthalmia 
in the infant or adult (Hutchinson). Ichthyol in 3 per cent, ointment, proves fairly 
efficient. Alum, gr. ij to the 5 of water, a sufficiently astringent application in ophthal- 
mia neonatorum (Roosa); gr. viij ad oj aqua:, applied every J or i hour in the puru- 
lent ophthalmia of children, its success depending on the frequency of the application 
(R). Copper Sulphate, gr. j ad 5 j aquae camph. as collyrium in purulent ophthalmia 
of infants (Wa). Cold, by ice or wet compresses, essential in the early stages of acute 
purulent ophthalmia (C). Cleanliness, of great importance; as the discharge is 
infectious the patient should be isolated and care taken to prevent inoculation of the 
other eye. 



R. Sodii Boratis, gr. iij. 

Aqua; Rosae, Aquae, ai 5 j- 

M. Sig. — Apply beneath lids three or 



R. Sodii Boratis, gr. xij . 

Zinci Sulphatis, gr. j. 

Aquae Camph., 5j- 

AquieDestillat., oj. f°ur times daily after cleansing, 

M. Sig. — Apply to lids 2 or 3 times daily 

in ophthalmia neonatorum, with solution of R. Atropine S_ulph., gr. j. 

Silver Nitrate, gr. J to the o injected under Glycerini, 5ss. Aqua;, o i j - 

lids twice daily. (Meigs.) M. Sig. — Two drops into the eye. 

Constipation. 

Nux Vomica, gtt. j-ij of tincture, twice or thrice daily (R); gtt. v-x in a glass of 
cold water before breakfast and dinner, often overcomes the most obstinate constipation 
(P); especially useful when great fecal accumulations from torpor of bowel (B). Strych- 
nine has the power to stimulate peristalsis, and should be given with all agents for intes- 
tinal evacuation (Pettey). Castor Oil is a mild and efficient cathartic (B); especially 



622 CONSTIPATION. 

for children (Little). Sulphur, gr. x with Confectio Sennae, often succeeds after other 
remedies fail (R); sulphurous mineral waters (B); or Sulphates in purgative waters; 
frequent small doses (R). Podophyllum, the most generally used cathartic when 
secretion deficient (B); gr. y 2 to £ night and morning when constipation with nervous 
and bilious headaches (P). Senna, as in the Pulvis Glycyrrhizse Compos., which may 
be taken in doses of a teasp. to a tablesp. as required, and kept up for months (Goodell). 
Mercury, Calomel or gray powder as a cathartic (R). Hydrastis, very valuable, 
when constipation is referable to a sluggish liver (P). Magnesium, the Bicarbonate, 
a useful and mild aperient (R). Alum, a cheap and serviceable laxative (B). Aloes, 
in minute doses, in pill with Ferrous Sulphate, as the official Pil. Aloes et Ferri, is 
one of the best agents in the management of chronic cases; purgation should not be 
aimed at. Chloral, is an efficient laxative in rebellious chronic constipation, particu- 
larly that of neuropathic cases (De Holstein). Ipecacuanha, gr. j every morning, 
fasting, when great torpor of bowel (R). Cocculus, flatus, hard lumpy motions (P). 
Turpentine, in purely atonic constipation, with gaseous distention of colon, has tri- 
umphed when all other remedies failed (P). Physostigma, very effective in intestinal 
torpor (B). Stillingia, itjx of fiuidextract in habitual constipation (B). Ammonium 
Chloride, in the so-called bilious state with constipation (B). Arsenic, nuij of Fow- 
ler's solution often overcome constipation (R). Belladonna, gr. \ of the extract at 
night, in habitual constipation (B); gr. \-\ once a day, especially when dyspepsia (R); 
acts directly on the bowel as a stimulant (P). Croton Oil, the most efficient cathartic, 
when simple impaction without inflammation; gtt. j-ij (B); when evacuations of black- 
ened feces (R). Cascara Sagrada, the fiuidextract in doses of 3j, produces large, 
soft evacuations without griping, and leaves behind it a laxative influence. Frangula, 
in similar doses, is equally efficient, but if from a fresh bark may produce griping. 
Cathartics, especially Confectio Sennae, Pil. Rhei Compos., Pil. Aloe's, the Comp. 
Cathartic Pill, as well as those above (B) ; purgation as usually practiced was denounced 
by the editor of the Lancet, October i, 1870. Saline Waters, are useful (B); Pullna, 
Friedrichschall, or Hunyadi, the first two with milk, are good for children (R). Ene- 
mata, of soap-suds and salt or a pint of cold water (B); or Turpentine, Castor Oil, 
aa 5ss to Oss-j of gruel (P); the habitual use of warm enemata increases torpor of 
the bowels (R). Tamar-Indien, a favorite mild aperient, is proprietary, and sup- 
posed to contain Cocculus, Glauber's salt, etc. Aliment, important in habitual con- 
stipation; corn bread, cracked wheat, oatmeal, bread of unbolted flour, fruits, green 
corn, tomatoes, and celery; \ dozen each of almonds and raisins daily. Water, a 
glass of cold water before breakfast may overcome habitual constipation (B); drink- 
ing largely of water is a most beneficial measure in cases of chronic constipation. Smok- 
ing a cigar or pipe after breakfast (R) ; tobacco smokers rarely suffer from constipation. 
[Compare Intestinal Obstruction.] 

R<. Ext. Colocynth. Co., gr. xij. Castor Oil Emulsion. 

Ext. Belladonna Fol, gr. ij. j ^ Q1 Ridni 

Ext. Gentians gr vj. Glycerini, aa §j. 

Olei Can ... gtt uj. Ti ' ct Aurantii 3;-. 

Ft. pilvj. Sig.— One pill at bedtime. Tinct. Senega 5j. 

Aq. Cinnamomi, q.s. ad oiv. 

R. Podophylli Resins, gr. ij. M. ft. emulsum. Sig.— A tablespoonful 

Quininae Sulphatis, ! or two for children, according to age; 5iJ-iv 

Ext. Aloes, aa gr. viij. 

Fellis Bovis, gr. xvj. 

Ft, pil. no. xvj. Sig. — One or two at bed- 
time. {Goodell.) 



for adults. 



R. Fluidextr. Rhamn. Pursh., . 5j- 

Fluidextr. Belladonnae, 3j- 

Tinct. Nucis Vom., 3ij- 

Syrupi et Aquae, aa ad 5iv. 

M. Sig. — Teasp. thrice daily in obstinate 

constipation. (Clarke.) 



Artificial Hunyadi Water. 

Ri. Magnesii Sulphatis, 

Sodii Sulphatis, aa §ss. 

Potas. Sulphatis, gr. ij. 

Sodii Bicarbonatis, gr. viij. 

Sodii Chloridi, gr. xx. 

Aquae, q. s. ad oviij. 

M. Sig. — A winegl. before breakfast. 



row \i ESC1 NCE CONVXJ1 SIONS, 



Convalescence. 

Lime, as Lime-water, or the ( Carbonate, in convalescence from serious disease (R), 
Quinine or Hydrastine, to promote digestion and appetite (B). Orexin Tannate 

promote appetite. Cod-liver Oil and other fats (R). Sodium Glycocholate, 

iromote the digestion of fats, in convalescence from typhoid and other exhausting 
diseases (Keown). Alcohol before and during meals (R). Bitters, especially Gen 
ban and Calumba (B); the latter especially when stomach weak (R). Eucalyptus, 

rviceable tonic t.B). Coca, ,~ss ij of the fluidextracl at a dose (B), Guarana, 
ur. w 5j may he given (B). Opium, as Laudanum injected per rectum, for insomnia 
of convalescents (R). Sea-baths, valuable in many cases (R). Nuclein, is used with 
;it. Orchitic Extract, has been employed with good results. Bone Marrow, 
u r i\es great satisfaction in anemic cases. Diet, requires the most careful attention; 
the prevalent error of giving food difficult of digestion too early must he guarded against, 

dally in intestinal and gastric disorders; the strictest modi-ration should he en- 
joined. Kumyss is a valuable food. The symptoms must he watched closely, and cont- 
inued by appropriate medication. [Compare Adynamia for Tonic Prescriptions, also 

\Xt MIA.] 

Convulsions. 

General Directions. — In all cases a horizontal posture, fresh air, clothing loose; 
a plug of spft wood or a cork between the teeth, to prevent biting the tongue; sprinkle 
the face and chest with cold water. Epileptic. — The general directions above will 
usually suttice. Hysterical. — The diagnostic peculiarities are: pupils not dilated 
but are sensitive to light, no wounding of tongue, face not livid, pulse usually normal. 
Infantile. — Administer some antispasmodic as Ether, alone or combined with Musk 
or Belladonna; then search for any mechanical cause, as a pin in a dress, etc.; lance 
the gums if dentition die cause (A). Solanum Carolinense, has a good reputation in 
the southern states for epilepsy and other convulsive affections, and has rendered 
excellent service in my hands (Napier); a tincture is prepared by bruising the berries 
and steeping them in whiskey, of which the dose is 5j, repeated until drowsiness is 
produced. [Compare Albuminuria, Epilepsy, Hysteria, Puerperal Convul- 
Uremia.] 

Convulsions, Infantile. 

Belladonna is of the highest value in certain congestive forms, as in fits due to 
the irritation of teething, or those referable to whooping-cough (P). Ignatia, is effi- 
cient in convulsions of children from intestinal irritation, no cerebral congestion being 
present (P). Valerian, has been successfully used in convulsions from the worms 
to which it is fatal (P). Potassium Bromide, in all forms of convulsions in children 

R I ; children bear it in large doses, gr. v thrice daily or oftener for a child a year old, 
in convulsions from teething (Br). Chloral, in large doses, gr. v, by mouth or rectum 

Br); best used as a suppository rather than by liquid injection, and is often very use- 
ful (R); it gives better results than any other agent. Chloroform inhalations are of 
great service (R); useful in all forms (B); should be used to arrest the convulsion 
and prevent recurrence (Smith). Alcohol, has remarkable power in arresting convul- 
sions of dentition; small doses of wine or brandy (W). Asafcetida, in the convulsions 
of teething, a small portion in an enema, appears to mitigate them (Wa). Opium, 
efficient but dangerous in young children. Veratrum Viride has been employed 
successfully (R). Amyl Nitrite, gtt. v, with gr. J of Morphine, was used in one case 
as a last resort after five hours' convulsions in a child of 18 months, and resulted in 
producing quiet sleep (Engel). Hot Baths, are important, with cold affusions or ice 
to the head (B). Spinal Ice-bag, may be very efficient (R). 

R. Chlorali Hydrati, gr- v. j R. Sodii Bromidi, 

Lactis OJ- Chlorali Hydrati, 



M. Sig. — As rectal injection. Or the Sodii Bicarb. aa gr. vnj. 

dose of hydrated chloral may be made into a I Aquje, 3j- 

suppository with cacao-butter and inserted M. Sig. — A teaspoonful every hour to a 

well up into the rectum. ] child under four months old. 



624 



CORNEAL OPACITIES — CORNS — COUGH. 



Corneal Opacities. 

Dionin in 10 per cent, ointment, gave better results in 20 cases than any other 
treatment (Arlt). Cadmium, is said to promote their absorption; gr. ij of the Sul- 
phate to oj of rose-water, as collyrium (R, Wa). Mercury, Calomel by insufflation, 
or the red Iodide gr. ij, Cerate gr. xl, Olive Oil gtt. xx, as ointment, successfully used 
(Wa); weak solutions of the Bichloride, or ointments of the Oxides, gr. f to the 5, 
as remedies among others to hasten absorption in recent cases (Arlt). Oils, Eel-liver 
and Cod-liver Oils, Ox-gall, Juniper Oil, Oil of Turpentine combined with Olive 
Oil, and others, dropped into the eye once or twice daily for the same purpose (Arlt). 
Opium, the wine at first, then insufflations of Calomel and Red Precipitate or Yellow 
Oxide ointment, frequently used in recent cases (Arlt). Potassium Iodide, as oint- 
ment with Potassium Carbonate after Cod-liver Oil or Oil of Turpentine with Olive 
Oil, in cases of longer standing (Arlt). Silver Nitrate, gr. v-x ad 5j aquae, as lotion 
(C). Iodine, internally and as collyria, has been efficacious, especially in strumous 
cases (Wa). Sodium Chloride, gr. x ad §j aquas destil., of which njjv-x injected 
subconjunctival^, to hasten disappearance of turbidity (C). Thiosinamin is use- 
ful to promote absorption (Suker). Ichthyol used with slow but considerable 
success for inveterate cases of granular conjunctivitis with corneal opacity and pannus 
(Jacovides). Operative Measures, only in case of incrustations (as of lead and lime) 
situated superficially, by removal of epithelium and anterior elastic layer; deeper inter- 
ference may lead to suppurative keratitis. Excision of opaque cornea and transplant- 
ing of one from an animal's or a recently enucleated human eye (keratoplasty), has 
always failed. Artificial pupil by iridectomy, for central opacities which are unremov- 
able. Tattooing to relieve deformity of disfiguring leucomata (Arlt). Stenopaic Spec- 
tacles, for semi-transparent opacities in pupillary region (Donders). [Compare 
Keratitis.1 



Corns. 

Salicylic Acid, in strong solution, removes excess of epidermis, warts and corns; 
is the essential ingredient of all corn-cures. Silver Nitrate, solid, after soaking and 
paring (Wa); the best application for soft corns and very irritable ones (D). Acetic 
Acid, strong, to remove corns (Wa). Mercury, Corrosive Sublimate in alcoholic 
solution locally to remove corns (Wa). Iodine, gr. xl ad oj Alcoholis, locally (Wa). 
Picric Acid, a saturated solution is very efficient for soft corns (Milward). Poultices, 
are useful; or a plaster of soft material with hole in centre (D). Water, hot and cold, 
alternately applied to inflamed corns. Keep a corn thin by frequent washing and 
paring; in performing the latter the knife should work downwards to the apex of the 
corn, so as to remove the central pressure on the subjacent tissue. 



1$. Acidi Salicylici, gr. xv. 

Extr. Cannabis Ind., gr. vijss. 

Alcoholis, 90 , mjxv. 

JEiheris, 62° trjxxxvij. 



Collodii Flexilis, njlxxv. 

Mix, and keep in closely-corked vial. 
Paint the corn every other day for a week, 
then it can be easily squeezed out. (Vigier.) 



Cough. 

Opium, in some form, is much used in cough -mixtures; Morphine and Glycerin 
applied to fauces (B); moderate doses are useful in irritative affections of the air- 
passages to allay irritation and hypersecretion, but it may do even fatal mischief in 
cases where secretion is copious and expulsory power feeble (P); opiates inadmissible 
when with copious expectoration there is any indication of bronchial congestion (Wa). 
Codeine, is often efficient in cough (Br); of particular value in f-gr. doses; is slightly 
expectorant, also laxative, does not nauseate or cause vomiting, or affect the appetite; 
is far the best agent for the cough of phthisis when morphine is not well borne (Kobler). 
Peronin, is intermediate in its effects between morphine and codeine, and has a very 
quieting action on the paroxysmal cough of phthisis (Schroder); gr. $-§ thrice daily, 



i 01 GH. 



625 



the latter dose giving a quiet night's sleep, even in cases where morphine and codeine 
were ineffective (Munk). Apomorphine Hydrochloride, very valuable in cough 
where there is persistent hacking without expectoration, or with difficult expectoration; 

the dose is only gr. .,'„ to t l fl in the 24 hours; solution rapidly alters unless a tew dl 
of Hydrochloric Acid are added (Stocquardt). Heroin is indicated in coughs ol 
kinds, whatever their cause (Hyams); is very satisfactory in laryngeal COUgh (Camp- 
bell^; is one of the most toxic members of the morphine group (Cohen). Dionin is 
efficient in irritative cough, especially in that of phthisis and heart affections (Salzmann); 
has sedative and analgesic action with no ill effects (Scherer). Nux Vomica, in 
laryngeal cough of neurotic origin, drop doses of the tincture every five minutes; is 
promptly efficient (Macfarlan); has specific action on the pneumogastric, and is one 
of the most efficient remedies in cough of any kind, whether from bronchitis, pneumonia, 
phthisis or emphysema, but especially in nervous coughs and periodic coughs which 
come on in the evening and stay all night (Jour, de Med.). Pulsatilla, as Anemonine, 

* gr. and gr. doses, very useful in irritative cough, asthma, whooping-cough (P). Iodine, 
by inhalation, for children in hoarse, hollow cough, wheezing (R); the tincture, =;-io 
drops, inhaled from boiling water for five minutes at bedtime, often gives most signal 
relief in the irritating cough of phthisis. Hydrocyanic Acid, for nervous, irritable 
cough and cough of phthisis, also mother's sympathetic cough (B); no more certain 
palliative for simple, nervous cough due to irritable state of the system (S); a valuable 
adjunct to ordinary remedies in cough of phthisis (Wa). Potassium Cyanide, is 
equally useful, gr. iij with 5j each of Fluidcxtr. Grindeliae, Syr. Scillae and Syr. Tolutan., 
makes a good non-opiate cough mixture, of which the dose is 5j every 4 hours (Waugh). 
Prunus Virginiana, has some influence, due to its Hydrocyanic Acid; is much used 
in cough mixtures (P). Laurocerasus, used as a substitute for Hydrocyanic Acid in 
spasmodic coughs (B). Conium, supposed to be useful (R); is very useful in spasmodic 
cough (Wa). Ipecacuanha, the fid. extr. for troublesome night-cough (B); in obstinate 
winter-cough, with wheezing, the wine as spray to fauces, efficacious (R); in coughs of 
childhood Ipecac is one of the most generally serviceable expectorants we can use (Wa). 
Lobelia, dry cough, continued tickling sensation, even in sleep (P). Sanguinaria, 
combined with Hyoscyamus, in nervous, spasmodic cough (P). Senega, as a stimu- 
lant expectorant in the cough of chronic bronchitis and subacute chest affections. 
Gelsemium, excessive irritability of the respiratory centre (R); often remarkably 
relieves convulsive or spasmodic, reflex and nervous coughs (B). Menthol, a few crystals 
wanned in a spoon and the vapor inhaled, or inhale from a few drops of a 40 to 50 per 
cent, alcoholic solution (Saenger). Asafcetida, its value due to the sulphur in it (Gar- 
rod); very serviceable in after-cough from habit, and in mother's sympathetic whoop- 
ing-cough (B). Phenol, as spray, a 5 per cent, solution in a steam atomizer 
will often prevent as well as cure a cough from cold. Valerian, in asthmatical and 
hysterical coughs (P). Chloroform, with Morphine and molasses in paroxysmal dry 
cough; may be painted on throat also (R); in irritable reflex cough, the vapor of a 
teaspoonful of the spirit may be inhaled from the surface of hot water, and repeated 
even - five minutes for four or five times (B); the inhalation of small quantities of chloro- 
form gives the greatest possible relief in the irritable cough of phthisis (Spencer Wells). 
Chloral, in convulsive coughs, ameliorates symptoms after hypnotic effect (Wa). Cam- 
phor, equal parts of Camphor and Chloral triturated together are said to allay spas- 
modic cough when painted over larynx (B). Glycerite of Tannin, applied to throat 
when chronically inflamed and so producing cough; often the case with children (R). 
Grindelia, used in cough of habit and spasmodic cough (B). Squill, in catarrhal 
cough, should not be employed until active inflammation has subsided (Wa); the 
syrup or vinegar of Squill is the best preparation for cough with tickling in the throat 
(P). Terpin Hydrate, in bronchial cough, and night-cough from habit, is very effi- 
cient in a 2-grain dose at bedtime, repeated early in the morning (Boyland). Aconite, 
irritable, tickling throat-cough; short, dry cough of asthmatics, with anxious look 
and full, strong pulse (P). Belladonna, often useful; no indications (R); internally 
and externally as plaster to the chest, very serviceable in spasmodic and nervous coughs 

• Wa). Hyoscyamus, very useful in spasmodic tickling night coughs (P). Alum, 
internally in spasmodic cough; gr. x to 5j aquae as spray, in chronic cough also (R). 

41 



626 



C0XALGIA — CROUP. 



Drosera, the fluidextract in \ teasp. dose to an adult every 2 or 3 hours, of high value 
when spasm predominates. Potassium Bromide, serviceable in various reflex 
coughs (uterine, renal, etc.), and in cough of phthisis it is occasionally ameliorative 
as a gargle (B). Cubeb, 5ss-j of the tinct. in half-glass of Linseed tea thrice daily, 
oftens cures like a charm the coughs of chronic catarrh, of emphysema, or acute catarrh' 
or following an attack of influenza (R). Cod-liver Oil, in chronic coughs (R). Lac- 
tucarium, the syrup as vehicle in cough-mixtures (B). Chamomile Oil, gtt. ij-viij, 
in coughs due to heightened reflex irritability, especially in hysterical women (P). Pix,' 
Tar-water in winter cough, especially when paroxysmal (R); allays the cough of bron- 
chitis and phthisis (P); the Plaster as rubefacient and counter-irritant in chronic 
coughs (Wa). The frequency and violence of nervous coughs may be controlled by 
a determined effort of the patient's will. [Compare Bronchitis, Pertussis, Phthisis.] 

Prescriptions for Cough Mixtures. 

R- Mist. Glycyrrh. Co., gij. 

Syr. Pruni Virginians, 

Syr. Tolutani, aa 5j- 

M. Sig. — Half teaspoonful 3 or 4 times 
daily for infants, teaspoonful doses at 1 to 
2 years, larger doses for older children. 

B- Tinct. Opii Deodorat., 

Vini Antimonii, aa 3ss. 

Fluidextr. Valerianae, 

Syr. Simplicis, aa o ij • 

Aquae 5 jss. 

M. Sig. — A teaspoonful every hour or 
two until cough controlled. For children of 
4 years and upward. (Meigs &* Pepper.) 



B- Spiritus ^Etheris Nitrosi, oij- 

Vini Ipecac, oss. 

Tinct. Opii Deodorat., .... 5j. 

Syrupi Tolutani, q.s. ad 5ij- 

M. Sig. — A teaspoonful twice or thrice 

daily. (Bowditch.) 

B- Liq. Morph. Magendie, 

Spt. Limonis, aa. oj- 

Syr. Ipecac, 

Spt. Lavand. Comp., aa. 5iv. 

Syr. Scillae Comp., 

Syr. Tolutani, aa oj- 

Syr. Pruni Virgin. ,..q. s. ad 5vj. 
M. Sig. — A teasp. as required. 
Each dose has of Morph. Sulph. gr. 2 J j. 



B- Codeinae, gr. v. 

Alcoholis, q. s. ad solv. 

Potassii Cyanidi, gr. v. 

Syr. Scillae, 5j. 

Aquae, q.s. ad oiv. 

M. Sig. — A teasp. every 2 or 3 hours for 
irritable cough. (Potter.) 



B- Tinct. Sanguinariae, 

Tinct. Lobeliae, aa ojss. 

Vini Ipecac, 3iij- 

Tinct. Opii Camphorat., 

Syr. Scillae, aa 5jss. 

Aqua: Cinnamomi, ad §vj. 

M. Sig. — 5j every three hours in the 
cough of bronchitis. (Potter.) 



Coxalgia. 

Barium Chloride, in considerable doses, gr. j-ij, persevered in for a month, is 
thought to be most valuable in scrofulous diseases of the joints (Wa). Sulphuric Acid, 
5j ad oj Adipis, as ointment, persevered in, has resulted in great benefit; a powerful 
irritant (Wa). Counterirritation, by blisters around the hip, with perfect rest in the 
straight posture, Cod-liver Oil, etc. (D). Ferrous Iodide, in scrofulous diseases of 
the joints, with Cod-liver Oil and nutritious diet (Wa). Iodoform, very successfully 
used by many continental practitioners in scrofulous diseases of the joints (Wa). Cod- 
liver Oil, the remedy on which most reliance is to be placed (R). [Compare Abscess, 
Caries, Suppuration, Synovitis.] 

Croup, Catarrhal. 

Aconite, valuable (R); has been employed with the best results (P); gtt. % to j every 
half hour, until an impression is made on the fever movement, then every hour or two 
(B). Hot Water, applications beneath the chin and along the whole course of the 
larynx (Wa). Hot fomentations or turpentine stupe to throat (El); hot bath, 05°-i02° 
F., in the paroxysm, a good method (M & P). Potassium Bromide, locally, a solution 
by atomization, has proved highly efficient in spasmodic croup (Wa). Lobelia, has 
been used with occasional success (P). Ipecacuanha, the syrup or fluidextract as 
an emetic at the outset (El) ; is a slower emetic than tartar emetic (P) ; the syrup to 



CROUP. 627 

vomiting during the paroxysm, and nev k every 2 or 3 hours next day (M &P). [I 
pare Laryngismi s Stridui is.] 

U. Potassii Citratis i;. Tinct. Bellodon., Fol. gtt.lv. 

oij. Tinct. Opii Camph get. 1. 

Tr. Opii Deodorat., gtt. xij. Uuminis (pulv.) gr. vj. 

' Simplicis oij. Syr. Vcaciee ;, 

•■<■■ ojss. uee JJjss. 

M. Sig. — Teaspoonful every 2 or 3 hours M. Sig reaspoonful 1 [hours 

:u 6 months old when cough frec|uent and at 6 months old when cough frequent 

-ing. (M. 6* P.) harassing. (M. &• P.) 

Croup, Membranous -Laryngeal Diphtheria. 
Antitoxin, has reduced the mortality in laryngeal diphtheria from 73 to 27 per 
cent.; under its influence the membrane loosens and clears off rapidly (Washboum); 

even after its use symptoms of laryngeal obstruction may develop (Tirard). Mercury, 
B remedy of established value, gr. ss-j of Calomel, with gr. $~i of Ipecac, according 
to age every 2 hours, with local and other general measures, especially the use of a 
hot (70°-75°) and moist atmosphere (YYa); the Sub-sulphate, given early, is the best 
emetic, gr. iij-v; Calomel is strongly urged as a laryngeal sedative and aplastic agent, 
allaying laryngeal spasm and preventing formation of membrane (B). Alum, one 
of the best emetics in this disease, a teasp. in honey or syrup, repeated every ten or 
fifteen minutes until it operates (M & P); a very useful and non -depressant emetic 

B). Sanguinaria, by many considered specific, is undoubtedly the best emetic for 
this disease 1'); is too harsh and too uncertain in action (B). Tartar Emetic, as an 
emetic, has established value in croup (W); is injurious, too depressant (B). Copper 
Sulphate, as emetic, small and frequent doses (R). Ipecacuanha, as emetic, the 
wine in doses of 5j, repeated at short intervals until vomiting is reduced (Tirard); 
inferior to Mercury (B); in severe cases vomiting should be caused 2 or 3 times a day, 
and should be commenced early (R); Apomorphine, effective, but highly dangerous 

B Senega, is considered a valuable auxiliary (P); has been employed (R). Qui- 
nine, in full doses is highly useful (B). Potassium Chlorate, as alkali, after emetics, 
the most reliable internal remedy, gr. ij-iij even' 2 hours to a child of 4 years (M & P). 
Ferric Chloride, may be combined with the preceding, in doses of 3-5 drops of the 
tincture at the same age (M & P); the combination makes a highly antiseptic gargle. 
Phenol, 3ij of a 5 per cent, solution, with Creosote Sj, and powdered Acacia 
rubbed together and put into a bronchitis kettle with a pint of water, the vapor to 
be constantly inhaled (Tirard). Sulphurous Acid, as spray, hourly or more frequently 
(R), Tannin, a 5 per cent, spray, several times a day for 15 or 20 minutes at a time 
(R). Hydrogen Dioxide, the solution, 1 in 4 of water, copiously sprayed over the 
nose, throat, mouth, etc., to destroy the membranes and prevent their reproduction; 
then Glycozone, a teasp. in a winegl. of water thrice daily internally, prevents any 
disturbance of the stomach and regulates the bowels (Edson). Lactic Acid, as solvent 
of membrane (B). Iodine, the tincture externally, affords great relief and tends to 
prevent formation of false membrane (Wa). Lime-water, by vaporization, or inhala- 
tions of the vapor of slaking lime for a few minutes in every hour, or some other alka- 
line solution during the whole treatment (M & P). Water, as warm bath, hot fomen- 
tations or compresses to the throat; watery vapor in room. Steam inhalations, with 
a few drops of Iodine or Bromine. Diet, water only in small quantities during attack; 
supporting diet may be required afterward. Intubation, is preferable to tracheotomy 
whenever practicable (Tirard). Tracheotomy, is fully justifiable, 21$ per cent, 
'.•ered out of 1024 operations; should be done when paroxysms become very fre- 
quent, and dyspnea is rather persistent than paroxysmal (M & P). [Compare LARYN- 
GITIS, Diphtheria.] 



^. Sanguinariae (pulv.), gr. xx. 

Ipecac, (pulv.), gr. v. 

Syr. Ipecac, 3ij- 

M. Sig. — A teasp. every J hour until 
emesis, then J teasp. every hour. (P.) 



fy Acidi Lactici T> iijss. 

Aq. Destillat 3*. 

M. Sig. — To be used as a spray, or ap- 
plied by a mop. 

(London Throat Hospital.) 



628 



CYANOSIS — CYSTITIS. 



Cyanosis. 
Amyl Nitrite, by inhalation, often gives marked relief (P). Quebracho, in that 
from asthmatic attacks of consumptives, lessened the cyanosis or entirely relieved it 
(Rbhrer). Oxygen, by inhalation in the cyanosis of asphyxia from toxic gases or due 
to opium and chloroform narcosis. Leeching is of sendee, in a manner not easily 
understood (P). Treatment must depend on the nature of the lesion or disease giving 
rise to the cyanotic condition (A). [Compare Asphyxia, Asthma, Dyspnea, Heart 
Affections.] 

Cystitis, Acute. 

Belladonna, is a good remedy in almost every form of vesical irritation (G) ; very 
useful in recent catarrh from chill, with pain (P). Cantharis, in large doses causes 
inflammation of the urinary tract, but gtt. j of the tincture every hour will often relieve 
vesical catarrh (Smith); in small doses continued very efficient (B); gtt. j-v of the 
tincture thrice daily, when bladder is irritable, its sphincter weak, and pain along the 
urethra (P); may be employed in cystitis with benefit (R); in small doses the best 
remedy for acute cystitis. Aconite, for febrile symptoms (P). Quinine, often useful 
for acute symptoms (B). Iodoform, in suppository for painful cystitis (R). Opium, 
a rectal injection of Starch and Laudanum will subdue pain and prevent the frequent 
micturition (R); dangerous if the kidneys are diseased (P). Alkalies, the Citrates 
and Bicarbonates if urine is highly acid; stop when it becomes alkaline (R); Liquor 
Potassae in barley-water or in a decoction of Triticum repens, preferred to all other 
alkalies; urine must be maintained at a neutral or very slightly acid reaction (Thomp- 
son). Urotropin, an excellent urinary antiseptic. Salol in emulsion or with milk, 
is of service. Argyrol, a i to 1,000 solution by irrigation, followed by a 5 to 10 per 
cent, solution injected into the bladder and retained five minutes (Small). Mercurol, 
a 1 per cent, solution freshly prepared, as wash for the bladder, highly successful. 
Cannabis Indica, an excellent anodyne in all bladder cases, having specific effect on 
that organ. Rest in horizontal posture, mucilaginous drinks, hot fomentations and 
hip-baths, laxatives for the bowels, light food. Milk-diet often necessary, especially 
in children. [Compare Bladder Irritable, Calculi, Dysuria, Enuresis, Hema- 
turia.] 



R<. Atropinae Sulphatis, gr. j . 

Acidi Acetici, gtt. xx. 

Alcoholis, 

Aquas, aaoss. 

M. Sig. — Four drops in a winegl. 
water before each meal. (G.) 



of 



R<. Opii Pulveris gr. xij. 

Camphorae gr. xxx. 

Ext. Belladonnss Fol., gr. iij. 

Ol. Theobrom., q. s. 

M. et div. in supposit. no. vj. 
Sig. — One to be used at bed-time. 



Cystitis, Chronic. 
Benzoic Acid, and the Benzoates, in chronic cystitis from any cause, when urine 
is alkaline (B); has some balsamic character, and is useful in some cases of chronic 
cystitis; gr. xxiv in the day at least, in pills made with Glycerin (Thompson). Sodii 
Benzoas, 5j in Tinct. Gelsemii oij-iij, and water to oyj, makes an excellent wash for 
painful cystitis of old men with enlarged prostate; a fluidounce should be warmed 
and injected and retained 20 to 30 minutes (Copeland). Alkalies, when urine is 
acid; the Liq. Pot. Hydrox. with Hyoscyamus as an anodyne, preferred notwithstanding 
its chemical incompatibility, to control painful and frequent micturition (Thompson); 
Bicarbonates or Citrates better, as the strong reaction of liq. potassae unfits it to be 
given in doses sufficiently large to affect in any great degree the reaction of the urine 
(R). Triticum, is very efficient as an internal remedy, Bij-iv of the rhizome boiled 
in a quart of water until reduced to a pint, this strained to be taken in four doses in 
the 24 hours (Thompson); a very useful remedy (Pancoast). Buchu, is probably 
the most efficient of the urino-genital remedies, the fluid extract in doses of t!Ex-5j 
(B); the best drug in chronic cystitis, especially when the catarrh implicates the ureters 



IVSII IIS. 



<>:<) 



or the kidneys themselves, producing considerable muco-purulenl discharge (!')• Uva 
Ursi, is decidedly effective (P); is less so than Buchu ill). Stigmata Maydis, an 
infusion, 5ij to the pint, a wineglassful every 3 or .| hours, has been used internally 
with considerable success (Dessein). Pareira, considered superior to 1 raUrsi 

often very successful (P). Chimaphila, is often very efficient, but is more ai : 
diuretic than the above-named remedies (B); by many practitioners it is considi 

the best remedy for chronic cystitis. Copaiba, is very useful by virtue of its local 
action on the mucous membrane, but objectionable for its nauseous taste and resulting 
gastric disturbance (B). Cubeb, is often useful from its stimulating effecl 1 1')- Uro- 
tropin as a urinary antiseptic, gives the best bactericidal results (Sachs); cured 40 
per cent, and remarkably improved the rest, of 54 eases due to bacterial invasion (Gold- 
berg). Helmitol completely cured 11 out of 16 cases (Heuss); parts with its formal- 
dehyde more readily than Urotropin. Turpentine, has been useful in many cases 
(R); when cystitis is due to urethral inflammation or prostatic disease (B). Juniper, 
the oil is indicated under the same conditions as is Turpentine (B). Eucalyptus, 
there is no more efficient remedy in chronic cystitis than this (B); the oxygenated 
oil of Merck is best, in doses of 3 drops on sugar every 6 or 8 hours. Myrtol, has 
been used with excellent results in the Paris Hospital. Salicylic Acid, in large doses, 
either internally or by injection into the bladder, is most efficient (B); the acid or 
Salicylates often useful to prevent decomposition (P). Salol, proves an efficient disin- 
fectant, as its constituents are excreted with the urine; solutions of 5 to 10 per cent, 
in Retinol gave gratifying results in subacute cases of obstinate character, where other 
agents were of no avail; this solution remains in the bladder, in diminishing quantity 
of course, after 6 or 8 urinations (Desnos). Camphoric Acid, in J to 3 per cent, 
solution in hot water, as injection, has cured several cases. Phenol and Phenol- 
sulphonates, as urinary disinfectants (R). Sulphaminol in doses of gr. iv, has been 
successfully used. Sulphites as urinary disinfectants (B). Pichi, the fluidextract, 
in 20 to 30 minim doses four times daily, gave excellent results in bad cases of long 
standing, the urine ammoniacal, ropy and purulent (Delamere). Iodoform, ojss of 
a 10 per cent, emulsion in glycerin, diluted with 5j or more of some non-irritant fluid, 
by intravesical injection every second day, is uniformly beneficial in obstinate cases 
not due to some special complication (Frendenburg). Picric Acid, a solution instilled 
into the empty bladder is most efficient in tubercular cystitis (Guillou). Ergotin 
hypodermically, increases the contractile power of the bladder, and enables it to empty 
itself more perfectly. Silver Nitrate solutions by intravesical injection after washing 
out the bladder with warm water, gr. ij to the 5 of distilled water (Ricord); gr. j in 
Biv to begin with, increased gradually to gr. J to the 3 at most (Thompson); stronger 
solutions are advocated by Professor Richardson of New Orleans, and Professor Gar- 
diner of McGill College, Montreal; in the writer's experience a solution of gr. v to 
the o used as a vesical wash, has been promptly efficient in curing many cases which 
resisted other treatment for months, — it sometimes produces serious symptoms, and, 
it is therefore well to have a neutralizing solution of Sodium Chloride on hand for use 
if required. Other Injections, which may be used to wash out the bladder are — 
Lead Acetate, gr. j to oiv of warm water, once daily; Nitric Acid, dilute, m>j-ij to 5j 
of water; Tannic Acid, gr. j to oj; Borax, oj in oij of glycerin and oij of water, 
of which oss in 5iv of warm water for one injection; Quinine, gr. j-ij to oj of water, 
with a drop of Acetic Acid. All injections must be used with great care, not more than 
5ij forced in at once and that very slowly; use flexible catheter, warm solutions, and 
a rubber injecting-bottle with a long nozzle and stop-cock (Thompson); washing the 
bladder is of great value (R). Evacuation of the urine, some of which is often retained 
in the bladder, is a matter of great importance. [Compare Bladder Irritable, 
Calculus, Dysuria, Enuresis, Hematuria.] 

IV Uvk Ursi Fob, B- Ol. Terebinth., oss. 

Pareine Radios, aaoj-ij- Camphone, gr. xv. 

Sig. — Boil in 3 pints of water until reduced Extr. Hyoscyami, gr. ss. 

to a quart, then strain, and take 1 or 2 wine- Fiat massa. Sig. — Take a piece the size of 

glassfuls 3 or 4 times daily. (Thompson.) a cherry-stone morning and evening. 

(Chauvel.) 



630 . CYSTS — DEAFNESS — DELIRIUM — DELIRIUM TREMENS. 



Cysts. 

Iodine, by injection very effective in cysts of the neck, and sometimes in unilocular 
ovarian cysts (B); after tapping (R). Silver Nitrate, gtt. v-x of a strong solution 
(gr. xx ad oij), as injection into cystic tumors (wens), after allowing the contents to 
escape, will cure by setting up adhesive inflammation (B). Galvano-puncture will 
permanently occlude cysts of the neck (B). Aurum Chloride, may sometimes cure 
ovarian dropsy (B). Remedies, internally, have all proved worthless (E). [Com- 
pare Ovaritis.] 

Deafness. 
Quinine, cures some forms, and often causes deafness (Brown-Sequard). Glycerin, 
for dryness of meatus; also to form a film to ruptured tympanum (R); either alone 
or in combination with Olive Oil (P); effects are temporary (Wa). Tannin, the 
glycerite as application for throat deafness (R). Gelsemium, the tincture, njxv-xjL 
repeated 2 or 3 times a day, is often useful in the treatment of nervous deafness, and 
seems to have an influence on the organ of hearing similar to that of Nux Vomica on 
the organ of sight. Colchicum, when from gout in ear (A). Cantharides, as oint- 
ment; gr. xxx ad o j Adipis, below and behind the ear bis die, with alterative mercurial 
treatment, in deafness from thickened tympanum (Wa). Collodion, contractile, 
applied to the membrana tympani, in deafness from relaxation of the membrane, has 
exerted a permanently beneficial influence, even in cases of long standing (Wa). Tur- 
pentine, gtt. xl in §ss Glycerin, a few drops into the meatus in deafness depending on 
deficient secretion of cerumen, results in much benefit (Wa). Morphine, gr. ss, 
sprinkled on surface behind the ear denuded by a small blister, has proved curative 
in chronic deafness, after all other remedies had failed (Wa). Gargles, in throat- 
deafness are of great value; of Potassium Nitrate, or Borax, in sthenic cases; tincture 
of Capsicum added in nervous forms; of Hydrargyrum Bichloride when from secondary 
syphilis (Wa). Water, washing in warm water, in deafness from general debility 
(Toynbee). Faradization of the ear in nervous deafness, in which slight results 
only to be expected from the treatment (R); demands the utmost caution (Wa). In- 
flation, by the Politzer bag, or Eustachian catheter, in throat deafness. Remove 
wax from the external canal. 

Delirium. 

Belladonna, in delirium of typhus and other fevers (R); in severe forms of delirium 
(P). Hyoscyamus, in delirium of typhus; for the mild, less inflammatory form, 
with hallucinations, nervous excitement, little cerebral congestion (P). Stramonium, 
in wild and furious delirium of puerperal mania, with general restlessness and suicidal 
or destructive tendency (Wa); no drug deserving of more confidence in the greater 
number of maniacal cases (Cullen). Opium, in traumatic delirium, as a rectal injec- 
tion, combined with Tartar Emetic in fevers; or better still Morphine hypodermicallv; 
Laudanum in low, muttering delirium (R); is regarded with suspicion (P). Cannabis 
Indica, the extract in doses of gr. $— | in nocturnal delirium occurring in softening of 
the brain (Wa). Potassium Bromide, in delirium resembling delirium tremens (R). 
Camphor Monobromide, useful in rambling delirium (Wa). Camphor, in 20 grain 
doses, every 2 or 3 hours, especially in low muttering delirium (R). Chloral, in violent 
delirium of fevers (R). Antimony, in delirium of fevers (R). [See Fever.] Water, 
the cold douche in maniacal delirium; place patient in warm bath during application 
(R). [Compare Cerebral Congestion, Fever, Mania.] 

Delirium Tremens. 

Chloral, at outset (R); very successful, but dangerous to old drunkards or when 
heart disease exists (B); the experience of inebriate asylum physicians does not bear 
out the teaching that chloral is very dangerous to old alcoholic subjects when under 
the stimulus of acute alcoholic intoxication, it being by them commonly given in 3c- 



I'll Ikll \l I K! Ml' 

grain doses every 3 or .| hours until sleep is induced, without apparent dang 1 Bella- 
donna, of proven efficacy when congestion of the brain (P); useful for the insomnia 
when coma vigil, cold surface, cyanosis (B). Stramonium can do all that Belladonna 
can do, and is more powerful (Tr). Hyoscyamus, in some forms admirabl (P 
Hyoscine, is a. useful drug in delirium tremens, and in other affections in which tn 
is a marked symptom (Weatherly). Duboisine, is even more sedative and hypnotic 
than Hyoscine. Opium, cautiously, if at all (B); as rectal injection, hypodermically or 
with spirits; if patient strong, delirium boisterous, and pulse full, add Tartar Em 

Iconite (R). Apomorpnine or some other hypnotic to induce sleep, instead of 
using physical restraint (Douglas). Potassium Bromide ~>j every 1 to 6 hours in 
the "horrors" preceding delirium (B); bromides are of less value in the delirium, 
and in subsequent attacks (R); a mixture of Potassium Bromide and llydrated Chloral 
in solution, gr. \xx of each every 2 hours until sleep is secured, is very efficient in strong 
subjects; Ammonium Bromide has been used with very good results (Wa). Chloro- 
form, inhalations to procure sleep (R); anesthetics are dangerous (B). Cannabis 
Indica, gr. ss-j of extract, one of the least dangerous and most useful hypnotics (P). 
Tartar Emetic, as hypnotic (B); combined with Opium to control mania and in- 
somnia (R). Capsicum, to induce sleep in early stages, gr. xx-xxx in a bolus with 
honey, repeated after three hours (R); in 20-30 gr. doses has remarkable success (P); 
the tincture in 5ss doses every three hours of great benefit (Wa). Nux Vomica, 
or Strychnine, should be more freely used than it is in alcoholism, and in delirium 
tremens may be used hypodermically almost to the commencement of tetanic action 
(Luton). Arnica, the tincture is exceptionally serviceable in cases where there is 
depression (B). Caffeine is a physiological antagonist to alcohol (Hall); Coffee is 
often very useful in delirium tremens (P). Digitalis, 5ss of tincture repeated in 
4 to 6 hours (R); a tablesp. of the infusion every 4 hours in pale subjects, where anemia 
of brain, with effusion and edema (B); has cured many cases promptly without produc- 
ing any unfavorable symptoms; its safety and efficacy are alike questionable (Wa); 
is very dangerous treatment (Br). Cimicifuga, an excellent tonic for the nervous 
system, is very successful (P). Quinine, with a mineral acid to restore digestion, 
in the "horrors," and in adynamic states (B); gr. j two or three times daily as a tonic, 
the best agent to produce nervous tranquillity (Anstie). Sumbul, very efficient for 
insomnia (P). Zinc Phosphide, gr. jss daily, in divided doses, for many weeks, is 
used with decided benefit. Zinc Oxide, is of essential benefit as a nerve tonic and 
sedative, gr. ij-viij, twice daily, gradually increased to the higher dose named (Wa). 
Piscidia the Jamaica dogwood, oj of the fluidextract every 2 hours, as a hypnotic 
and nervous sedative, is very efficient. Lupulin, the tincture or oleo-rcsin, useful in 
mild cases as stomachic tonic and cerebral sedative (B). Ammonium Carbonate, 
when anemia of brain and feeble heart-action (B). Conium, combined with Opium, 
is useful (P). Alcohol, of undoubted use where failure of stomach to appropriate 
food (B); in some form is necessary, as its sudden withdrawal aggravates this con- 
dition and frequently causes it (Douglas) ; is best omitted entirely from the treatment, the 
experience in inebriate asylums showing that cases recover more rapidly and surely 
without alcohol. Water, about 6o° with ice to head, to reduce temperature in the 
hyperpyrexia (R). Treatment, should tend to nourishment and establishing of 
digestion; concentrated liquid food with moderate use of stimulants (H). Diet and 
Hygiene, the immediate source of danger is exhaustion, hence animalized and nutri- 
tious, digestible diet should be used in fluid form, small quantities frequently repeated; 
beef-tea, soups, yolk of eggs, warm milk, cocoa, cayenne pepper or stimulants in soups; 
coffee, to still nervous excitement; hot baths and wet pack to eliminate the poison; a 
quiet, dark room. Kumyss is a valuable nutrient. [Compare Alcoholism, Poison- 
ing by Alcohol.] 

R. Tinct. Capsici, R- Chlorali Hydrati oyj. 

Fluidextr. Lupulini, aa 5 j • Fluidextr. Conii, ojij. 

Mucil. Acacia?, oss. Fluidextr. Hyoscyami 5jy. 

Aquae Cinnamomi, 5 jss. Mucil. Acacia:, oij- 

M. Sig. — Dessertsp. as required for the Aquas Menth. Virid., ad §ij. 

wakefulness and excitement which precede M. Sig. — Teaspoouful in water after each 

an attack of delirium tremens. meal, to prevent delirium tremens. 



632 



DEMENTIA PARALYTICA — DHOBIE ITCH. 



Dementia Paralytica. 

Physostigma, has seemed to retard the progress of the disease in some few cases 
(B). Paraldehyde, in one or two drachm doses as a calmative and hypnotic, is as effi- 
cient as Chloral and without danger (B). Tonics, may be used, though treatment 
is only palliative; Calcium Lactophosphate, Cod-liver Oil, etc.; no remedies have 
hitherto been of any avail. 

Dengue. 

Emetics and Purgatives are indicated at the outset, also free diaphoresis. Qui- 
nine, in five-grain doses every four or five hours for the fever (Da C); should be given 
more for its tonic than for its antiperiodic effect (Fayrer). Opium, in some form for 
the pains and nocturnal restlessness. Salicylic Acid or Salicylates, for the pains in 
joints and muscles. Phenol, as lotion, a 4 per cent, solution for the itching, or 
Camphorated Oil. Belladonna, confers great relief, njx-xv of the tincture may 
be given every hour for two or three doses (Fayrer). Aconite, with salines and Nitrous 
Ether, during the pyrexia, which may be so high that cold sponging or the cold bath 
may be required. Bitter Tonics, as Gentian or Calumba, with Quinine and a mineral 
acid or Strychnine during convalescence. Treatment is entirely symptomatic. 



Dentition. 

Belladonna, in convulsions of dentition, rarely fails to relieve (P). Hyoscyamus, 
to alleviate pain and subdue irritation; better than Opium for children (P). Chamo- 
milla, njj of the tincture every \ hour, an excellent sedative for children (A. A. Smith). 
Potassium Bromide, for irritability and convulsions in teething (R). Dulcamara, 
the infusion, in the diarrhea of dentition, quickly checks symptoms (P). Calumba, 
excellent for the accompanying vomiting and diarrhea (P). Hypophosphites, of 
Calcium or Sodium, as a general tonic, are highly recommended (R). Rhubarb, 
with Soda, internally for the aphthae, with perfect cleanliness of the mouth and a wash 
of Borax or Potassium Chlorate in Glycerin, gr. x to the o (E. Smith). Castor Oil, 
for the diarrhea of dentition to clear out the bowels, then a mixture of Chalk and Catechu, 
or Zinc Oxide gr. j to the dose, with gtt. j of Laudanum if required to reduce peristalsis 
(Id). Lancing the Gums to relieve tension when gum is actually swollen; should 
not be indulged in indiscriminately. 

1$. Sodii Bromidi, Sodii Bicarb., 

Chlorali Hydrati, aa.gr. xx. 

Aq. Menth. Viridis 5 jss. 

Syr. Zingiberis, oss. 

until M. Sig. — Half-teasp. to a dessertspoonful, 

(B.) according to age. 



R<. Potassii Bromidi, 3j- 

Olei Anisi, TTjij. 

Mucil. Acaciae, 

Aq. Menth. Pip., aa §j. 

M. Sig. — Teasp. every half-hour 

the child is relieved. 



Dhobie Itch. 

Chrysarobin, gr. xx to the o of vaselin, rubbed in twice daily, is almost invariably 
successful; stains the clothing, must not be applied to the face, and should be stopped 
when it causes an erythematous ring at the edge of the diseased patch (Mn). Silver 
Nitrate, a 4 per cent, solution in alcohol, painted over the surface daily, has given 
satisfaction in many cases. Salicylic Acid, a 10 per cent, ointment, or a mixture 
in collodion, is a very efficient application. Hydrargyrum, the Bichloride in 1 to 500 
or 1 to 1000 solution, allowed to dry on the surface. Calcium Sulphide, as in Vletn- 
inck's Solution [formula on next page], applied every night 3 or 4 times, after a thorough 
use of soap and water, generally brings about a rapid cure (Mn). Cassia Alata, a 
tincture of the leaves painted on, or the crushed leaves themselves well rubbed in, are 
successful (Id). Iodine, the liniment freely applied and of double strength, is the 
best remedy for the ringworms of the thick-skinned natives (Id). Zinc Oxide, with 



DIABETES INSIPIDUS — DIABETES MELI.ITUS. 633 

Boric Acid and Starch, equal parts of each, as a dusting powder to the crutch and 
axilla after the daily bath, to prevent infection of the skin (Id). Dhobie Itch is a 
term used in the far East for any itching, ringworm like affection of any part of the skin, 
but most commonly refers to some form of epiphytic disease of the crutch or axilla. 
The chief parasites attacking these localities are the trichophytons or ordinary body 
ringworms; microsporon minutissimum, of erythrasma; and the diplococcus of pem- 
phigus contagiosus (Mn). [Compare Tinea Cironata.] 

R*. Ac. Salicylici gr. xx. 

Chrysarobini gr. xxx. 

Traumatidni ,' j. 

M Sig. — Apply as a paint to the affected 
area. (Morrow.) 



R>. Quick -lime gj. 

Precipitated Sulphur, oij. 

Water g.w. 

Boil in an earthenware vessel until re- 
duced to jx; after subsidence decant the 
fluid, (Vlemiuck's Solution.) 



Diabetes Insipidus. 
Opium, large doses necessary, gr. vj-xij a day (B); combined with Gallic Acid, 
the most generally useful remedy (W). Ergot has cured many cases, the fiuidextract 
in doses of 3ss-j thrice daily (Da C); one of the most efficient remedies (B); is the 
most useful remedy (R); but if used in large doses or long continued symptoms of 
ergotism appear and the drug has to be stopped (Ralfe). Adrenal Extract, has 
given good results. Nitroglycerin, has been employed with good results (Id). Ar- 
senic, improves the general condition and given with other special remedies it greatly 
increases their power (Id). Iron and Strychnine are very useful for tonic effects 
(Da C). Valerian, in large, increasing doses (R); restrains the flow of urine but 
does not cure (B). Sodium Salicylate, in small doses, very effective in some cases. 
Muscarine has been used with apparent success (R). Potassium Iodide is curative in 
many cases of syphilitic origin (B). Alum has produced good results (B). Pilo- 
carpus, is used successfully to reduce the quantity of urine (B). Krameria lessens 
the quantity of urine (P). Galvanism, the constant current over the upper part 
of the spinal cord; or one pole to the loin and the other to the hypochondrium on 
the same side for a few minutes, then on the opposite side; or the anode to the nape 
of the neck and the cathode first to the loins and then to the epigastrium (Kolz). Diet, 
a dry diet beneficial (B), but is very difficult to carry out. 

Diabetes Mellitus. 

Phosphoric Acid, largely diluted, assuages the inordinate thirst; in one case it 
seemed to act as a curative agent (Wa). Arsenic, when from fatty assimilation, in 
diabetes of hepatic origin, and in thin subjects (B); the Bromide is credited with several 
cures (see Aurum below): the Lithiated Arsenical Water was used in 70 cases, with 
cure of 96 per cent. (Martineau); [see infra for formula.] Morphine, is very efficient 
in reducing sugar when used by mouth, but is of no value when employed subcutaneously, 
even in the same case (Bruce). Opium in large doses, gr. vj-xij a day, ameliorative. 
Codeine, is especially serviceable (B); abates thirst and controls appetite (R); its 
value much disputed (P); is of great value in many cases (W); is one of the best reme- 
dies in doses of gr }-£ (Da C). Jambul, has given favorable results after abandon- 
ing all the usual remedies (Lawrence); in 2 severe cares, in which 7 and 3 per cent, of 
glucose were excreted, the urine was brought back to normal by preparations of the 
bark, and kept so for two years (Vix); should be given after meals, in water or wine 
sweetened with Saccharin. Sodium Salicylate has cured when all other drugs have 
failed (R); gr. x-xv in compound spirit of Lavender and water, thrice daily, is my 
favorite remedy (Da C); the urine of patients taking Salicylic Acid gives the reaction 
of sugar with trammer's test (R). Salol in doses of gr. xv thrice or four times daily, 
improved 5 out of 8 cases (Teschemacher). Alkalies are used on theoretical grounds, 
but have not produced much benefit; one case apparently cured by the diligent use 
of Ammonium Carbonate (B); are serviceable (Da C); alkaline mineral waters for 
diabetes of hepatic origin and in obese subjects, are extremely useful; tepid drinks 



634 



DIABETES MELLITUS. 



for the intense thirst (B); alkalies in large doses for the coma, being antidotal to the 
acid toxins (see Coma). Lithium Carbonate gr. v-x, with Sodium Arsenate g 
in the same solution, thrice daily, is very effective (Martineau). Sodium Glycocho- 
late, to promote the digestion of fats, is a valuable auxiliary (Keown). Aloin, for 
the accompanying constipation (Da C). Nux Vomica, or Strychnine, is generally 
beneficial. Calcium Lactophosphate benefits the thin, nervous type of diabetic 
remarkably (B). Antipyrine affects secretion, and has been used with benefit. Methy- 
lene Blue, has given satisfaction in two cases (Estay). Orchitic and Adrenal Ex- 
tracts have been given with reported success. Ergot is one of the useful drugs, lessen- 
ing the amount of sugar and the volume of urine (Da C). Potassium Iodide gr. i 
every 3 hours, has corrected many cases without relapse, and will not cause iodism 
while sugar appears in the urine (Galloway). Iodoform, in doses of gr. j-ij, rapidly 
reduced the sugar and caused its disappearance in 4 or 5 days in five cases, without 
any change in diet being made (Moleschott); the amount of testimony for its value 
in this disease is quite considerable (B). Iodol, can be advantageously substituted 
for Iodoform in all the diseases to which the latter is applicable (B). Uranium Nitrate, 
gr. i-iij, thrice daily has caused decided improvement in several cases (Hughes). Potas- 
sium Bromide, gr. xx ter die, cured two cases in six weeks (Begbie); useless (Da C). 
Krameria lessens the quantity of urine (P). Phosphates, to avert failure of nutrition 
(B). Aurum, the Chloride is one of the promising remedies (B); the Bromide of 
Gold and Arsenic caused so much improvement in one case that he was accepted as a 
good risk by one of the foremost life insurance companies (E. A. Wood). Iron Sul- 
phate as an oxygen carrier, gave good results in the form of Hooper's pill (Thompson). 
Salines, a warm solution of the Phosphate and Chloride of Sodium, by intravenous 
injection in diabetic coma, produced astonishing results in one case (B). Oxygen as 
oxygenated water, instead of carbonated water, has been successfully used (Le Blond 1. 
Glycerin has produced good results (B); used in place of sugar (W). Cod-liver 
Oil in large quantity, has cured several cases (Thompson). Taka-diastase is useful 
in cases due to pancreatic disease. Diet and Hygiene are of the utmost importance; 
avoid amylaceous food and everything containing sugar, especially ordinary bread; use 
fresh, nutritious animal food, with bread of bran or almonds; warm baths, warm 
climate, flannel underclothing. Professor Lupo of Naples maintains that some 1 
may be cured by an exclusive vegetable diet, including all sorts of vegetables, and 
gives two cases in which this treatment proved successful. Professor Saundby permits 
the ingestion of the maximum amount of carbohydrates which the patient can assimi- 
late, especially potatoes, which contain only 15 to 20 per cent, of starch. Potatoes are 
an admissible food if cooked by steaming with skin on, so as to retain their salts (Sau 
a useful and beneficial substitute for wheaten bread (Mosse). Peanuts form an ex- 
cellent food for diabetics, being rich in albumin, of which they contain 47 per cent., 
together with 19 per cent, of fat and non-nitrogenous extractive matters (Furbringer). 
Milk-cure, by skimmed milk, very successful, 6 to 10 pints daily; give no other food 
for six weeks, then animal food (R). Saccharin, as a substitute for sugar, does well 
for sweetening purposes, but is not a nutrient and has no influence on the disease. 
Dulcin, is sweeter than saccharin, and is harmless in reasonable doses, up to 24 grains 
in the day (Kobert). Levulose, is a saccharine food which can be taken freely and 
without any injury by diabetic patients; it most nearly approaches the ideal carbohy- 
drate food indicated in diabetes (Hebra); it is assimilated well and nearly all oxidized 
by diabetics, who are able to partake freely of it in comparatively large quantity (Eb- 
stein) ; sugar and sugar-forming food constitute more than half the nourishment needed 
by a healthy person, and it is the imperative duty of the physician to furnish a diabetic 
with a moderate amount thereof, to prevent death from inanition, and to lessen the 
danger of diabetic coma which is induced by a diet of meat alone (Leyden); Levulose, 
formerly very high in price, is now sold at a reasonable rate under the name Diabetin. 



R. Liq. Potassii Arsenitis, 5jss. 

Tinct. Opii Deodorati, 5 v. 

Syrupi Zingiberis, § j. 

Aquae Cinnamomi, ad oiv. 

M. Sig. — Teasp. thrice daily. 



r> 



Lithii Carbonatis,. 
Sodii Arsenatis, . . . 
Ext. Gentianae,. 
Ft. pil. no. xxv. 



. . . . gr. xl. 
.... gr.j. 

-----' g rxx - 

n. pn. no. xxv. Sig. — One night and 
morning until sugar disappears. (Vigier.) 



DIARRHEA 055 



K. Codeine gr. viij. 

Alcoholis, q. s. ad solv. 

Syrupi Sij. 

Aquce q. s. <ul oiv. 

M. Sig. A teasp. twice daily, the dose 
to be gradually increased up to a tablesp. 



li- Sodii \rsenatis ^r. iij. 

\'i»' 1 ' Oj. 

A tablesp. of this with Lithii Carbonat. 
gr. iij, into a quart siphon filled with car 
Donated water, which is to be taken freely, 
as daily beverage. (Martineau.) 



Diarrhea. 

Castor Oil, in cathartic dose for diarrhea due to irritating material in the intestinal 
i anal, as undigested food or irritant secretions, no remedy more useful (li); makes a 
good preparatory treatment for other medication. Bismuth Subgallate, gr. xx xxx 
every 2 or 3 hours, does good service. Bismuth Subnitrate, is effective, requires 
large doses, gr. xxx-lx every 3 or 4 hours; is especially indicated when desire for stool 
is felt immediately after eating (B); gr. j hourly with milk, sometimes with gr. 4 of 
gray powder in various forms of infantile diarrhea (R). Bismuth and Ammonium 
Citrate, in diarrhea without irritation but rather relaxation of the intestinal mucous 
membrane. Bismuth Salicylate, is highly praised in the diarrhea of phthisis and 
in that of typhoid. Tannic Acid, in profuse and chronic diarrhea (B); with milk 
diet in chronic diarrhea and dysentery (S). Tannigen, in the simple diarrhea of 
children, also in that of phthisis, tuberculous peritonitis, etc. (Sieger). Tannocoll in 
doses of gr. iij-viij, is excellent for children (Goldiner). Tannalbin, is useful in the 
acute form, but especially in chronic diarrheas (Einhorn); also in that of phthisis (Gale). 
Haematoxylon, is devoid of irritating qualities and is well adapted to the diarrheas 
of young children. Calumba, in diarrhea due to relaxation of the mucous membrane 
and not dependent on inflammation (B) Gambir, in atonic diarrhea and in that 
following withdrawal of morphine or opium from habitues, also in the diarrhea of 
children; in the latter the tincture with Chalk-mixture is very serviceable. Kino, 
in atonic diarrhea; the tincture in doses of oj for the diarrhea resulting from the disuse 
of opium or morphine. Coto, the fluidextract, or Cotoin, is one of the new remedies 
for atonic diarrhea. Opium, is commonly used, but is best when evacuations are 
very watery, combined with mineral Acids or with Lead Acetate (B); with Starch as 
an injection in severe cases (R). Codeine, gr. ss-j answers most satisfactorily in 
the milder forms of diarrhea and leaves no unpleasant after-effects (Braithwaite). 

Mercury, in diarrhea of children with bad digestion, flatulent distention and clay- 
colored, pasty, stinking motions, gr. j of the Bichloride to oviij of water in doses ofoj 
every hour; or still better Hydrarg. cum Creta, gr. ^ every hour or two, will restore 
the natural bilious color and limit the number of the stools (R); Calomel in minute 
doses, gr. 2 Vi to /.v every half hour, is useful in the diarrhea and dysentery (ileo-colitis) 
of children, when there is much irritability of the stomach (B); in mucous diarrhea, 
gr. j of the Bichloride to a quart of water, in doses of oj every hour (A. A. Smith). 
Antipyrine, in doses of gr. £ to ii, has rendered signal service in the diarrhea of infants 
and children. Aconite, in diarrhea from chill, with high fever and cutting pains in 
the abdomen (P). Camphor, in summer diarrhea and the preliminary diarrhea of 
Asiatic cholera (B); when from effluvia of drains or exposure to cold (R); useful in 
many forms (P). Ipecacuanha, in summer diarrhea and dysentery of children with 
greenish stools (B); hourly drop-doses of the wine, especially if vomiting (R); when 
from nervous irritation, especially in young children (P). Dulcamara, in diarrhea 
of children from damp or with dentition (P). Pulsatilla, dyspeptic diarrhea, mucous 
discharges, active piles (P). Quinine, in periodic diarrhea, with dysentery and jaun- 
dice (B). Veratrum Album, in the vomiting and purging of summer diarrhea (R). 
Podophyllum, in chronic, with high-colored motions and cutting pains, also in morn- 
ing diarrhea (R); gr. ^ n to f \ T , with occasional doses of Aconite, for vomiting and 
diarrhea of gastro-enteritis and prolapse of rectum (P). Chamomile, an infusion 
in summer diarrhea of adults, or in that of dentition (R); the Oil in diarrhea of children, 
especially from worms (P). Arsenic, for evacuation of undigested food (B); gtt. j of 
Liq. Pot. Arsen. before meals when diarrhea excited by food; also in chronic and 
membranous forms (R). Nux Vomica, a very useful adjunct to other remedies (B); 



6 3 6 



DIARRHEA. 



often of much service in epidemic diarrhea (P). Sulphuric Acid, in summer and 
choleraic diarrhea; small doses in the chronic form and in the straining diarrhea of 
children (R). Magnesium Sulphate, a teaspoonful in a wineglassful of water every 
3 hours when intestinal inflammation (B); very efficient in acute diarrhea of soldiers. 
Peptenzyme, is excellent in cholera infantum and the summer diarrhea of children. 
Balsam of Peru, is excellent in diarrhea, with or without tenesmus (Tr). Kola, 
is useful in atonic diarrhea. Zinc Salts, are very efficient in the summer diarrhea of 
children (B). Alkalies, Mistura Cretee in sour-smelling stools (B); Sodium, Potassium 
or Magnesium Bicarbonates when acid canal (R). Calcium Carbonate, as Chalk- 
mixture, in the later stages, also in the diarrhea of typhoid or phthisis (R); may be 
combined with Opium and with vegetable astringents. Lead Acetate, with Opium 
as an injection (R); is excellent in all forms (B). Calcium Chloride inhibits peristal- 
sis and is indicated in diarrhea accompanying hysteria or any form of nervous irritability 
(McCallum). Nitrous Acid is specific in serous diarrhea and the sudden, acute form 
of hot climates (Hope); as in Hope's mixture (see formula below) a very efficient 
remedy in serous diarrhea with disordered secretion of the liver and other glands of 
the alimentary canal (W). Mineral Acids when painless, watery stools, fight colored 
and alkaline (B). Ichthoform gives satisfaction in the diarrhea of tuberculosis (Scha- 
fer); also in that of typhoid (Polacco). Salol, is very efficient in acute diarrhea due 
to action of microbes. Resorcinol, gives very marked satisfaction in the diarrhea of 
children. Thymol, gr. xx to 3ij in 24 hours in divided doses for adults, is a very 
efficient internal antiseptic in all cases of diarrhea, especially that of phthisis, teething 
children, and chronic diarrhea (Martini); avoid alcohol in any form with or after 
thymol, lest poisoning result. Phenol, is very useful in fermentative diarrhea, 
especially combined with Bismuth in cholera nostras and cholera infantum (B). Rhu- 
barb as a purgative in the early stage to get rid of irritant, afterwards it checks the 
diarrhea (R) ; when torrefied it has no purgative power, but its astringency is retained. 
Rumex, in morning diarrhea (R). Arnica, checks exhausting diarrhea with great 
certainty (P). Silver Nitrate, in diarrhea of children, with white, pasty, and offen- 
sive stools; combined with Opium the most effective remedy for that of phthisis and 
typhoid (B). Copper Sulphate, the most effective astringent in chronic diarrhea and 
that of phthisis (B). Ergot, in persistent, chronic diarrhea (B). Iodine, one or 
two drops of tincture in diarrhea from atony of mucous membrane (B). Taka-dias- 
tase is efficient in the diarrhea of infants (Wolff). Hypodermoclysis to replace fluid 
in the vessels in excessive watery diarrhea (Kemp). Diet, should be cool or cold, 
light bland food; gruel, rice, arrowroot, whey, barley-water, in recent cases; in chronic 
cases the most digestible but nutritious food, as fresh fish, game, raw eggs, rice, mucilag- 
inous drinks; Milk and Lime-water or Soda-water very useful; also raw meat pulp; 
avoid beef, pork, veal, and much starchy food. In most forms of diarrhea in children 
it is wise to cut off milk and substitute some artificial food (R). [Compare Dysen- 
tery, Cholera.] 



R. Acidi Nitrosi, 3 j- 

Misturae Camphorae, §viij. 

Misce et adde — 

Tinct. Opii, ttjj xl. 

Sig. — One-fourth part every 3 or 4 hours. 

(Hope's Mixture, original formula.) 



ty. Ac. Nitrici Diluti, gij. 

Tinct. Camphorae, 

Tinct. Opii, aa. 3j. 

Syr. Zingiberis, 3iv. 

Aq. Menthas Pip., . .q. s. ad §vj. 
M. Sig. — Tablesp. doses to be used after 
a cathartic. (Hope's Mixture as modified 
by Thompson.) 



R. Tinct. Opii Deodorat., njx. 

Bismuthi Subcarb., 3jss. 

Syrupi Zingiberis, 3yj. 

Mist. Cretas, q. s. ad %iv. 

M. et fiat emulsum. Sig. — A teaspoon- 
ful every 2 or 3 hours, for a child of one year 
old, when the stools are acid and green. 

(Goodhart) 

R. Tinct. Opii Camph., 

Tinct. Gambir Comp aa3uj- 

Mist. Cretae, 3x. 

M. Sig. — A teaspoonful four or five 
times daily for children. 

R. Tinct. Opii Deodorati, 3j- 

Tinct. Calumbae, q. s. ad §ij. 

M. Sig. — Teasp. in winegl. of water 
before meals. 



DIHI nil EU \. 

Diphtheria. 

Antitoxin is eminently successful, especially when used early in the case; [see the 
article on Antitoxin in Part I]; 2,000 to 3,000 units, repeated in 24 to 48 hours, with 
Resorcin solution, gr. x to the 5 as a throat spray, and Quinine Salicylate gr. iij v 

thrice daily, is my treatment (Sir J. Moore); neglect to use it is almost criminal in 
the present state of medical knowledge (Salinger). Mercurous Chloride (Calomel), 
my chief dependence for 20 years, gr. ,',, every hour tor 12 to 24 hours, then evi 
hours (Miller); gr. v repeated boldly every hour up to oiv, for a child of ,< years, until 
the stools appear like polyps in water-troughs, gelatinous and of a bright, dark -green 
hue,— then a dose of Castor Oil if salivation is feared (Rciter); the safest and most 
efficient germicide with which we can saturate the system; nothing like it in diphtheria, 
gr. £-J every hour, even gr. j every 2 hours has no bad effects, no salivation (Fowler). 
Hydrargyrum Bichloride internally, with Ichthyol rubbed into the skin over the 
cervical glands, is employed with marvellous success (Davison); has given me the 
best results, with a gargle of Thymol or Boric Acid (Da C); gr. jss in 5iv of glycerin 
and water, of which 5 j every i hour for 6 doses, then every hour night and day, to a child 
of 4 years (Grant-Bey); locally very efficient, gr. ij to Oj of water, applied on a cotton 
swab, which should be burned after one using; this hourly night and day (Oatman). 
Hydrargyrum Cyanide, in solution of gr. ,'„ to the 5, of which a teasp. every J hour 
day and night to older children and adults, with a gargle of the same solution (Sellden); 
gr. ./,;-,'.,, according to age, every hour or two (Erichsen); gr. j in 5ivof water, of which 
oj to iv as per age every hour (Schultz). Iron, the tincture of the Chloride with Potas- 
sium Chlorate, as a gargle, also internally (Jacobi); the Perchloride, gr. ss-j every 2 
hours in syrup and water, is easier to take than the tincture and doesn't hurt the throat 
(Da C). Arsenic, in medicinal doses for malignant cases, or when sloughing of throat 
(R); the Iodide, in doses of gr. tjV every hour or so, (see under Throat, Sore), an 
excellent remedy for the so-called diphtheritic sore throat. Calcium Chlorate, in 
solution locally as lotion for the mouth; considered almost specific by some; its chief 
utility is in removing fetor; may influence germs (R). Potassium Chlorate, grain- 
doses every h hour (Smith); is more largely used than any remedy, both internally 
and locally (B); in full doses with Liq. Cinchonae, seems to be of service in some cases 
(Wa); with the tincture of Ferric Chloride as a gargle, also internally (Jacobi). Bella- 
donna, an excellent remedy; if given early will abort the exudation and later is useful 
to sustain the heart (B); especially when throat and tonsils acutely inflamed and much 
swollen (R). Pilocarpine, used in 80 cases without a single death; produces free 
salivary discharge, but it is depressant to the heart (Guttmann); many opinions for 
and against it; is decidedly injurious in adynamic cases (B). Quinine, in tonic doses 
recommended from my experience (Da C); when headache with high temperature, 
vomiting, and symptoms of septic poisoning, then in full doses (Wa); is most useful 
after serious symptoms have abated, then with Iron and a mineral acid (Mackenzie); 
the Salicylate in conjunction with the antitoxin treatment (Sir J. Moore); freely with 
Calomel as it prevents hydrargyrism (DeWitt). Calcium Sulphide gr. $ every J 
hour or hourly as per age, curative in mild cases and in severe ones is a valuable adjunct 
to the antitoxin treatment (Abogado). Sulphurous Acid the gas recommended by a 
royal commission in Victoria, as a means of arresting the disease; crude sulphur burned 
in the room, all apertures being closed (R); the official acid in full and frequent doses, 
causes rapid disappearance of the exudation, and improvement in the general condi- 
tion; 5j every J hour to an adult in severe cases, in ordinary ones every two hours; 
an 8-ounce mixture should have 2 or 3 ounces of syrup and be given in milk to young 
children (Snow). Sodium Sulphite, 5j to oj aquae, locally, an easily managed appli- 
cation (B); an injection for nares in nasal diphtheria (Da C). Sodium Hyposul- 
phite, in solution of oj to oij of water, of which hourly doses of oj, to be retained 
in throat several minutes before being swallowed, an excellent local and constitutional 
remedy which may also be used by a brush or spray to the throat, and by a syringe 
to the nares (Fruitnight). Sodium Benzoate, is highly efficient, 75 to 100 grains 
daily, according to age, also used locally (B). Myrrh, the tincture internally to pro- 
duce leucocytosis, used in 80 cases with only one death, and in 300 cases with good 
results (Stroll). Cubeb is very efficient in the catarrhal form (Robinson); the freshly 



638 DIPHTHERIA. 

ground berries in large doses in early stages of the disease, a very successful treatment 
(Trideau). Turpentine, 5j of the oil thrice daily, with njjiv of Spiritus Athens as a 
corrective, at the same time using ice-bags and a gargle of Potassium Chlorate solution, 
and internally ^-ounce doses every 2 hours of a 2 per cent, solution of Sodium Salicy- 
late (Roesse, Baruch). Potassium Permanganate, gr. \ in distilled water internally 
and also used locally, is of undoubted benefit (B); is credited with brilliant results even 
in malignant cases. Sanguinaria, the best emetic, and by many is considered specific 
in this disease (P). Chlorine- water, tablesp. doses internajly and as a gargle, highly 
efficient; a mixture of Chlorine-water 2 parts and Distilled Water 1, of which 5j inter- 
nally every 2 or 3 hours, is by far the best treatment of this disease; no water should be 
given after the mixture (Schubert); as a prophylactic the same may be given 2 or 3 
times daily (Id). Nuclein, has been used with benefit. Stimulation, freely, the 
essential part of the treatment; infants are not injuriously affected by teasp. doses of 
whiskey every \ hour; stimulate for effect and not by dose; those cases do best which 
are stimulated freely and early (Da C); there is more danger from giving too little 
alcohol than from too much; a three-year-old child can comfortably take 5j-5v of 
Cognac, or gr. xv of Musk or Camphor, or gr. xv-5j of Ammonium Carbonate in 24 
hours; in the septic form especially, the intoxicating action of Alcohol is not experi- 
enced, and young children with general sepsis began to improve when their 3iv of 
brandy were increased to oxvj daily (Jacobi). Water, as ice in the mouth and the wet 
pack to the throat, is extremely serviceable (B) ; Ice sucked, especially at commencement, 
and continued until the disease declines (R); Ice packed in bladders or thin india- 
rubber bags, to the throat (W). Aliment, good foods, wines or brandy, necessary 
from the start to maintain the patient's strength (R); a teasp. of glycerin every 3 or 
4 hours, plenty of good soup and wine, nutritive enemata, are necessary to sustain the 
system. Moist inhalations. Temp, of room 68° Fah. Removal from the house 
wherein attacked is advisable. Tracheotomy, only in extremis (R); should be done 
before there is much lividity (Tirard). Intubation of the larynx is preferable to 
tracheotomy whenever practicable (Id). [For Laryngeal Diphtheria see Croup, 
Membranous.] Strychnine hypodermically, for the subsequent paralyses, which 
may include any form of motor paralysis. . 

Local Applications. Hydrogen Dioxide, a 3 per cent, solution as gargle at 
short intervals, also internally, used alone with results equal to those from antitoxin 
(Novikov); is much more powerful against young bacilli than against those of two 
days old, and hence its value is especially available at the very outset of the disease, 
and as a prophylactic during epidemics (Traugott). Thymol, oj in Glycerin oj and 
Water oiij, is the best agent for use as a gargle (Da C). Toluene, with Menthol, 
Creolin, etc., as in Loeffler's Solution, which is applied on a swab of cotton every 3 hours 
for 4 or 5 days, after cleansing the surface; is highly efficient for destroying the bacilli 
and preventing absorption of toxin (Loefner). Resorcinol, gr. x to the of water, 
as gargle or spray to the fauces (Sir J. Moore). Picratol, a saturated solution locally, 
causes the membrane to shrivel and become detached (Yale). Collargolum by 
inunction, in connection with antitoxin, gave good results in severe cases (Netter). 
Papain, by atomized inhalation, is used to destroy the membrane. Pineapple Juice 
and Papaya Juice, used by sipping and swallowing the juice after chewing the pulp, 
highly efficient in India (Chambers). Boracic Acid, in solution as gargle, ranks next 
best after Thymol (Da C). Sulphur and Alum, equal parts, powdered and blown 
into the throat at the moment of deep inspiration, as often as asphyxia is threatened, 
are efficient (Jones) ; Sulphur is a very old and efficient local remedy in diphtheria, 
the flowers (sublimed sulphur) rubbed up with water as a gargle, or blown upon the 
throat through a quill, was the method of Dr. Field, who had a great reputation in 
England some years ago for curing this disease (Lancet). Trypsin, is a good solvent 
of the false membrane; of all remedies used with the spray-atomizer it has given me 
the largest percentage of recoveries (Fruitnight). Chinolin, a 5 per cent, solution 
painted over the affected parts with great advantage (Seifert); the tartrate in 10-grain 
doses internally (B). Bromine, the vapor by inhalation, is useful (Wa); a T Arr solu- 
tion in distilled water, of which gtt. j-iij every J hour in a teasp. of sweetened water, 
using a glass spoon; and a saucer full of Bromine Water in the room, renewed every 
12 hours, has seemed to be extremely efficient in a number of cases. Iodine as inhala- 



DROPSY. 



639 



lion frequently; with use the solution may be increased to Sss al each inhalation 
Sodium Sulphite, 5j to 3j aqua;, locally, an easily managed applii an 

injection for nares in nasal diphtheria (Da C). Phenol, as a spray, a 5 per 

ant. solution in the atomizer cup; locally to the fauces, to remove fetor ami destroy 
disease-germs (B); the strong acid in Glycerin as caustic on .1 mop ,, r brush i \\ l; 
with Iodine internally to prevent systemic infection (B). Lime-water, dissolves 1 
membrane; the vapor of slaking lime inhaled; or, better, Lime-water by atomizer to 
hack of fauces while patient inspires deeply (W). Ferric Chloridej as solution 
painted on or applied by spray to the throat (R). Tar and Turpentine vapor, made 
by burning in the room Coal tar 7 parts to Oleum Tcrebinthin.e 3 (Delthil). Methy- 
lene Blue, was used with success after losing cases by other treatment; even in simple 
non-diphtheritic ulceration o\ the throat, patients would, after one or two applications 
of the solution, express themselves with delight as being cured 1 Rose). Tartaric Acid 
locally, converts membrane into a gelatinous mass, easily expelled (Vidal). Chloral, 
a dilute solution in glycerin and water makes an excellent local application for the 
throat; internally may be used as a symptomatic remedy in the early stages, but not 
when the heart is weak. Alcohol, is probably as good a local antiseptic as any; diluted 
with equal parts of water, by hand-ball atomizer every A hour; is the prince of anti- 
septics, and the most perfect and reliable medicine in diphtheria of which we have any 
knowledge (Hills). Lactic Acid, oiijss to §x of distilled water, as gargle, on mop 
or by spray, to dissolve membrane (B). Tannin, a 5 per cent, solution as spray (R). 
[Compare Croup membranous.] 

R . Hvdrarg. Chlor. Corros., gr. jss. 

Glycerini, 5j. 

Aqure Destillatae, oiij. 

M. Sig. — A teasp. every t hour for 6 
then every hour night and day to a 
child of four years. Also, — 

R. Ung. Iodoformi (1 in 10), rubbed in 
over swollen glands every 3 hours. 

(Grant-Bey.) 



R. Tinct. Ferri Chloridi, 5j- 

Syrupi Tolutani, 

Liq. Potassii Citratis, aa 5ijss. 

M. Sig. — Teasp. to dessertsp. according 
to age, every 3 hours; 5j = 1K X of the tinc- 
ture. (Anderson.) 

R. Sodii Sulphitis, oiij. 

Glycerini 5 i j • 

Aqua;, q. s. ad §iv. 

M. Sig. — Nasal injection. (Da Cosla.) 



R). Mentholis, 10 Gm. 

Toluene, q. s. ad 36 I 

Dein adde — 

Creolini, 2 Cc. 

Liq. Ferri Chloridi, 4 Co 

Alcoholis, q. s. ad 100 Cc. 

Sig. — To be applied by cotton swab every 
3 hours for 4 or 5 days. 

(Loeffler's Solution) 



Vf. Potassii Chloratis, gr. l.xx.x. 

Tinct. Ferri Chloridi, njcl.x. 

Glycerini, 3ij- 

Aqua; Destil q. s. ad 3 viij. 

M. Sig. — 5ss as a gargle; for children 
of 2 to 6 years 3j every hour internally- 

(Jacobi.) 

R;. Ac. Tartarici, 3j- 

Glycerini, 5 jss. 

Aqua; Menth. Pip.,.q. s. ad 3iv. 
M. Sig. — Gargle frequently. (Vidal.) 



Dropsy. 

Arsenic, in dropsy from feebleness of heart, and in old age (B); swelled feet from 
debility (R). Aurum, has an ancient reputation in several forms of dropsy. Digi- 
talis, one of the best remedies, especially in renal dropsy from acute desquamative 
nephritis; the infusion in doses of Sss (B); the fresh infusion best for that of heart disease, 
especially when tricuspid regurgitation (R); induces striking effects in cardiac dropsy, 
when scanty urine and venous engorgement; has high rank as a diuretic (P). Apocy- 
num Cannabinum, actively diuretic (P). Diuretin has been employed with marked 
benefit in both cardiac and renal dropsy, in hepatic cirrhosis, and in various diseases 
of the heart and kidneys accompanied by edema: gr. xv several times daily, in aqueous 
solution, avoiding acids or acid vegetable juices. Caffeine, the Citrate in 5-grain 
doses is eminently diuretic. Agurin a valuable diuretic in cardiac dropsy, also in 
that of chronic interstitial nephritis (Holle); gr. x.x.x-xlv twice daily is very effective 
in about two days (Ketly). Theocin gr. iv thrice daily, a powerful diuretic in many 



640 



DUODENAL CATARRH. 



cases (Meinertz). Picric Acid, gr. ss in Bviij of water, of which 3ij every 3 hours, 
is remarkably efficient in scarlatinal dropsy (Couch). Cactus, has long had a high 
reputation in dropsy amony the natives of its habitat; is probably of service in cardiac 
dropsy. Hydrargyrum, a classical pill in dropsy with dyspnea from cardiac disease 
is the combination of Dr. Baillie, containing Mercury, Digitalis, and Squill (see formula 
below) ; Calomel in doses of gr. ss— ij is eminently diuretic, especially in cardiac dropsy, 
but by many it is thought to act by aiding the action of other diuretics. Bryonia, 
as a drastic purgative and diuretic; care necessary, as it depresses the heart; the infu- 
sion best (P). Hellebore, the tincture, in doses of gtt. v-xv, every 2 or 3 hours, very 
successful in dropsical effusions, especially in general anasarca after scarlatina (P). 
Senega, as a diuretic when dropsy is dependent on kidney disease; has been praised 
(P). Chimaphila, is useful as a diuretic in renal dropsy especially when loss of appe- 
tite and debility (P); may be substituted for Scoparius (B). Juniper, largely used 
as a diuretic in cardiac and renal dropsy (B); esteemed in post-scarlatinal dropsy (R). 
Iron, purgative chalybeate waters (B): the Liquor Ferri et Ammonii Acetatis (Ba- 
sham's Mixture), in anemic dropsy (Da C). Pilocarpus, very valuable in renal dropsy 
when secretion of urine is much reduced or suppressed (B). Jalap, the compound 
Jalap powder, gr. xv-xx, with 3iij of Potas. Bitart. and a little Ginger, early in the 
morning, 2 or 3 times a week, no hydragogue superior in dropsy from Bright's disease 
(Wa). Turpentine, controls dropsy with albuminous urine, from non -desquamative 
renal disease; gtt. ss every 2 to 4 hours (P). Colchicum, as a hydragogue in hepatic 
and cardiac dropsy when patient is vigorous, also in post-scarlatinal dropsy (B). Sco- 
parius, esteemed by English physicians (B); is most useful in cardiac dropsy; Cullen 
found it the most certain diuretic; diluents should be freely used with it (P). Squill, 
in cardiac dropsy; cautiously if from kidney disease; if anemic add Iron (R). Taraxa- 
cum, is occasionally used as a diuretic, with limited utility (B). Copaiba, gives good 
results, especially in ascites, which see for formula (B). Potassium Bitartrate and 
Acetate, are very certain as diuretics when largely diluted with water, as cream-of- 
tartar lemonade; indicated in desquamative nephritis, and in general dropsy from 
valvular disease of the heart (R). Elaterium, of unquestionable value as a derivative 
in many passive forms of dropsy, though many fear it (P). Acupuncture, or better 
still, incisions from | to an inch long, one over each external malleolus generally suffi- 
cient; a hot sponge, moistened with weak phenol solution kept to incisions (R). 
Aliment, dry diet is of advantage in dropsy of serous cavities (B); should be light in 
acute dropsies; nourishing in chronic. Water not injurious but beneficial as drink. 
Warm baths, Holland gin in small doses, tapping for alleviation in incurable cases. 
A moderately warm, dry atmosphere. Skim-milk diet said to be of great value in 
renal dropsy. [Compare Ascites, Hydrocele, Hydrocephalus, Hydrothorax.] 



3. Pulv. Scillje, 

Pulv. Digitalis aa 5ss. 

Potassii Nitratis, 3j- 

M. Fiat massa et div. in pil. xxx. 
Sig. — One pill thrice daily. 



B- Elaterini, gr. j. 

Spt. ^Etheris Nitrosi, §ij. 

Tinct. Scillas, 

Tinct. Colchici, aa oss. 

Syr. Simplicis, 5 ]• 

M. Sig. — A teaspoonful 3 or 4 times daily, 
for hepatic and.cardiac dropsy in sthenic sub- 
jects. 



R. Pulv. Digitalis, gr. j-jss. 

Pulv. Scillae gr. j- 

Hydrarg. cum Creta vel 

Pil. Hydrargyri, gr. j-iij. 

Ft. pil. no. j. Mitte tales xxiv. 

Sig. — One pill thrice daily. {Baillie) 

~fy. Potassii Acetatis, 3vss. 

Spt. ^Etheris Nitrosi, 3 i j - 

Aquae, q. s. ad Bviij. 

M. Sig. — Tablesp. every 3 or 4 hours. 

fy. Aceti Scillas, 5ss. 

Infusi Digitalis, q. s. ad Biv. 

M. Sig. — A tablesp. 2 or 3 times daily. 



Duodenal Catarrh. 

Salol, is the most efficient remedy. Sodium Phosphate, 3j four times daily, 

extremely efficient in catarrhal conditions of the duodenum and bile-ducts, resulting 

in jaundice, hepatic colic, etc. (B). Vichy Water, in similar conditions, probably 

owes its efficacy to the Sodium Phosphate contained in it (B). Potassium Dichro- 



DYSEN1 i K\ 

mate, in doses of gr. ,',, - . two or three times a day, is an excellenl remed) in bo called 
duodenal dyspepsia, manifested by .1 bitter taste, coated tongue, pale stools, vomiting 
of glairy fluid and dull pain in right hypochondrium. Arsenic, has been used with 
ess in jaundice from catarrh of bile-ducts after duodena] catarrh (B). Aurum 
silts will often remove duodenal catarrh and that of the bile-ducts, also tin- jauni 
therefrom (B). Podophyllum, in catarrhal and malarial duodenitis. Nitro-muriatic 
Acid, internally in mucous duodenitis; also as hath to right hypochondrium, 3jjj to 
gal. j, temp, of hath g6° F. (B). Aliment, no starches or fats; milk, egg8, oysters, 
beef-broth, broiled or raw beefsteak, white-fish (B); the diet should he exclusively 
animal, in order to let the stomach deal with it. [Compare BILIOUSNESS, Jaundice.] 

Dysentery. 

Ipecacuanha, is the remedy for acute dysentery of the ordinary type; large doses; 
gr. xx\ x\\ \ P); gr. xv in milk (B); valuahle in acute or epidemic forms, also in summer 
dysentery of children, with greenish stools, mucus and blood, gr. ij-v every 2 hours in 
milk (B); in dysenteric diarrhea of children, especially with vomiting, which will often 
yield to hourly drop doses of Ipecac wine (R). Castor Oil, as a mild cathartic, is 
very valuable in appropriate cases (Wa); gtt. v every hour, in water with sugar and 
gum, is excellent for dysenteric diarrhea of children (Smith): 5j of the oil, guarded by 
10 to 20 drops of laudanum, the best preliminary treatment for all cases of catarrhal 
dysentery. Magnesium Sulphate, the best remedy for the acute form, especially 
when fever, pain, tenesmus, stools containing mucus and blood (B). Opium, as 
enema, with starch and milk, after canal is emptied by salines; indispensable in chronic 
dysentery (B); for the purging (R); a remedy of great value, and applicable to every 
stage and every form of the disease, allaying pain and vascular excitement, moderating 
peristalsis, promoting the cutaneous secretion; is inferior to Ipecac in acute dysenteiy, 
and is most valuable in the chronic form (Wa). Silver Nitrate, in pill, gr. |-j, with 
Opium, in acute dysentery after subsidence of acute symptoms; also as enema beyond 
the sigmoid flexure gr. x-xx ad Oj aquas, using from 3 to 6 pints (O) : also as escharotic 
through speculum to ulcer of rectum (B). Potassium Bitartrate, in acute dysentery 
with scorbutic symptoms, as seen in miners, sailors, etc.; a full cathartic dose, 3ss or 
more, has acted most beneficially as a preliminary to other treatment, and in many 
cases has proven to be the only remedy required. Bismuth Subnitrate, in doses of 
gr. xv-xx eyery hour or so, is highly efficient; may also be used in suspension with 
Starch or Chalk-mixture, as a rectal injection. Bismuth Subgallate, may be used in- 
stead of the subnitrate and in the same doses, or 30 grains may be given at longer inter- 
vals. Bismuth Salicylate, gr. xv in milk or cachet 4 times daily; gr. xx twice daily 
with gr. ij of Ammonium Carbonate to prevent flatulence (Tirard). Quinine, when 
periodic (B); in malarial subjects is as successful as Ipecacuanha in dysentery of the or- 
dinary ty'pe (P). Mercury, in minute doses for the ileo-colitis of children; gr. 55 to 
! l : of Calomel or Hydrargyrum cum Creta every half hour (B); gr. r J of the Bichloride 
hourly or every 2 hours, in acute or chronic dysentery if stools are slimy or bloody 
(R); Calomel in fractional doses every hour, is most in vogue in Germany, and is bets 
suited to the croupous form (Mn). Zinc Phenolsulphate, gr. ij-iij in pill 4 or 5 
times a day as an intestinal antiseptic. Tannic Acid, in solution, 3j to the pint, by 
rectal irrigation, as an intestinal antiseptic. Cinnamon, sometimes does good in 
chronic dysentery, may be combined with Ailanthus (Mn). Iron, weak solutions of 
the tincture of the Chloride for irrigation of the bowel have been used in bad cases 
with great benefit; the Pemitrate for the anemia in chronic dysentery (Maclean); 
sometimes useful in the chronic army form (B). Balsam of Peru, 3 grains, with 
alcohol oj, syrup of lemons 5iv and water 5iij, excellent for dysentery (Tr). Arnica, 
is highly extolled as an internal remedy for cases where the vital powers are depressed 
(Wa). Gamboge, gr. J internally in the 24 hours, exceedingly valuable in young 
persons (P). Taka-diastase in the dysentery of young children (Wolff). Ichtho- 
form is used with benefit (Polacco). Protargol, a 1 per cent, solution as rectal injec- 
tion, very efficient in two cases (Van Hoesen). Hydrogen Dioxide diluted for lavage 
in colitis with dysentery, proved very successful when other measures failed (Roger). 
42 



642 



DYSENTERY. 



Simaruba Bark is more suitable in subacute cases, the seat being in the caecum and 
ascending colon, than when the sigmoid flexure is affected (Longhurst). Salol is 
an efficient intestinal antiseptic, and has proved very effective in combination with 
Bismuth and Opium (Masaiev). Olive Oil 5j in hot milk thrice daily, the dose doubled 
after 5 days, used with great benefit in many severe and intractable army cases (Ruther- 
ford). Ailanthus Glandulosa, as infusion, sometimes succeeds where other measures 
have failed, and seems to be especially serviceable when the case has become subacute or 
chronic (Mn). Monsonia Ovata, a tincture gave wonderful results in chronic cases 
and in acute ones which had resisted the ordinary remedies (Maberly). Glycerin, 
with infusion of Linseed, 1 to 4, to allay tenesmus (B). Lead Acetate, as enemata, 
in acute and chronic dysentery to allay tenesmus (B) ; with Ipecac and Opium in pill, 
for acute form (Da C). Hamamelis, when the discharges contain much blood (R). 
Aconite, when fever and cutting pains (P). Nux Vomica, in epidemic dysentery 
(P); prune-juice stools, much gas, vital depression (B). Arsenic, Fowler's solution 
gtt. ij with gtt. v of Opium often benefits (B). Copper Sulphate, useful in acute 
dysentery; in chronic the most valuable astringent (B); gr. x-xx ad Oj aquae (R). 
Ergot, in chronic after acute, and also in the acute form (R). Grape-cure, is used 
successfully in the chronic form (P). Calumba, is of great value in chronic dysentery 
with ulceration of colon (P). Chekan, is used with benefit. Injections of mucilag- 
inous enemata, as Linseed, are of great value (R). Diet is of prime importance (B); 
avoid animal food and stimulants, liquid foods best, all to be cold (R) ; milk diet alone 
during exacerbations. Boiled and peptonized milk, light animal broths and beef-juice, 
not beef teas; barley or rice may be added to such broths, but should be thoroughly 
cooked (Ty). [Compare Diarrhea, Enteritis, Sprue.] 



1$. Magnesii Sulphatis, B viij . 

Ac. Sulphurici Dil., Bss. 

Aquae, Sviij. 

M. Sig. — Tablesp. in a wingl. of water 
every hour or two until it operates. (B .) 



B- Fluidextr. Ergotae., Biijss. 

Tinct. Opii Deodorati, §ss. 

M. Sig. — A teasp. thrice daily. 

(A ndrew.) 

1$. Liq. Ferri Nitratis, 

Ac. Nitrici Dil., aa 3ss. 

Syr. Zingiberis, ., 5 j- 

Aquae, q. s. ad giij. 

M. Sig. — A teasp. thrice daily for a child 
of 2 years. Tonics to follow palliative treat- 
ment. (Starr.) 



R. Plumbi Acetatis, gr. iv. 

Morph. Acetatis, gr. ss. 

Aquae Fervid., 5 j- 

M. Sig. — Enema to allay tenesmus. 



B- Ferri Sulphatis, gr. xl. 

OpiiPulveris gr. xx. 

Fiant pil. no. xx. Sig. — One pill thrice 
daily, in chronic dysentery. 



B 



Phenylis Salicylatis, 
Bismuthi Subnitratis, 

Sodii Bicarb., aa 3j- 

Opii Pulveris gr. iij. 

Misce, et div. in chartas no. xij. 
Sig. — One powder every two hours. 

(Masaiev.) 



Dysentery, Tropical. 

Magnesium Sulphate proved more effective in Africa than Ipecac (Longhurst); 
-drachm doses of a saturated solution with njx of dilute sulphuric acid, every hour, 
gives striking results in acute tropical dysentery (Thorpe); oiv of a sat. sol. with tt|[xv 
of ac. sulph. dil. every 2 hours, and a milk diet, acted like magic in all my cases of tropical 
dysentery (Wiglesworth) ; produced complete and permanent cure in a bad case from 
India, in which many other remedies had no effect (Alexander). Ipecacuanha is 
highly valued in India and Burmah (Goldsmith); its use is most common in tropical 
climates (W); the de-emetinized root used with excellent results, and with slight vomiting 
•or none (Harris). Silver Nitrate, in solution gr. xx-xxx to the pint, 3 or 4 pints care- 
fully injected once in 3 or 4 days, the remedy of greatest value (Kieffer); a solution 
of 1 in 1000 as antiseptic wash daily, up to 60 washes in series, entirely successful in 
many cases of the recurrent form of tropical dysentery, having lasted from 1 to 5 years 
(Gallay, Surgeon-Major for French Colonies). Creolin in h to 1 per cent, solution 
as injection twice daily, has many advantages and ranks next to silver nitrate (Kieffer). 



DYSMENORRHEA. 



643 



Quinine, warm solutions of 1 in 5,000 to 1 in 1,000, by rectal Injectii t amebic 

dysentery (Ty); is amebicide not bactericide. Acetozone, solution of 1 in 1,000 as 
injection for amebic dysentery, is both amebicide and bactericide (Strong). Methy- 
lene Blue, gr. be in Oij of warm saturated solution of Boric Acid, a very successful 
injection in sigmoid cases due to amebae (Goldsmith); internally may be of servi< 
amebic cases, being partially excreted in the leas (Armstrong). ' Ma'tico, the infusion 
by the mouth and rectum was found serviceable in the malignant hemorrhagic dj 
tery of Trinidad. Sulphuric Acid dilute, with saline purgatives (B); as a remote 
astringent much used in India (see formula below). Cold Water encmata are better 
than tepid ones, injections should be either cold or hot to wake up reaction (Kieffer). 
Local Treatment the mainstay, but requires careful technique and persistence to 
secure toleration (Id). Colostomy was done on an old and bad case of amebic dysen- 
tery, the colon then irrigated daily with a weak solution of hydrogen peroxide, resulting 
in immediate relief from pain and finally complete cure (Barbat). [Compare Diarrhi \, 
Enteritis, Sprue.] 

I!. Morphinic Sulph., gr. ij. [ 1$. Acidi Sulphurici Dil., 

Strychninae Sulph., gr. \. Vini Ipecacuanha, 

Ac. Sulphurici Dil. Sss. Tinct. Opii, aa 3j- 

Aquae Camphora:, Siijss. Olei Ricini, 3v. 

M. Sig. — A teasp. well diluted even' M. et agita. Sig. — 5 to 10 drops ire- 
hour or two. In epidemic dysentery with ; quently, the smaller dose as often as half- 
prune-juice stools and marked depression. | hourly. 

Dysmenorrhea. 

Ammonia, the Aromatic Spirit in doses of 5j every 4 hours or oftener, a thoroughly 
trustworthy remedy, and should be used in place of the alcoholic stimulants generally 
prescribed (Illingworth). Ammonium Acetate, has remarkable power over many 
forms of dysmenorrhea; the Liq. Ammonii Acetatis, in oss doses, with gr. ^ of Ipecac, 
every 2 or 3 hours, to keep up the action of the skin until the flow is well established 
(E). Antipyrine, as an analgesic, is efficient. Acetanilide, is equally efficient for 
the pain. Cimicifuga, relieves pain in the congestive variety and is decidedly useful 
(P); is said to be very efficient (R); is valuable (Wa). Opium, necessary when pain 
is very severe; one hypodermic of Morphine at each period is often sufficient (Wa). 
Codeine, when Morphine is not well borne, has given very complete satisfaction in 
several cases; gr. \ to J morning and evening (Oliver). Dionin gives good results as 
an analgesic (Frankl). Cotarnine Hydrochloride, is an excellent remedy, having 
anodyne and hemostatic action (Gottschalk). Gelsemium, ttjjv-x of the fluid extract 
every 2 hours, in the neuralgic form, to relieve pain (B). Sodium Borate, in the 
membranous form, has been used with great benefit combined with Ext. Belladonna? 
(Wa). Camphor, is my favorite remedy, gr. x in mucilage and Cinnamon -water; 
repeat the dose in an hour or two if necessary (Dewees). Guaiacum, is very useful 
(P); drachm doses of the ammoniated tincture in the neuralgic or rheumatic forms (B). 
Caulophyllum, is by many considered the best curative remedy for spasmodic dys- 
menorrhea, if given in the intervals. Viburnum Opulus, the fluidextract, in half- 
drachm doses, has considerable reputation in some sections for uterine pains of various 
kinds, and is useful in the spasmodic variety of this affection; may be used in com- 
bination with Cannabis Indica (Thomas). Cannabis Indica, is very useful as a pallia- 
tive in painful menstruation (B); gr. ss-j thrice daily to relieve the pain (R). Nux 
Vomica, in neuralgic form; Syrup or Elixir of Iron, Quinine and Strychnine (B). 
Apiol, neuralgic form (B); as emmenagogue, night and morning, for several days near 
the period (Wa). Pulsatilla, in the functional form; is of much benefit when discharge 
is scanty or profuse, black and clotted; should be persevered in for two months or more 
(P); gtt. ij every hour is most effective when the affection is not of membranous, ob- 
structive, or neuralgic character (Smith). Belladonna, in neuralgic or spasmodic 
forms, dark and fetid discharge, crampy pains, and cold chills; a suppository or mild 
injection together with internal administration, will relieve (P); in neuralgic dysmen- 
orrhea it will permanently relieve (B). Aconite, a valuable remedy when commenced 



644 



DYSPEPSIA. 



early (P); for the congestive form in plethoric subjects (B). Arsenic, gtt. iij-x of 
Fowler's sol. with gtt. x of Tinct. Digitalis, ter die between the periods, gives excellent 
results (Athill); indicated when copious membranous discharge from bowels and 
uterus (R). Hydrastinine, has been used with benefit. [See under Menorrhagia. 1 
Chloralformamide, in one dose of gr. xxx, to prevent an impending attack, has been of 
service. Chloroform, as the liniment on a flannel wrung out of hot water, or by inha- 
lation as an anesthetic when pains very severe; sometimes exerts a permanent influence 
(Wa). Ergot, given when the molimen begins, is useful in the congestive form (B). 
Amyl Nitrite, may be inhaled with benefit in the neuralgic variety, especially in chloro- 
tic girls (Wa). Ichthyol with Glycerin, on vaginal tampons, also saline aperients, in 
the inflammatory cases. Aletris, is advertised as a highly efficient agent. Carbonic 
Acid, injected into the vagina. Electricity; in neuralgic, a galvanic current; in 
congestive, the inverse current (B). Croton-chloral, in neuralgic form (R). Iron, 
if depending on anemia (B). Cajuput Oil, said to relieve the pains (R). Rue and 
Sumbul, are reported useful (P). Emetic of Ipecac, with warm covering in bed, 
feet in hot water, hot ginger tea, Liquor Ammonii Acetatis; if pain very severe, a sup- 
pository of Morphine and Belladonna per rectum; best to avoid anodynes (E). Acces- 
sories, spinal ice-bag, when scanty discharge; when menorrhagic, hot water spinal- 
bag; sitz-baths, either hot or cold, or cold alone, during intervals. 



gr. iv. 



R. Ext. Belladonnas Fol., . 

Ext. Stramonii, 

Ext. Hyoscyami, aa gr. v. 

Quininae Sulphatis, gr. xl. 

Fiant pil. no. xx. Sig. — One pill thrice 
daily, in neuralgic dysmenorrhea. 



-g r - 



B). Fluidextr. Viburni Prunifol. 

Ext. Senec. Aurei, aa 5ij. 

Tinct. Guaiaci Ammoniat. . §xij. 
M. Sig. — A teasp. in new milk, thrice 
daily, between attacks, 3j every hour dur- 
ing attack, and a hot sitz-bath. 



R. Ext. Opii, 

Ext. Cannabis Ind., 

Ext. Hyoscyami, aa gr. x. 

Camphorae, gr. xxv. 

M. Fiant pil. no. x. Sig. — One pill two 
or three times daily. (McLane.) 



1$. Fluidextr. Cannabis Ind,... 5jss. 
Fluidextr. Viburni Op.,. . . . 3vj. 

Mucil. Acaciae, 3iij- 

Aq. Cinnamomi, q.s. ad %iv. 

M. Sig. — Dessertsp. every 4 to 6 hours. 



Dyspepsia. 

Pepsin, is beneficial; Scheffer's or Beale's saccharated pepsin with diluted HC1 
acid (B): is especially adapted to gastric indigestion. Pancreatin, for intestinal indi- 
gestion; Liquor Pancreaticus to peptonize milk, gruel, soups, etc., before administra- 
tion; in cases of great digestive debility. Peptenzyme, is said to be very efficient. 
Papain (Papoid), acts equally well in gastric and intestinal indigestion, and hence is 
particularly indicated in cases of difficult diagnosis as to the location of the trouble; 
is used in the various forms of dyspepsia and indigestion with most excellent results; 
has marked proteolytic action in acid, alkaline and neutral solutions, and in the pres- 
ence of many chemicals, antiseptics and therapeutic agents (Chittenden). Ingluvin, 
promotes digestion (B). Pineapple Juice has the power of digesting proteids (Mar- 
cano); the fresh juice is a very constant and powerful digestant of albuminous matters, 
its ferment being decidedly active in the presence of either acids or alkaline carbonates, 
but most energetic in neutral solution and between 122 and 140 F. (Chittenden). 
Taka-diastase, gr. ij-v after meals, is very efficient in amylaceous dyspepsia, in which 
the digestion of starches is faulty (Watson); an effective substitute for the inefficient 
pancreatic extracts, etc., hitherto employed (Wilcox). Mineral Acids, Hydrochloric 
or Lactic with Pepsin after meals in atonic dyspepsia; Hydrochloric after meals for 
acid pyrosis; Nitro-muriatic for dyspepsia with mental despondency, oxalates in urine, 
offensive gas, sallow complexion (R); Phosphoric, dilute, very efficient before meals 
(Da C). Sulphurous Acid, njrv-Sj, well diluted, for acid pyrosis (B). Alkaline 
Mineral Waters, before meals in atonic dyspepsia, and highly useful in the dyspepsia 
of obese subjects (B). Alkalies in acid dyspepsia, Soda being the best (W); Lime- 
water is often efficient. Sodium Bicarbonate is the most efficient drug for general use, 



DYSPEPSIA. (i 15 

gr. iij v an hour before meals for atonic form, 3ss j two hours after meals In hyper- 
chloridic dyspepsia (Huchard). Nux Vomica, gtt. \ \ ter in die before meals as 
stomachic tonic (B); when flatulence, weight on head, and heartburn (R)j often of the 
highest possible value in simple atonic form, or in the dyspepsia of drunkards (P). Igna- 
tia is useful in nervous dyspepsia (P). Orexin is valuable in the nervous form (Kolbl). 
Chloroform, gtt. XV w in sweetened water, when rapid fermentation of food and 

evolution of gas soon after eating; is promptly efficient in giving relief (Willis); a highly 
efficient remedy in acute dyspepsia. Chloral, is a very good remedy in doses of 5 to 
10 grains in 5j oi cinnamon water; acts as a gastric antiseptic and sedative, and is 
efficient in the nervous dyspepsia of neurotic subjects with severe gastric pain. Ar- 
senic, drop doses of Fowler's solution before meals in irritative dyspepsia (B)j also 
when diarrhea is excited by food (R). Bryonia, in dyspepsia of hepatic origin' and 
bilious headache with vomiting (P). Mercury, Gray powder, gr. j 3 or 4 times a day, 
when dyspepsia during chronic disease or convalescence; if constipated, Calomel, gr. ss, 
with Ext. Hyoscyami, gr. iij, in pill for 3 nights (R); the Yellow Oxide, in closes of 
. for dyspepsia septica and kindred disorders of the alimentary canal; remark- 
ably efficient in Austrian navy (Schaffer). Ipecacuanha, irpv-x of the wine most 
valuable in atonic and chronic catarrhal dyspepsia (P); constipation, depression, food 
like a heavy weight (R). Hydrastis, gtt. v-xv of the tincture before meals, a good 
stomachic tonic (B); in chronic dyspepsia, sluggish liver (P). Pulsatilla, a good 
remedy when depression with fear of death, white-coated tongue, little or greasy taste, 
nausea, flatulency, heartburn; gtt. v in water every 4 hours (P). Cinchona, with 
mineral acids in atonic dyspepsia (P). Quinine, especially for town-dwellers and 
elderly people; checks excessive fermentation in alimentary canal (R). Chamomile, 
njtij of oil, very useful in atonic dyspepsia (P). Cannabis Indica often renders good 
service. Ferropyrin, gr. -$ with gr. h of soluble pepsin after each meal, is efficient in 
the dyspepsia of chloranemia. Taraxacum, certainly does good in simple atonic dys- 
pepsia (P). Belladonna, gr. £ to \ of the extract, once a day when there is consti- 
pation (R). Bismuth, mixed with vegetable Charcoal in flatulent dyspepsia (R); gr. 
x with same quantity of Calcined Magnesia, in chronic gastric catarrh where diet can- 
not be regulated (Rose); the subgallate (Dermatol) is said to be an efficient remedy. 
Aurum, the Chloride is useful in nervous dyspepsia. Manganese, gr. x-xv of the Black 
Oxide in gastrodynia and pyrosis (B). Sanguinaria, gtt. ij-v of tincture or gr. T 'j of 
alkaloid, in atonic dyspepsia promotes secretion and increases the appetite (B). Silver 
Oxide, ^grain doses with same quantity of Ext. Hyoscyami before meals in nervous 
dyspepsia (B). Xanthoxylum, as stomachic tonic, oj of the fluidextr. in atonic dys- 
pepsia (B). Simple Bitters, Calumba is the best; Quassia or Gentian or infusions 
of them as vehicles for acids and alkalies (B); Calumba is easily tolerated when the 
stomach is weak (R); Gentian as stomachic and tonic, very useful in atonic dyspepsia 
and that of gouty subjects; the tinct. in some aromatic water, or in combination with 
alkalies and sedatives (Wa); Chirata is particularly serviceable in the dyspepsia of 
gouty subjects. Rhamnus Purshiana, in all cases of dyspepsia associated with a 
torpid liver and constipation; small doses at first, gradually increased (Wa). Salo- 
phen, is used with decided benefit in intestinal dyspepsia with flatulence. Strontium 
Bromide, is excellent in dyspepsia, also in acetic and lactic fermentations. Glyco- 
zone, is an excellent remedy for atonic and acid dyspepsias, in which it gives very 
gratifying results (Edson). Aloes, combined w^ith other agents, where habitual con- 
stipation accompanies dyspepsia (R); especially indicated in duodenal dyspepsia, gr. 
ij-iv with Ipecac gr. j-ij two or three times a week (Wa). Water, a dry diet will en- 
tirely relieve the ice-water dyspepsia, or that due to excessive beer-drinking (B); half 
a tumbler of cold water \ hour before breakfast acts to some people as a purgative and 
removes many dyspeptic symptoms, but flatulent dyspepsia is often traceable to excessive 
water drinking at meals, especially that of iced beverages (R). Hot Water, i a pint 
to a pint at no°-i5o° F. an hour before each meal and \ an hour before going to bed, 
each draught sipped slowly during 15-30 minutes; as a cure for dyspepsia this is an 
old and efficient practice (Wa). Milk-cure has succeeded admirably (B); fresh 
Buttermilk a most excellent article for dyspeptics, as also is Kumyss. Alcohol, in any 
form, especially good wines, is useful in the atonic dyspepsia of sedentary livers (B); 



6 4 6 



DYSPHAGIA — DYSPNEA. 



when loss of appetite and digestive power from fatigue, a glass of wine or brandy-and- 
water before eating is very appropriate; useful also in indigestion of town-dwellers, 
or during convalescence from acute disease (R). Diet, avoid tea and hot beverages, 
over-cooked food, over-feeding and iced-water; masticate all food well, eat slowly, 
small quantities and frequently. Active out-of-door habits should be cultivated, and 
all articles of food known to disagree should be strictly avoided. [Compare Bilious- 
ness, Flatulence, Gastralgia, Gastric Acidity, Pyrosis.] 



1$. Acidi Hydrochlor. Diluti,... 3jss. 

Glycerini, 5ij- 

Syr. Rubi Idaei, 5 jss. 

Liq. Pepsini (Fairchild), §iij. 

Spt. Chloroformi, 5ss. 

Vini Albi vel Xerici, . q. s. ad % xij . 
Sig. — oss thrice daily after meals. 



R. Tinct. Capsici, njxvj. 

Tinct. Nucis Vom., 3ij- 

Tinct. Gentianse Co., q.s. ad §ij. 
M. Sig. — A teasp. in water thrice daily, 
with gr. \ of Aloin at bedtime, avoiding a 
starchy diet. For aggravated dyspepsia 
with constipation. {Da Costa.) 



B- Creosoti, IRviij. 

Bismuthi Subcarb., 3ij- 

Glycerini, 

Aq. Menth. Pip., aa 5j- 

M. Sig. — To be well shaken. A teasp. 
every 3, 4 or 6 hours, for pain in stomach 
and wind. (B.) 



R. Ac. Hydrochlorici Dil., 3j- 

Tinct. Capsici, 3ss. 

Tinct. Calumbae, 5jss. 

Vini Pepsini, q. s. ad 5iv. 

M. Sig. — Dessertsp. after meals. In atonic 

dyspepsia. {Pancoast.) 



Dysphagia. 

Cocaine, the Hydrochloride in solution, 20 per cent., as spray or by swab, relieves 
the dysphagia of phthisical laryngitis (P). Cajuput Oil, in nervous dysphagia, used 
in India with considerable success (P). Potassium Bromide, for congenital dysphagia 
of liquids in children, when no diphtheria or malformation (R) ; in hysterical dysphagia 
(Wa); benefits a curious affection sometimes seen in children, who from their birth 
can swallow solids with ease but choke at liquids (R). Sprays of Ammonium Bromide, 
Chlorine-water, or other sedative agents in warm solution, for the dysphagia depend- 
ing on specific disease of the larynx (Muirhead). Galvanism, in the vicinity of the 
esophagus will speedily remove hysterical dysphagia (Muirhead). Tonics, as Strych- 
nine, Iron and Quinine, for post-diphtheritic dysphagia. Iced Fluids, slowly swal- 
lowed, will often remove spasmodic dysphagia (Wa). 



Dyspnea. , 

Morphine, hypodermically, the most efficient agent in relieving dyspnea from 
cardiac disease, or any other form; but if albumin in the urine it must be withheld 
(Allbutt); controls dyspnea from any cause, more energetically than any other agent, 
giving the very power to breathe (Huchard). Heroin is indicated (Hyams). Oxy- 
camphor in doses of gr. xv, or Oxyphor in doses of 5ss, is sedative to the respiratory 
centre like morphine without producing the injurious effects of the latter agent, and is 
an excellent remedy for many forms of severe dyspnea. Grindelia, of great service 
in dyspnea with cough, occurring in emphysema (W). Cimicifuga, has often relieved 
most distressing cases from cardiac disease (P). Spigelia Anthelmia, produces and 
often relieves it when with palpitations (P). Valerian has proved useful when nervous 
(P). Prunus Virginiana, has proved very efficacious in cardiac dyspnea (P). Amyl 
Nitrite, serviceable in cardiac dyspnea and other forms (Wa). Asafcetida, in com- 
bination with other anti-spasmodics, often very beneficial in dyspnea of chronic bron- 
chitis (Wa). Strychnine, is a stimulant of the respiratory centre, and in small doses 
is useful for the dyspnea of pulmonary affections and that with cardiac palpitation in 
hysterical subjects. Arsenic, is efficient in the dyspnea of weak heart and in that of 
chronic bronchitis. Ether, in 3 -doses internally, for uremic dyspnea (Whitla) ; seems 
to be of service only where there is much pulmonary engorgement [see under Uremia]. 
Chloroform, a few whiffs give great relief in the cough and dyspnea of phthisis and 



DYS1 ki \ EAS Alii i nONS I CCHYMOSIS. 

bronchitis (Wa). Ethyl Iodide, by inhalation, ia verj serviceable in tnanj forma See). 
Terpin Hydrate, of especial value in asthmatic dyspnea, gr. ij every i how until ■■ 
are taken (Boy land). Terebene, for the dyspnea ot chronic emphysema of the lungs; 
efficient in combating this symptom of various pulmonarj is. Bleeding, in a 

plethoric subject of pneumonia, with firm and incompressible pulse, suffering from 
dyspnea, or much pulmonary embarrassment and lividity, may !><• relied on to turn the 
scale in the patient's favor (Whitla). Oxygen inhalations, relieve the dyspnea of 
advanced phthisis and also the cardiac dyspnea connected with mitral disease (P). 
Dyspnea is a symptom, and may be due to cardiac, pulmonary, pharyngeal, laryngeal 
or trachea] disease (T). [Compare Angina Pectohis, ASTHMA, BRONCHITIS, Croup, 
Emphysema, Heart Affections, Phthisis, Pneumonia] 



H- Potassii Iodidi 5 j- 

Tinct. Lobelia- 5iv. 

Syr. Sanguinaria, 5 j- 

M. Sig. — A teasp. every hour. 



1$. Liq. Morph. Magendie oj. 

Spt. .Ktheris CompOS., ~>ij. 

Syr. el Aqua; U q. s. ad 5'v. 

M. Sig. — oj-ij thrice daily. 



Dysuria. 
Cantharis, gtt. j sometimes v of tincture ter die, for frequent micturition with pain 
(R); for irritable bladder, vesical tenesmus (B). Cannabis Indica, relieves dysuria 
(R); when bloody urine (P); an excellent anodyne in painful affections of the bladder, 
having specific action on that organ. Belladonna and Hyoscyamus, have similar 
sedative effects in vesical and urethral irritation (P). Linseed, as infusion, is often a 
valuable adjunct (P). Opium, in suppository, gr. ij combined with Hyoscyamus, gr. 
x, an excellent palliative (P); an enema of Laudanum or Morphine hypodermically 
to relieve the strangury caused by blisters (B). Camphor, is said to relieve strangury 
(R). Chimaphila, has undoubted power (P). Squill, often produces the best effects, 
especially a combination of the Acetum with Spt. /Etheris Nitrosi equal parts, of which 
oss in 5ij of Anise-water, every hour or oftener (Wa). Gelsemium, a useful remedy 
(B). Ergot, in paralytic dysuria, with sensation of bladder being imperfectly emptied 
(P). Alkalies, the Citrates, when dysuria from uric acid crystals in young male chil- 
dren (R). Nitrous Ether, Spt. ^Etheris Nitrosi, 5j-jss in any convenient vehicle, 
a popular and efficacious remedy (Wa). Diluent Drinks, freely, especially a decoc- 
tion of Uva Ursi or of Cotton-root (P). [Compare Bladder Irritable, Cystitis.] 

Ear Affections. 

Boric Acid, dry by insufflation, to destroy aspergillus in the external meatus; used 
after weak astringent injections, leeches, fomentations, etc., in general inflammatory 
conditions of the external ear (Whitla). Sodium Bromide, in large doses, gr. xxx ter 
die, gives some slight benefit in tinnitus aurium (Id). Cocaine, by instillation, some- 
times gives considerable relief in tinnitus aurium, from its influence on arterial pressure 
(Id). Water, warm, by syringe, to remove wax and foreign bodies. Olive Oil, poured 
into the canal, to drive out insects or their larvae. Iodol, renders good service in eczema 
of the ear; in moist, confluent eczema of the pinna, extending within the auditory canal, 
the surfaces should be thoroughly cleansed and the powder insufflated into the canal; 
in dry, external eczema it is best applied in the form of a Lanolin ointment. The 
inflammation disappears completely under this treatment in about i weeks, but irriga- 
tion should be kept up for a short time afterwards to complete the cure (Chatellier). 
Mercurol is the least irritating efficient antiseptic for use in ear affections (Lake). 
[Compare Boils, Deafness, Otalgia, Otitis, Otorrhea, Vertigo.] 

Ecchymosis. 
Arnica, rapidly disperses, if administered shortly after injury, njv-x in water every 
two or three hours (P). Alcohol, diluted more or less, according to the amount of 
irritation present, is a good lotion (P). Hamamelis, the tincture diluted with 5 to 8 



648 ECTHYMA — ECTROPION AND ENTROPION — ECZEMA. 

parts of water, as lotion, when much discoloration. Ammonium Chloride, in solu- 
tion, as lotion on lint, or with bread or Linseed to form a poultice, in ecchymosis of 
the eyelids (Wa). Capsicum, the tincture or a strong infusion mixed with an equal 
bulk of mucilage or gum arabic and a few drops of glycerin added, painted on over 
the bruised surface, a second or third coating being applied as soon as the first is dry; 
there is nothing to compare with this treatment for a black eye. [Compare Bruises, 
Purpura.] 

Ecthyma. 

Quinine, cures, though in many subjects will cause it (B); when due to malnutrition 
(R). Lead, the Liquor Plumbi Subacet, oj ad Oj aquae, a soothing application 
(Wa). Zinc Oxide, the Glycerite with a little Camphor, an excellent application (Wa). 
Cod-liver Oil, internally and locally (B). Grape-cure, often happily modifies (P). 
Borax, a solution in rose or elder flower water (Wa). Chlorinated Lime, a solution 
as a lotion (Wilson). Chrysarobin, internally, half-grain doses, in wafer or pill, given 
with good results (Stocquart). 



Ectropion and Entropion. 

Silver Nitrate, freely to the exposed surface, in ectropion of lower lid due to hyper- 
trophy of conjunctiva after inflammation (C). Collodion, successfully used in entro- 
pion to restore position of the lid by its contraction; should be concentrated (Wa) 
Faradization, in paralytic ectropion (C). Operative Measures, of great variety, 
are in use, Arlt's being the best for bad cases of the upper lid (Roosa). Epilation 
of lashes gives temporary relief in entropion. 



Eczema. 

Arsenic, wv of Fowler's solution thrice daily on a full stomach, gradually dimin- 
ishing the dose, in the chronic type (B); especially in eczema of vulva, anus and scro- 
tum (R); small doses for acute, full doses for chronic form; the urine to be closely 
watched and the drug discontinued on the least sign of renal irritation (Pf); rarely 
does any good and often irritates (Hutchinson). Sodium Arsenate hypodermically into 
an eczematous patch to change the indolent form into an active one (Pf). Tar is the 
chief local remedy for eczema and is specific for all forms, next in order of value being 
Lead and Mercury; it should be employed in weaker solutions than are usual, the best 
being the alcoholic solution of coal tar named Liquor Carbonis Detergens, 3j to the 
pint of water, used freely (Jonathan Hutchinson) : internally, the Pix Liquida in doses 
of gr. ij-v thrice daily, when Arsenic fails to relieve or is contraindicated; locally in 
third stage when redness, drying and scaling; Oleum Cadini when genuine is the best 
form of tar, mixed with simple ointment, 5ss-j to the 5 (Pf)- Mercury, as black 
and yellow washes in early vesicular and pustular conditions; mercurial ointments are 
the most efficient of the local applications, especially those of White Precipitate, Nitrate, 
mild Chloride, and Black Oxide; ointments of the Biniodide or Bichloride as irritating 
application in chronic indolent form (Pf); Brown Citrine Ointment nightly in eczema 
of the margin of the eyelids after detaching scales (B); very useful when eczema on 
hairy parts of face; often is best mixed with a tar ointment (R). Lead, soluble salts as 
lotions when much inflammation and discharge (R) ; also in early vesicular and pustular 
conditions; Diachylon ointment comes next in efficiency to mercurial ointments (Pf). 
Zinc, the Oxide and Carbonate as dusting powders (R); the Sulphate with Alum, 
Glycerin and Rose-water, an excellent lotion (B); the Oxide is not curative, but as a 
protective is the best ointment, when freshly and well made, for use over a large surface 
(Pf); Zinc Stearate with Boric Acid, as dressing in senile eczema (Black); with 
Salicylic Acid remarkably efficient in eczema rub rum (McGowan). Ichthyol inter- 
nally and externally renders brilliant sendee (Unna); a remedy of remarkable value 
and power (Mueller); gave surprising results in eczematous ulceration with great itch- 



KCZKM \. 



649 



iag, resisting other remedies (Nussbaum). Thiol, the dry form as a dusting powder 
has been used with remarkable benefit. Tannoform is efficient in weeping eczema 
(Franck); a 10 per cent, ointment gave excellent results in pustular eczema, alter removal 
of the inflammatory symptoms by iced solutions of Resorcinol applied on compn 
(Ullmann). Picric Acid in saturated solution, is very effective as an ana iagu 

lant in weeping eczema, but should not be used when pus is presenl lesl it confine the 
organisms and cause lymphangitis or abscess (Milward). Phenol, externally 
and internally in chronic forms (B); is analogous to Tar, and suitable to the same 
types of the affection as the latter is (Pf). Phytolacca has cured obstinate cases B 
Graphite, in ointment. 1 to 10, or with some inert powder, as Lycopodium or precipi- 
tated Calcium Phosphate, in fissured eczema, especially that of the hands and behind 
the ears (Pf). Bismuth, the Subnitrate or Subcarbonate locally (R); the Subgallate 
(Dermatol) has proven very useful in the treatment of moist eczema. Lime-water, 
as sedative application and to check discharge; after inflammation is subdued, Lime- 
water and Glycerin (R); mixed with Carron Oil a very good application in acute 
eczema. Buckwheat Flour, one of the best dressings; a limb may be enveloped 
in a bag filled with the flour (Bulkley). Salicylic Acid, locally, in eczema of hands 
and feet has been very successful (B); in plaster is of very great value, and becoming 
more recognized (Unna, Pick); the best form is a salicylated soap-plaster (formula 
on next page). Salol, as an antiseptic powder, has done good service. Belladonna, 
gr. \ of extract with gr. iij of Quinine Sulphate thrice daily in eczema of the hand, with 
Bismuth Subcarb. as dusting powder (B). Thymol Iodide, is an excellent application. 
Acetanilide 4 parts, with Zinc Oxide 12, and Iodized Starch 16 used as a paint, a 
valuable antiseptic, astringent, and protective application (Lusk). Conium, the 
tincture may be added to one of the ointments for the pruritus, which is usually very 
obstinate; so also Stramonium or crude Petroleum (Pf). Hamamelis, locally as anti- 
pruritic, and in chronic eczema marked by decided venous retardation (Pf). Ben- 
zoin, to allay itching, the compound tincture painted on the skin (R). Liquor Po- 
tassii Hydroxidi, or a stronger solution to infiltrated patch of chronic eczema, before 
attempting to heal it (Pf). Croton Tiglium, the seeds bruised in alcohol, as liniment 
Wa); the Oil as basis of stimulating applications in the chronic form (Pf). Glycerite 
of Tannin, locally or Glycerin at night when caustic lotions have been used (R). 
Chaulmoogra Oil, in old cases is often of great benefit, as an ointment (Wa). Oil 
of Cajuput, put up by mistake of druggist for Oil of Cade, made a remarkable cure 
in a case which had resisted treatment for some time (Claiborne). Water, locally 
is injurious, unless its sp. gr. approaches that of the blood serum; Rose-water with a 
little Glycerin and Sodium Chloride when ablution necessary in second stage, that of 
exudation and crusting (Pf). Soaps, Petroleum, Cade or Phenolized (R); Sapo 
Viridis, to soften up infiltrated patches of chronic form, instead of the potash solutions 
mentioned above (Pf). Anacardium Orientale (Oil of Cashew), as ointment in 
patches of indolent chronic eczema (Pf). Iris Versicolor, in chronic eczema of 
gouty patients invaluable as a hepatic stimulant, itrv-x of tincture from the fresh root 
twice daily (P). Rhus Tox., externally and internally, when burning and itching, 
quickly subdues in some cases (P); in chronic form with rheumatism, worse at night- 
time; also in acute cases if given at the very beginning, njj , ,', ,, of a good tincture is dose 
enough to begin with (Pf). Phosphorus, of undoubted service in eczema of long 
standing, probably acts as a hepatic stimulant, gr. T ^ ff to 5 V i n oil or reliable pill (Pf). 
Viola Tricolor, an infusion the best form, with purgative doses of Senna for a few 
days then alone, in eczema of the head and face; gives prompt results, good or bad; 
often aggravates, which though good in chronic forms must be avoided in acute types 
(Pf). Calcium Sulphide, gr. , ,', ,, to z S in acute and chronic cases of pustular character, 
the impetigo of old writers; small doses in acute form, larger ones in chronic cases (Pf). 
Sulphur, internally and Sulphides as baths, but not in the acute stage (R); solution 
of Potassium Sulphide in water locally (B). Potassium Iodide internally when a 
syphilitic history or inheritance can be traced. Tartar Emetic internally in acute 
cases (Hutchinson). Saline Cathartics are useful (Id). Electricity has cured 
obstinate cases (B). Thyroid Extract has been administered widi benefit. Diet 
should be largely vegetable, especially those which may be eaten raw; avoid sugar. 



650 



EMACIATION — EMPHYSEMA OF THE LUNGS. 



fruit and milk (Hutchinson); abstinence from alcohol and a non -saccharine diet are 
essential in gouty eczema (Tirard). [Compare Diabetes Mellitus, Gout.] 



Py . Vini Ferri Amari 5 jss. 

Syrupi Tolutani 3iij- 

Liq. Potass. Arsenit., 3 j • 

Aquae Anethi, §ij. 

M. Sig. — A teasp. to a dessertsp. thrice 

daily. (Wilson.) 

1$. Potassii Citratis 3 ij • 

Liq. Potassii Arsenit., 3 j-ij- 

Tinct. Nucis Vom., 3ij- 

Tinct. Cinchon. Comp., ad -jjiv. 
M. Sig. — A teasp. in water, after meals, 

as a tonic and alterative. (Bulkley.) 



Py. Picis Liquidae, 

Pulv. Sem. Anisi, aa 3ijss. 

Magnesias Calcin. , q. s. 

M. Ft. pil. no. c. Sig. — Two to ten pills 
daily. (Miguel.) 



fy Emplas. Diachyli Simplicis, 

Emplas. Saponis., aa p. xl. 

Petrolati, p. xv. 

Acidi Salicylici, p. v. 

Sig. — Emplas. Salicyl. Compos. (Pick.) 



R. Acidi Salicylici, 3 j- 

Zinci Oxidi, 3iij- 

Pulveris Amyli, 3iv. 

Adipis Lanas Hydrosi, % j . 

M. Fiat unguentum. Sig. — Apply daily 

as a paste for eczema. (Practitioner.) 



R. Ol. Cadini, gas. 

Glycerini, 3j- 

Ung. Diachyli, Sijss. 

M. Ft. unguentum. In squamous ec- 
zema with thickened skin. (Fox.) 



Emaciation. 

Calcium Phosphate, is especially useful in chronic wasting disease (R). Arsenic, 
is used by cattle-breeders to fatten oxen, etc., quickly (Tr). Iodine, improves the 
appetite and digestion, and gives strength and plumpness to the body (Wa). Cinchona, 
in small doses improves the appetite and the general tone (Wa). Iron Salts, cause 
marked gain in flesh and color (Wa); remarkably promote the appetite and digestion 
(B). Cod-liver Oil, internally and externally with friction, often very effective in 
the malnutrition and marasmus of children (P). Olive Oil, by friction daily; inunctions 
are of value in many wasting diseases (P). Pepsin, to promote digestion of food (P). 
Compare Appetite, Atrophy, Phthisis, Tabes Mesenterica.] 



Emissions and Erections. 

Hyoscine, the Hydrobromide in pill, gr. y^ to ^ at bed-time, will always check 
seminal emissions (W). Belladonna, when emissions, genitalia relaxed, atonic state 
(B); in gradually increasing doses produces good results, even in extreme cases of 
emissions (Wa). Camphor, fails as often as it succeeds (P). Potassium Bromide, 
exercises special influence as a sedative in irritable states of the genito-urinary or- 
gans (Wa). Cimicifuga, as tonic to the nervous system, removes irritation and 
melancholy, produces sound and refreshing sleep (Wa). Lupulin, useful to check 
emissions (P); gr. v-x or xv to keep penis at rest (Wa). Ruta, in small doses to limit 
discharge (P). Chloral, at bed-time, repeated every night until the habit is broken 
off (Wa). Iron, the tincture of the Chloride in 3 doses at bed-time, sometimes con- 
quers nocturnal emissions (Wa). Cocaine, a few drops of a 4 per cent, solution upon 
the glans penis, promptly controls an erection. [Compare Chordee, Spermator- 
rhea, and the List of Anaphrodisiacs.] 



Emphysema of the Lungs. 
Morphine, gr. £, and Atropine, gr. T ^ hypodermically for the asthmatic at- 
tacks; no remedy so efficient; the disease being incurable treatment must be chiefly 
palliative (B). Heroin is a useful remedy. Thiocol gives satisfactory results (Frisier). 
Iodipin has proved curative (Frese). Potassium Iodide, in full doses alone or 



EMPYEMA ENDOCARDITIS. (.51 

combined with the Bromide, affords most relief next to Morphine (B Strychnine, 
is a valuable respiratory stimulant; useful where there is constanl dyspnea with pro- 
longed expiration (Wa). Stramonium, the leaves smoked for the asthma and dysp 
nea before retiring, will often give a good night's rest (Wa). Ammonium Iodide, 
with Arsenic for the bronchitis, with Copaiba, Turpentine or Eucalyptol, continued 
for some time (B). Digitalis, or hydragogue cathartics as Pulvis JaJapse Comp. 
for the dropsy (Da C). Arsenic, when emphysema is connected with recession of 
a rash, is useful (R); long continued it ameliorates (B). Terebene, gives good results 
for the dyspnea. Lobelia, allays the dyspnea which accompanies capillary bronchitis 
in emphysema (R). Senega, often aets beneficially (P). Cod-liver Oil, continued 
for a long time (R). Hypophosphites, are useful (B). Chalybeates, the Phosphate 
of Iron, Quinine and Strychnine (B). Grindelia, for asthmatic breathing and bron- 
chitis (B); of great service (Wa). Chloral, for the short breath of such patients 
brought on by catching cold; if obstructed circulation caution required (R). Bleeding 
and Purging, have been used with great success in many emphysematous conditions (R). 
Breathing into Rarefied Air, the only scientific remedy yet brought forward for 
this affection, affording much relief which is sometimes permanent. The Waldenberg- 
Schlitzner apparatus is the best for this purpose. When there is co-existing bronchial 
catarrh it is necessary to precede the expiration into rarefied air by inspiration of com- 
pressed air, else irritative cough is excited (Y). [Compare Asthma, Bronchitis, 
Dyspnea.] 

1$. Potassii Iodidi 3 ii j . 1 R. Potassii Chlorat., 

StrychninaeSulph. gr. j. Tinct. Belladon., aa 3jss. 

Liq. Potassii Arsenit., 5'jss. Fluidextr. Pruni Virgin. 

Aquae Laurocerasi, q. s. ad 3iv- Tinct. Cinchonae Comp., aa 5 i j . 

M. Sig. — Teasp. 4 times daily. For re- j M. Sig. — A dessertsp. 4 times a day, 



lief of dyspnea, toning the cardiac action, 
removing the bronchial catarrh, and pre 
venting the progress. (Hughes.) 



when chronic bronchitis and anorexia. Dry 
cups also to chest night and morning. 

(Da Costa.) 



Empyema. 

Phenol, a weak solution to be injected after evacuating the pus (R); Iodized Phenol 
has been injected with benefit (B). Iodine, in solution to be injected after 
tapping (R); the undiluted tincture may be thrown in without risk and with 
great benefit; or the compound solution 5j to oxv aquae, as wash for the cavity to 
prevent re-formation of pus (B). Chlorine Water, or a solution of Quinine, to 
wash out the cavity (R). Salicylic Acid, in solution, answers well for the same 
purpose (P). Hydrogen Dioxide as a wash for the cavity after operation, abates 
the fever and promotes healing (Gorges). Ammonium Acetate, the official Liquor 
Ferri et Ammonii Acetatis, with Quinine and stimulants, if the affection shows a ten- 
dency to linger (Da C). 



Endocarditis. 

Aconite, should be given early in all inflammations of serous membranes (Wa); 
gtt. i or less, frequently (R); it is rare to meet with permanent organic heart disease 
as a result of rheumatic fever when the disorder is treated with Aconite from its com- 
mencement (P). Lactophenin, gr. v-viij every 2 hours for the fever, either alone or 
in connection with quinine (Patton). Quinine at the onset may check the inflamma- 
tion (B). Spigelia Anthelmia, is very useful in rheumatic endocarditis (P). Opium, 
in inflammation of serous membranes (B). Digitalis, to control the circulation, 
especially where irregular heart action (Da C). Veratrum Viride, has been used 
with remarkable effect on the pulse (Wa). Alkalies, as Potassium or Ammonium 
Carbonate, freely until urine is alkaline, to prevent permanent changes about the 
valves or orifices (Da C). Potassium Iodide, to promote absorption of the exuded 



652 



ENDOMETRITIS — ENEMATA . 



lymph. Collargol intravenously or by inunction, proved curative in several cases 
of ulcerative endocarditis (Netter); by daily inunction cured a case of malignant type 
(Davis). Salicylic Acid, is useful in the rheumatic form (P). Iron, the tincture 
of the Chloride with alkalies, if pyemic symptoms are manifested (Da C). Rest for 
some days after active signs have abated, with agents to lower the blood-pressure within 
the heart and vessels (Fothergill). Leeching, in the stage of acute inflammation 
is to be recommended if done early, later is useless; use cups if no leeches are at hand 
(Da C). Poultices, give great relief and are of decided benefit (Id). Stimulants, 
as Ammonium Carbonate, etc., freely, if signs of oppressed circulation appear (Id). 
[Compare Pericarditis.] 



Endometritis. 

Phenol, undiluted, on cotton -wrapped probe; no better method of treating 
uterine catarrh (B). Iodine, the most valuable of all local remedies (E); Churchill's 
tincture is one of the most useful applications to the endometrium (Munde"). Iodized 
Phenol, Iodine j, Phenol, part, iv on cotton-wound probes, applied to the uterine 
cavity, has given the best results of any agent used for years past (Battey). Chromic 
Trioxide, as caustic, when slough is required; should only be used after dilatation of 
cervical canal, and at the patient's home (Munde); a solution of gr. xv to 3j of hot 
water applied with success to the uterine cavity for catarrh (Wooster). Nitric Acid, 
fuming, to uterine cavity through intra -uterine speculum (Atthill); is considered by 
many the one agent for all forms of intra -uterine medication; is efficient and com- 
paratively safe but produces too much cicatricial tissue (Munde). Iodoform, as 
suppository in rectum (B); in pencils to uterine canal. Iodo-tannin, locally in 
chronic cases (B). Ichthyol undiluted, applied to the uterine cavity after drying it, 
gives excellent results (Kurz); in 10 per cent, aqueous or glycerin solution very ser- 
viceable (Bagot); facilitates the absorption of exudates and improves the tissue nutri- 
tion in chronic uterine inflammation. Ichthoform, a 10 per cent, solution in glycerin, 
is odorless and equally effective as Ichthyol (Goldmann). Formalin in 30 to 50 per 
cent, solution, applied by cotton -wrapped probes once a week (Menge). Picratol 
in saturated solution in glycerin on tampons to relieve pain and congestion (Yale). 
Ergotin gr. j subcutaneously, for the train of uterine disorders depending on passive 
congestion of the organ (P). [See Hysteria for formula.] Glycerin, as a local applica- 
tion, introduced by Sims, is of great value; especially as a vehicle for the impure Phenol 
or Iodine, on cotton or oakum (E). Hot Water injections in large quantity 
about the os uteri, are of great value (E); as usually made are of no value; must be 
applied by special syringe, in the dorsal recumbent posture with elevated hips, at a 
temperature of ioo° to 120 F. twice daily for at least 20 minutes each time, and per- 
severed in for months and years (Munde). [Compare Uterine Congestion and 
Hypertrophy.] 

1$. Potassii Iodidi, 

Potassii Bromidi, aa gr. xx. 

Tinct. Iodi, 5ss. 

Aquae, 3ij- 

M. For hypodermic injection into cer- 
vix, in chronic cervical metritis. (Bennett.) 



1^. Ergotini, gr. xx. 

Tinct. Iodi oj. 

Glycerini, q. s. ad 5j- 

M. Sig. — Apply twice daily with camel's- 
hair brush, in cervical metritis. (Dabney.) 



Enemata. 






Enemata, for an infant, oss-j; child of 2 to 5 years, oij-vj; 5 to 15 years, ovj-Oj; 
adult, Oj-quart j. A simple domestic enema consists of soapsuds with a little common 
salt, or a pint of cold water (B). Simple warm water or gruel sometimes; or to one 
or the other of these add Soap, Turpentine, or Castor Oil, with soap or gruel to sus- 
pend the two latter. Very cold water may be used without inconvenience. Starch, 
boiled or raw, of cream consistence, temperature ioo°, with a few drops of Tinct. 
Opii, in extreme cases of choleraic diarrhea, or that of phthisis or typhoid fever (R). 



ENTERITIS ENURESIS. 

Nutrient Enemata, should contain materials for artificial digestion, aa the rectum 
is not an organ oi digestion, and to secure rapid osmosis should have an a< id reaction 
A suitable formula is appended below. Injectslowly and not frequently; five times in 
twenty-four hours should be the maximum. Defibrinated blood has also been used 
as a rectal injection with good results, being completely absorbed (B) Enemata 

should not exceed three or four ounces of bland material, injected slowlv. alter as. it 
taining that the rectum is not filled with feces (R). Compare the subtitle [K 
in Part 11. 

Nutrient Enema. Enema Ricini et Terebinthinct. 
\\ [nfusi Carnis (Beef-tea),... 3 »v. | R. Ol. Rieini 7, 



Acidi 1 lydrochlorici itjjx. 

Glycerin Pepsini (SchcfTer), ~)ij- 
If rectum irritable add io to 20 drops of 
Laudanum. 



t >1. Terebinth 

l ivum j. 

DecOCti Ilordei, vcl 

Aq. Fervid., 5 xiv. 



Enteritis. 

Opium, to the point of tolerance, is the remedy, the deodorized tincture in 10-drop 
loses every second or third hour, according to age (Da C) of great value to control 
inflammation and quiet the intestines (B); proves of signal use (Wa). Aconite, of 
great utility in acute inflammation with high temperature, sthenic condition, resisting 
pulse (R). Arsenic, surprisingly curative; small doses with Opium (B). Podo- 
phyllum, with occasional doses of Aconite, will often allay the vomiting and diarrhea 
P). Ricinus Communis, is employed with great advantage (P). Lime-water, 
in mucous enteritis. Tannalbin, is very efficient in the acute and chronic enteritis of 
children (Goliner). Ichthoform as an intestinal antiseptic, is valuable in acute 
gastro-enteritis and chronic gastro-intestinal catarrh (Goldmann). Turpentine 
stupes, hot, over seat of disease, are of advantage (Wa). Skim-milk, is of the highest 
value as sole diet in acute inflammation of digestive organs (B). Poultices, Linseed, 
large and hot (Wa); may be used or not, as the patient feels benefit from them or 
otherwise (Da C). Water, hot fomentations, followed by a wet compress; cold and 
hot, principally cold, or ice, of unquestionable advantage (B). Ice or cold water freely 
swallowed. Perfect quiet in bed. Diet, no food until inflammation subsides, then 
beef-tea, milk, gum-water, etc., the very mildest and most bland diet for four or five 
DaC). [Compare Appendicitis, Cholera, Diarrhea, Dysentery, Peri- 
tonitis, Typhlitis.] 

Enuresis. 
Belladonna, no single remedy so uniformly successful; children require large doses; 
small doses are useless (P); a solution of Atropine best, gr. , i <» t0 btj (B); the best 
remedy for children, gtt. x-xx of the tinct. three times a day; if unsuccessful and no 
worms or other irritation exist, try Strychnine, Cantharides, Turpentine, Santonin or 
Galvanism (R). Santonin, in over-doses produces incontinence of urine in children, 
tiut curiously will sometimes stay the habit, even when not dependent on worms and in 
cases where Belladonna fails (R); in the enuresis from worms (P). Cantharides, 
one or two drops of the tinct. three or four times a day in middle-aged women or the 
aged, even when due to paralysis; sometimes also in children, but for them Belladonna 
is generally better (R). Hydrated Chloral, enuresis in children (R); three-grain doses 
thrice daily for infantile incontinence (Da C). Strychnine, may succeed when the above 
remedies fail (B); sometimes useful for old people with paralysis of bladder, also for 
:hildren (R). Quinine, in full doses, does good service in cases where chorea exists 
Potts). Buchu, often successful in chronic enuresis (P). Turpentine, small doses 
sometimes remove the trouble (B). Lupulin, said to be useful; Herzfelder used it 
*'ith advantage. Rhus Aromatica, has proven curative in 75 per cent, of cases treated 
with it and of great benefit in the other 25 per cent.; the fluid extract, nvx-xv four times 
laily in glycerin and water (Stein). Scutellaria, remarkably efficient in many instances, 



654 EPIDIDYMITIS— EPILEPSY. 

3j of the fluidextract thrice daily for a child 12 years old. Potassium Nitrate, has 
been recommended for children (R). Potassium Bromide, succeeds in some cases 
(Wa). Collodion, painted to form a cap over end of prepuce (R). Ergot, when 
from paralytic state of sphincter (B); said to be useful (R). Iron Iodide, the syrup 
njytv-xx, well diluted with water, ter die, in pale, delicate, strumous children (B); 
sometimes useful even when no worms (R). Habits, children to be taught to retain 
water as long as possible during the day, little salt to be eaten, abstinence from fluids 
not necessary, bland fluids diminish acridity of the urine. Removing meat from the 
diet has cured several cases permanently, after all remedies had been tried without 
success. Removal of starchy food corrects the enuresis of children (Lewis). 



B- Strychninae Sulph., gr-j- 

Cantharidis, gr. ij. 

Morphinae Sulph., gr. jss. 

Ferri Reducti, gr. xx. 

Ft. pil. no. xl. Sig. — One thrice daily for 



1$. Tinct. Ferri Chloridi, 3ij- 

Fluidextr. Ergotae 3 v. 

Spt. Chloroformi, 3 i j - 

Tinct. Quassias,. . . .q. s. ad 5'v. 
M. Sig. — A teasp. in a winegl. of water 



child of 10 years. (Gross.) \ thrice daily for children. 

Epididymitis. 

Aconite, alternately with Pulsatilla, the latter in very small doses, a few drops 
of tinct. in a glass of water, a teasp. every 2 or 3 hours, produces the happiest effects 
(Pf, St). Belladonna, the extract, 3j-ij ad 5j of glycerin and water, on lint, applied 
to the inflamed testicle (Bumstead). Tobacco, with Linseed meal, as poultice, cau- 
tiously! (P). Mercury and Morphine, locally, a 20 per cent, oleate by inunction, in 
cases of syphilitic origin (R). Silver Nitrate, gr. lxxx ad Biv aquas destil. freely applied 
to the scrotum will sometimes abort an epididymitis (Wa). Guaiacol in 20 per cent, 
ointment with Lanolin as a base, used first with gentle massage, then applied on lint 
daily for 6 days, followed by Ichthyol ointment, 25 per cent. (Christian). Lobelia, 
the tinct. with an equal amount of glycerin, locally to relieve the pain. Moist Heat 
locally for 2 or 3 days before beginning the guaiacol treatment, will give speedy relief 
(Christian). Strapping and suspensory bandage to support the testicle, also rest in 
the recumbent posture from the beginning, with a saline cathartic to clear the bowels, 
are all measures of great importance (Bumstead). [Compare Orchitis.] 

Epilepsy. 

Bromides, should be first employed in all cases, there being no remedy equal to 
large doses of Bromine salts, which should be persistently continued for many months 
and with short periods of rest may be kept up for years; the combination mixture of 
Bromides has been taken by patients for 8 to 10 years without harm (Brown-Sequard); 
Bromides taken for long periods without a physician's supervision have caused pro- 
found muscular depression, mental alienation and death (Hammond). Ammonium 
Bromide, preferred in petit mal by many authorities; combined with other bromides, 
as in Brown-Se'quard's mixture before meals, with Strychnine or Arsenic and a vegetable 
bitter after meals; in combination with Antipyrine (W). Aurum Bromide, is highly 
efficient in doses of gr. \ to \; the solution of Aurum and Arsenic Bromide, in 5-minim 
doses thrice daily, increased to 10 minims, gave very satisfactory results in a severe cas 
in a boy aged 7 J years (Barclay). Potassium Bromide, gr. xl ter die before meals, 
double dose at bedtime, for two or more years after all epileptic indications have ceased; 
is generally useful, especially in daytime seizures and grand mal of sexual origin; a 
for infantile convulsions (B); especially in convulsive form, but often powerless (R)- 
Sodium Bromide, gr. xx ter die, will arrest epilepsy without producing the cerebral 
symptoms of bromism (Clymer). Lithium Bromide, 3ss daily, acts in some cases 
after Pot. Brom. has failed, and is generally efficient in about one-half the dose of the 
latter salt (Weir Mitchell). Nickel Bromide, gr. v thrice daily is remarkably efficient 
in the epilepsy occurring at the menstrual epoch, and cases which have withstood the 
action of the other bromides (Da C). Ferrum Bromide, will often cure cases 



EPILEPSY. 



655 



weak and anemic subjects; also with Potassium Bromide to combat the anemia and 
depression produced by the latter (B). Zinc Bromide, gr. v in water and glycerin 
four times daily; may be combined with the other bromides. Strontium Bromide, 
in doses of gr. \x thrice daily, gradually increased; has been beneficial] . an 

alternate, being much loss liable than die others to produce bromism (See); should 
be given in 30-grain doses, and combined with a dose of Physostigmine, when its efl 
OH epilepsy is very marked (Stanley); both the Strontium and Calcium Bromides 
may be used with benefit (Fe"r6). Bromipin has proved effective when the bromides 
were ineffective (Schulze); fully replaces the alkaline bromides and is the best of all tin- 
bromine compounds (Frieser). 

Opium, a valuable adjunct to the Bromide treatment, a prolonged treatment by 
opium rendering the organism extremely susceptible to the action of bromides; for 6 
weeks ascending doses beginning with 1 grain, up to a daily dosage of 15 grains or 
more; then suddenly stopped and replaced by 30-grain doses of Potassium Bromide 
four times daily, produced remarkable effect on cases in which all other medication 
for several years had failed (Flcchsig). Apomorphine gr. ,',-, hypodcrmicallv, an 
excellent sedative in hystero-epilepsy and pure epileptic seizures (Faucher). Bella- 
donna, for petit mal and nocturnal epilepsy, in pale and anemic subjects, should be 
given for a year or more; extract and leaves, gr. \ of each in pill, every day at same 
hour, one additional pill every month (Tr); useful, especially when from fright (P); 
when the bromides fail of effect (Brower). Atropine is better than belladonna, drop 
doses of a 1 per cent, solution of the sulphate in brandy (Tr). Sodium Borate, in 
doses of gr. xx 3 or 4 times a day, has produced very good results in nocturnal epilepsy; 
is of real value and better than Bromides in symptomatic epilepsy, may also be found 
useful in nervous forms after the bromides have failed (Mairet); if begun with small 
doses may be gradually increased to 90 grains a day; when dose exceeds 60 grains daily- 
it is advisable to add glycerin to the water and syrup used as excipients (Dijoud); ex- 
cellent results obtained from a combination of Borax with Bromides, especially Sodium 
Bromide (Alexander). Digitalis is valuable in petit mal and in nocturnal epilepsy 
(Da C), a good addition to the bromides when there is cardiac weakness (Huchard); 
10-minim doses of the tincture with 20 grains of Potassium Bromide thrice daily, in 
cases complicated with cardiac dilatation (Gowers) : Digitalis, Belladonna or Phyostigma 
in combination with the bromides give better results than the latter alone (Poulet). 
Physostigma used in 12 cases, of which 6 were improved, and in the others a notable 
increase took place in the number of the paroxysms (Williams). Chloral, a valuable 
auxiliary in troublesome cases with tendency to insomnia, violent convulsions or mania- 
cal excitement; should be given in the evening, combined with bromides and used 
with caution when cardiac debility (Y); in full doses at night the most suitable remedy 
for the nocturnal variety (B). Chloretone is used with benefit (Sinkler); in doses 
of gr. iij very effective in a severe case of epilepsy in a child of 5 years, apparently due to 
alcoholic poisoning (Ellis). Antipyrine in combination with Ammonium Bromide, gr. 
vj with gr. xx, has proved very efficient, alleviating some quite hopeless cases (W); is 
a real gain in the management of epilepsy (Y); Potts has published a report of 43 cases 
treated with this combination. Acetanilide, of great value where bromides fail; in 
four such cases it produced definite cures in doses of 7I grains in cachets thrice daily 
(Dujardin-Beaumetz); of very uncertain action (Y); is most useful in the diurnal form 
and in cases of full habit, active circulation, red face and injected eyes (B). Trional, 
is a useful substitute for the bromides (Mackcy). Ignatia, in convulsions unattended 
with cerebral congestion (P); is par excellence the controller of functional phenomena 
of the cerebro-spinal axis (Pf). Strychnine, is useful in idiopathic epilepsy, but injuri- 
ous in symptomatic form; benefits when Potassium Bromide fails; when cerebral 
anemia, nocturnal attacks (S, Pf); if bromides fail and case is anemic, give Strychnine, 
gr. -jV ter die, and push it (B); when the circulation is poor (Brower). Amyl Nitrite 
inhaled at the beginning of the aura will prevent an attack (B); or "1 ij-v in mucilage 
when fits are very frequent (R). Nitro-glycerin, is slower in action than Amyl Nitrite, 
but more enduring (Pf); is a useful alternative to the bromides (Pellegrini). Chloro- 
form, by inhalation during paroxysm and also in intervals (Wa) ; is of high value espe- 
cially in cases of an hysterical character (Brown-Sequard). Anesthetics are rarely 



6 5 6 



EPISTAXIS. 



called for (W). Amylene Hydrate, in 10 per cent, solution, of which a tablesp. or 
two daily, of value in petit mal and nocturnal epilepsy, also when bromides have failed, 
and where the attacks are not only very frequent but severe (Nache). Hydrastinine, 
has been used with benefit, in doses of gr. \ to gr. £ of the Hydrochlorate, up to gr. ij 
daily. Picrotoxin, anemic subjects, attacks occurring at night, g\y to ^ of a grain 
hypodermically, or -J u to -^ by stomach (B); benefits cases resulting from onanism (P). 
Cannabis Indica, has given good results; is suitable for petit mal, the nocturnal variety, 
and with Strychnine, Belladonna, or Picrotoxin for cases characterized by anemia and 
depression (B). Quinine, when of malarial origin (P); often useful in intermittent 
epilepsy (Ros). Arsenic is sometimes useful (R); in epileptiform vertigo from gastric 
disorder (B); the Bromide of Gold and Arsenic (see above). Silver Nitrate, is not 
without efficacy, and was formerly much used, but the danger of staining the skin has 
caused its disuse, especially as better agents have been found (Wa). Copper Salts, 
may be useful in cases originating from the stomach; were formerly much used (B); 
the Nitrate or Oxide often given with benefit (R); the Ammonio-sulphate, gr. \ in pill, 
thrice daily to begin with; should not be continued beyond 3 or 4 months at a time 
(Brown-Sequard). Zinc Salts, have been much used in place of silver and copper 
salts, not having the serious drawbacks attending the latter agents; the Oxide is prob- 
ably useful only in cases originating from the stomach; much said for and against 
it (R) ; in doses of gr. iij-v may be added to the bromide treatment with benefit (Brower); 
the Citrate and the Lactate are preferred by many, as less likely to cause stomach 
derangement (Y). Orchitic Extract, also Spermine, have been used with benefit. 
Turpentine, has long been used, when due to reflex impression of intestinal parasites 
(B). Conium, not equal to the bromides (B); not of much value (P). Valerian, 
has been used with some advantage (R). Bryonia, has an ancient reputation (P). 
Rue, may benefit when seminal emissions (P). Solanum Carolinense (the Horse- 
nettle), in tincture of the berries, made by bruising them and steeping in whiskey, has 
quite a reputation among the negroes for epilepsy and other convulsive affections, and 
has rendered good service in my hands (Napier); the fluidextract 5ss-ij, as synergist 
to the bromides (Brower). Adonis Vernalis, the fluidextract, trjss-v, in cases showing 
feeble heart (Brower). Hypochlorization by the removal of Sodium Chloride from 
the food, replacing it by Sodium Bromide, an important adjuvant to the treatment 
(Clark). Fats and Oils, especially cod -liver oil, when faulty assimilation exists (B). 
Galvanism is of sendee in idiopathic epilepsy (B). Diet, the use of meat must be pro- 
hibited entirely in many cases. Trephining the skull, has cured two cases of Jack- 
sonian epilepsy (England); has given good results in several cases where a distinct 
impression from injury existed; in others where apparently indicated it has been of 
no service. [Compare Convulsions, Hysteria.] 



R<. Potassii Bromidi, oj- 

Ferri Bromidi, gr. iv. 

Aquas, oij- 

Syrupi Simplicis, ovj. 

M. Sig. — A tablesp. twice daily. 

R. Strychninae Sulphatis, gr. j. 

Acidi Sulphurici DiL, wjjx. 

Aquas Destil. oiv. 

M. Sig. — A teasp. gradually increased to 
a dessertsp. after each meal. 



R<. Potassii Bromidi, 

Sodii Bromidi, 

Ammonii Bromidi, aa oiij- 

Potassii Iodidi, 

Ammonii Iodidi, aa 5jss. 

Ammonii Carbonat., 5j- 

Tinct. Calumbae, ojss. 

Aquas, q. s. ad §viij. 

M. Sig. — A teasp. and a half before each 
meal, and three teasp. at bed-time. 

{Brown-Sequard.) 



Epistaxis. 
Aconite, has been used with the best results (P); small frequent doses quickly 
check epistaxis in children and plethoric people (R). Antipyrine, has been highly 
efficient; in 5 to 15 per cent, solution as a local hemostatic, it will arrest almost any 
nasal hemorrhage (Huchard). Adrenal Extract, used both locally and internally, 
is very efficient. Adrenalin Chloride, the 1 to 2,000 solution sprayed into the anterior 
nares, is effective (Robinson); on cotton tampon into the nares proved efficient in a 



i ki PTIONS PRODI a D i;v DRUGS. 

persistent and alarming case resisting other treatment (Booth). Cotarnine, the Hj 
drochloride in 10 per cent, solution locally, remarkably successful (Munk). Gelatin, 
5 parts dissolved in o> of normal salt solution and sterilized by boiling at a temperature 
not above 230° F., is a promptly styptic application (Carnot). Arnica, Internally, 
is of great service in epistaxis from mechanical violence 1 P). Belladonna, when the 
bleeding is of congestive origin (P). Ipecacuanha, has been highly praised (R); 

acts upon the vessels | B); gr. j ij every quarter hour until nan , but vom 

need not be excited (Wa). Hamamelis, venous hemorrhage (Pf). Ergot, 3ss 
of fresh powdered Ergot, or 7>j oij of fluidextr. every half hour or hour, necessary in 
urgent cases (B). Alum, injected or snuffed up in powder (R). Iron Spray, in 
obstinate cases Liq. Ferri Subsulph., 3j to Sviij aqua: by spray or injection; the tinct. 
of the Chloride also useful (B); diluted oij in gvj injected into the nostrils is often 
effectual (Wa). Ferropyrin as a styptic and hemostatic, is remarkably efficient 
Tannin, finely powdered, blown into the nostrils through a quill (Wa); a strong solution, 
5ii ad oiv. by nasal syringe (B). Turpentine, may be given internally with advantage 
(Wa); especially in debilitated conditions (B). Lead Acetate, gr. ij— iv with Opium 
gr. ss-ji proves signally useful (Wa). Vinegar, on lint introduced into the nostrils, 
sometimes highly efficient (Wa). Digitalis, is of undoubted benefit (B); the infusion 
best (R). Tamponade, a condom makes an excellent tampon, inserted and inflated 
by means of a flexible catheter, then tied close to the exterior nares (Matthews). Facial 
Artery, compression of (R). Keep head elevated and cool, warm the feet and hands 
by plunging into hot water, apply ice over the nose, resort at once to the tampon if 
bleeding becomes alarming. Cauterize with electric cautery any ulcers in anterior 
nares. [Compare Hemorrhage.] 



Eruptions Produced by Drugs, etc. 
Aconite, vesicular exanthemata. Antimony (locally), papules, vesicles, pustules, 
similar to the eruption of small-pox. Antipyrine, erythema and urticaria, chiefly on 
thighs and abdomen, with much itching and dyspnea. Antitoxin (Diphtheritic), 
erythema, with pain in the joints. Arsenic, erythema, eczema, papules, vesicles, pus- 
tules. Atropine, erythema, like the rash of a scarlet fever. Belladonna, as Atropine. 
Borax, papules, scarlatiniform. Bromides, acne, chiefly on the face and back; pus- 
tules, deep tubercles with ecchymoses, ulcers, pemphigus. Castor Oil, urticaria. 
Cinchona, as Quinine. Phenol, erythema. Hydrated Chloral, erythema, 
on face and neck, itching, desquamation, eczema, petechia?, purpura. Codeine, as 
Opium. Copaiba, also Cubeb, urticaria, erythema, eczema, pemphigus; the Copaiba 
rash has a preference for the ankles and wrists. Cod-liver Oil, acne. Croton Oil 
(locally), papules, pustules. Digitalis, erythema, after long usage. Enemata, of 
the simplest form, as soap and water, may cause a bright scarlet rash and other symp- 
toms of a mild septic toxemia (Burford). Iodides, acne, papules, vesicles, pustules, 
eczema, ecthyma, ecchymoses and purpura; the Iodide rash prefers the face and back 
of neck and shoulders. Mercury, erythema, eczema. Opium and Morphine, ery- 
thema, papular eruption with marked desquamation and itching. Phosphorus, pur- 
pura. Quinine, erythema, scarlatina, papular erythema, hemorrhagic purpura, pem- 
phigus and prurigo; the prevailing type of the Quinine eruption is erythema, or excep- 
tionally eczema or purpura, and is essentially ephemeral; it is of a bright vivid hue, 
disappearing on pressure, and resembles the scarlatinal rash, first appearing on face and 
neck, and thence spreads over the body: in some instances it comes in distinct spots 
and resembles measles; in others it is an urticaria, with some edema, and distressing 
burning, tingling, and itching; five cases of purpura are authentically reported. Rhus 
Toxicodendron (and other varieties of Sumac), vesicles perhaps pustules, with redness, 
swelling and intolerable itching. Salicylic Acid, urticaria, purpura, pemphigus, vesi- 
cular angina. Santonin, pemphigus, vesicles. Stramonium, as Atropine. Strych- 
nine, as Quinine. Sulphur (locally), erythema, eczema. Tar, acne. Tartar Emetic 
(locally), as Antimony; in some cases of poisoning by tartar emetic a rash of the above 
description appeared all over the body. Turpentine, as Copaiba. 
43 






658 ERYSIPELAS. 

Articles of Food producing eruptions are: Acid Fruits, may cause acute eczema. 
Strawberries, urticaria. Apples, acneform efflorescence about the mouth. Walnuts, 
inflammation of buccal mucous membrane. Shell-fish, urticaria. Roast Turkey, 
in one case caused great urticaria. Lager Beer, acne in some. Alcohol, aggravates 
cutaneous inflammations. Butter, Oatmeal, Buckwheat, Fish, are popularly 
credited with causing eruptions, but there is no evidence therefor. Mangos, pem- 
phigus and other eruptions, in persons who are not accustomed to this fruit. 



Erysipelas. 

Pilocarpine, to abort the disease, very efficient if used early, gr. £ hypodermically, 
or fluidextract of Pilocarpus internally; when free diaphoresis occurs, the temperature 
and pulse fall to normal and the disease is checked ; not suitable to debilitated cases or 
those with a weak heart (Da C). Aconite, a favorite remedy with Liston, if used at 
beginning when fever high (Wa); no more useful agent in idiopathic erysipelas espe- 
cially facial, and cases of sthenic type (B); at onset often cuts the attack short; is very 
useful in the erysipelas following vaccination (R); very valuable in sthenic cases (P); 
especially so in traumatic erysipelas (Tr). Belladonna, nj;v of tincture in water every 
hour for five or six doses, also locally; has astonishing power in superficial and non- 
vesicular forms, also when erysipelas attacks the brain and in the phlegmonous type 
(P); for similar indications' as noted under Aconite, also when adynamia; if much 
fever combine it with Digitalis or Aconite, when much depression give it with Quinine; 
gr. \ of the extract with gr. ij of Quininae Sulph. every 3 or 4 hours (B); the extract 
with Glycerin, equal parts, spread thickly over the surface (Quain); should be used 
both internally and externally and may be combined with Aconite (R). Iron, Tinc- 
ture of the Chloride, the nearest to a specific yet discovered; the remedy of most 
service, any man being decidedly to blame who neglects its use; requires decided doses, 
gtt. xl every four hours (Da C); treatment by it very general but questionable (B); 
should be given with shorter intervals than 4 hours (R); is very successful in this disease 
(P); ten -drop doses every hour, or itjxI every 4 hours (Quain); is also used locally 
with much success, being painted over the surface in full strength. Quinine, may be 
given with the Iron, also alone if thoracic complications, wherein Iron might be contra- 
indicated (Da C); a combination of Quinine and Tincture of the Chloride of Iron 
offers special advantages (Wa); in the more severe cases to sustain the vital powers 
and prevent cerebral embolism; but large doses, gr. xv-xx every 4 hours, are alone of 
any use (B). Ammonium Carbonate, when feeble circulation, cyanosis and delirium, 
also when any signs of embolism appear (B); highly useful in debilitated subjects 
(Wa); after free purgation the continued use of this salt is all that is needed in most 
cases (Watson). Sodium Salicylate has an almost specific effect (Hallopeau); used 
internally also externally as a 5 per cent, lotion on compresses (Moore). Quinine 
Salicylate is an excellent adjuvant, especially in the advanced stages when a tonic is 
required (Id). Potassium Iodide, with agents to secure free action of the bowels, 
skin and kidneys, the most efficient treatment in erysipelas ambulans, in which Iron 
and Quinine are useless (Da C). Antipyrine, is particularly efficient when hyperpy- 
rexia (Ernst). Rhus Tox., a very useful remedy in the vesicular form (P). Tartar 
Emetic, in doses of gr. T V frequently repeated, renders incontestable service (B). 
Calomel and Jalap, as purgative at onset, followed in 4 or 5 hours by Magnesium 
Sulphate Sss (Da C). Chloral, is an admirable adjunct to give sleep at night (Id). 
Turpentine, as a stimulant in traumatic erysipelas, more generally serviceable than 
alcohol (B). Streptococcus Antitoxin was used in 411 cases with a mortality of 3I 
per cent. (Marmorek) ; used in several cases with Ichthyol ointment locally, all recov- 
ering (Davis). 

Local Applications. Silver Nitrate, by Higginbotham's method in traumatic 
form; gr. lxxx of the brittle stick dissolved in 5iv of water and painted 2 or 3 times 
over inflamed surface and beyond, after careful washing and drying (R); no agent more 
useful in subduing external inflammation. Iodine, painted over affected and neighbor- 
ing surfaces, to prevent spreading (R). Ichthyol, is very efficient as a 10 to 25 per 



I KN Mil M \. 6m 

cent, collodion: Ichthyol and Ether, of each 5. Collodion 10 parts, with or without the 
addition of Castor Oil; has almost specific properties in this disease (RadclifTe); ii 
[ht cent, ointment with Lard as a basis, the best external treatment, being almost 
■pecific (Eberson); affects the micrococci and shortens the duration of the dii 
one-half (Klein); was employed in 100 cases with excellent results (Allen). Thiol, 
the dry form as a dusting powder, is an excellent application. Thigenol pure, 
efficient agent. Sulphurous Acid and Glycerin, equal parts, or a solution of Sodium 
Hisulphit Zinc, Benzoated, as ointment, or the (Jnguentum Zind Oxidi, 

anything to exclude the air, and whichever one is most agreeable to the patient (Da ( 
Bismuth, the Ointment of the Oleate, a very certain application to allay itching and 
burning and lessen pain (Shoemaker). Picric Acid in saturated solution, relieves 
the pain and burning sensations (F). Guaiacol with Menthol, in camphorated oil, 
painted on every -> hours (Desesquelle). Protargol, a 5 per cent, solution on com- 
ived very efficient in a severe case (Van Eioesen). Mesotan cured a severe 
ease of the facial form (Ruhemann). Glycerin, as the official cataplasm of Kaolin, 
an excellent application. Collodion, a thick coat relieves the symptoms (H); the 
Iodized Collodion is a serviceable application. Oil, by inunction is very grateful in 
simple erysipelas (B). Oil of Turpentine, painted over surface is said to he remark- 
ably efficient. Vaselin, Lard or Mercurial Ointment diluted, ~>j to 5j of Yaselin; 
the simplest applications are the best (B). Phenol, one part, with 8 to 14 parts 
of t Mcic Acid, locally by inunction for 3 or 4 minutes every J hour, all around the edge 
of the diseased part until it ceases to spread (Jacobi). Cotton Wool, sprinkled with 
Hour or a mixture of Starch and Zinc Oxide, is a good application (B). Earth, clean 
yellow clay, free from grit or sand and powdered, applied directly to the skin in the 
form of a smooth paste, made by mixing it with water, the best of all applications, 
having properties of antiseptic, antiphlogistic, antipyretic, and antimorbific nature 
(Jlewson). 

Tracheotomy, promptly if edema of glottis occurs, the operation giving time for 
inflammation to subside (Da C). Incisions, may be necessary in traumatic erysipelas 
when limb is greatly swollen and inflamed; also in the phlegmonous variety (Id). Diet, 
a milk -diet is generally suitable; should be light but nutritious (R); feed the patient 
well (Da C). [Compare Phlegmon.] 

IV Quinins Sulphatis, 5j- R- Pyroxylini, 3j. 

Ac. Sulphurici Dil., q. s. .Ktheris, 

Aquae 5ij. Alcoholis, aa f>v. 

Tincture Ferri ChJor., 5ss. Solve, et adde — 

Spt. Chloroformi 3yj. Ammonii Iod. 5j- 

Glvcerini q. s. ad 5iv. Ammonii Bromidi gr. x.x. 

M. Sig. — A teasp. in water every two M. Sig. — For local use with a camel's 

hours. {Loomis.) hair pencil. {Humphreys.) 



1$. Tinct. Ferri Chloridi, R. Plumbi Acetatis, 

Sympi Tolutani, aa 3j. Ammonii Carb., aa oj. 

Liq. Potassii Citratis, 3iv. Aqua? Rosae Jviij. 

M. Sig. — Teasp. to tablesp. according to Ft. lotio. Sig. — Apply on lint, to allay 

age, every 3 hours. (W. F. Anderson.) irritation. {Peart.) 



Erythema. 

Antipyrine, internally for the itching, is efficient. Belladonna, useful in cases 
resisting ordinary treatment (B). Quinine, the most valued remedy in erythema 
nodosum (B). Rhus Toxicodendron, a valuable remedy (P). Zinc Sulphate, as 
lotion, with Alum and Glycerin, or the Acetate, in ointment (see below). Picric 
Acid, in 1 to 5 per cent, solution locally, for erythema due to poison oak (Maddock). 
Bismuth Subcarbonate, dusted over erythema about genitals of infants soothes pain 
and promotes healing (B). Mineral Acids, Nitric and Nitro-hydrochloric, have been 
advantageously used in erythema from imperfect digestion (B). Dusting Powders, 



66o 



ESOPHAGEAL AFFECTIONS — EXOPHTHALMOS. 



of Starch, Lycopodium or Buckwheat flour are very useful. Thiol, the dry form, as a 
dusting powder. [Compare Intertrigo.] 

B;. Plumbi Carbonatis, 

Bismuthi Subnit., aa 3j- 1$. Zinci Acetatis, gr. ij. 

Sodii Bicarbonat 3ss. Aquae Rosae, 3j. 

Ung. Zinci Oxidi Benz., §ij. Ung. Aquas Rosas, 5j- 

Ft. unguentum. Sig. — Local use. M. Sig. — Ointment. 



Esophageal Affections. 

Belladonna, the liniment with frictions to the sternum, often very useful as a pallia- 
tive in stricture of the esophagus (Wa). Conium, in spasmodic contractions, with 
crampy pains of stomach, flatulence, and globus hystericus, has proved very serviceable 
(Wa). Hyoscyamus, or Conium, in stricture of esophagus, if much irritability; 
with occasional leeching to relieve exacerbations of pain or spasm (D). Silver Nitrate, 
in stricture of the esophagus, a weak solution on sponge probang (D). Thiosinamin, 
a 10 per cent, solution in glycerin and water, hypodermically in the interscapular region 
every other day, to promote absorption of scar-tissue in cicatricial stenosis of the 
esophagus (Teleky). Anesthetics, should be used only to meet temporary indications 
(W). Nutrient Enemata, in stricture of the esophagus, when swallowing impossible 
(R); may, in some cases, even preserve life (Wa). [See Enemata.] Dilatation, 
by bougies, in non -spasmodic (structural) stricture, the only appropriate treatment (H). 
[Compare Choking, Dysphagia.] 

Exhaustion. 

Acetanilide, for the "tired feeling," a pinch put into the mouth, mixed with saliva 
and swallowed, rests one up in a few minutes and makes one as fresh as before (Brodnax). 
Arnica, a few drops internally for aching of the muscles (R) ; in nerve prostration with 
general aching from over-fatigue (P). Phosphorus, for physical or mental exhaustion; 
also in depression from overwork (R). Calcium Phosphate, combined with Calcium 
Carbonate and Ferric Phosphate, gr. j of each for a dose (R). Potassium Bromide, 
when insomnia, bad dreams and irritability (R). Opium, gtt. j of Laudanum with 2 
or 3 of the Tinctura Nucis Vomica;, 3 or 4 times a day, for symptoms of exhaustion 
with headaches, flushing and dyspepsia (R). Ammonia, internally; its influence is 
but brief (R). Coffee or Tea, in hot or cold climates (R). Castor, is serviceable 
but seldom used (P). Musk, benefits all forms of nerve-exhaustion (P). Cimici- 
fuga, for headache from overstudy or excessive fatigue (R). Alcohol, of value in all 
conditions of fatigue (P). Coca, lessens the sense of fatigue under exertion, relieves 
thirst, and obviates the effects of a too rarefied atmosphere; is suitable for weakly sub- 
jects easily fatigued and convalescents (P). Cocaine, has been used successfully in 
exhaustion from sunstroke, loss of blood and diarrhea (P). Wet Sheet, dripping, 
cold, as a restorative and to prevent aching of muscles (R). Sea Bathing, is valuable 
(R). Habits, change of occupation better than absolute rest. [Compare Adynamia, 
Convalescence, Insomnia, Myalgia, Neurasthenia.] 



Exophthalmos. 

Exalgin, has been used with some success in the treatment of exophthalmic goitre 
(Churton). Belladonna, lrjv of tincture hourly, of great service (R); results recorded 
from its use are very remarkable, but Digitalis will usually answer better (P). Du- 
boisine, gr. T ^y of the sulphate 2 or 3 times daily, has produced remarkable results in 
one case (Hunt). Opium, may be of use in some cases (P). Iron, with Digitalis, 
seems to do more good than any other medicine (Da C). Chalybeate Waters, are 
beneficial (B). Aurum Bromide, in daily doses of gr. £ to &, continued until its 
characteristic headache is produced (Goubert). Bromides, with Iron, of very great 
value in the milder forms associated with anemia in young women (Y). Digitalis, 



EXOSTOSIS — 1:\ 1 l<l -I > 

to raise arterial tension and slow the heart, is decidedly ameliorative in young subjects 
t,B); in some eases beneficial, but in others it increases the cardiac excitement and 
makes matters worse, while its tendency to cause gastric irritation is more manifest in 
this disease than in any other (Y). Strophanthus, quiets the cardial a. lion and 
real service in this malady; 5 minims may be given thrice daily (Y). Convallaria, 
ameliorates the painful palpitation (Wa). Arsenic, gr. ..,' .. twice daily, increased with 
intermissions up to gr. ,',., daily, is my favorite remedy (Jaceoud). Zinc Valerate, 

fr. j thrice daily, is valuable to allay the nervous symptoms and the insomnia (Y). 
•icrates are specific in exophthalmic goitre (Hammond). Sparteine will control the 
pulse-rate and general symptoms (Clarke). Splenic Extract is worthy of trial though 
practical difficulties attend its administration (W). Thyroid Serum has given good 
results (Mcebius); cured one case and improved several others (Schultes). Pancrea- 
tin, in full doses successfully used (Liegeois). Galvanism, of the cervical sympathetic 
and pneumogastric, also of the eyes and thyroid gland, is decidedly curative in uncom- 
plicated cases (B). 

Exostosis. 
Potassium Iodide, may promote absorption when recent; also use friction with 
an ointment of Mercury or iodine (D). Aconite, was used by Storck (P). Mercury, 
a moderate course of mercurials may be effectual, when exostoses are due to a blow or 
from syphilis (D). Excision, if required (MacCormac). Exostoses of the clavicles 
in children almost always disappear of themselves (D). 

Eye Diseases. 

Belladonna, locally and internally in iritis, conjunctivitis and other inflammations 
Atropine, in iritis, locally; hypodermically in glaucoma (R); the best application 
generally in inflammatory conditions of the eye; the indiscriminate instillation of Atro- 
pine in persons over 35 or 40 years of age by general practitioners is to be condemned, 
being liable to light up an incipient or latent glaucoma. Pilocarpus, is used with great 
benefit in many eye-affections, particularly amblyopia from alcohol and tobacco, de- 
tachment of the retina, chronic iritis, keratitis, hemorrhage into the vitreous, glaucoma, 
muscae, atrophic choroiditis, hemorrhages of the retina, white atrophy of the optic nerve, 
and inflammatory affections with effusion and exudation, to promote resolution and 
absorption (Wecker). Strychnine, hypodermically in muscular asthenopia, amblyopia, 
amaurosis, and in progressive nerve-atrophy not dependent on intercranial disease (R); 
increases the sensibility of the eye, the field of vision becoming extended, and the vision 
more acute (Br). Ergot, is useful in many eye affections, especially disturbances of 
accommodation, acute and chronic inflammations, and the blepharitis and pustular 
conjunctivitis of children (Wa): is a myotic. Acetanilide, is exceedingly effective in 
optic neuritis with pain, not only to remove the latter but also to arrest the inflammatory 
process (Dujardin-Beaumetz). Cocaine, as a local anesthetic in ophthalmic surgery, 
a 4 per cent, solution, by instillation, sometimes injection required, as into the muscles 
for squint operation; is mydriatic, and in some cases panophthalmitis has resulted 
after operations under it (R). Dionin, in 4 to 7 per cent, solution locally, a most 
efficient analgesic without the bad effects of cocaine, for corneal ulcers and lacerations, 
trachoma, etc. Sodium Salicylate in large doses, the most important drug in all 
non-specific inflammations of the iris, ciliary body, sclera and episcleral tissue, whether 
rheumatic or not (Gifford). Chloroform, vapor, close to a photophobic eye, relieves 
(R). Oleate of Mercury and Morphine, outside the eye in palpebral conjunctivitis 
and stye; also in syphilitic iritis (R). Silver Nitrate, Copper and Zinc Salts, are 
much used in weak solutions for conjunctivitis, etc. Euphrasia, had an extended 
reputation in Germany, is a mild astringent, and of service in catarrhal conjunctivitis 
(P). Pulsatilla, as lotion in conjunctivitis (P). Santonin, gives good results in 
inflammatory and atrophic conditions of the retina and optic nerve, and in the stage 
of effusion of many other inflammations (Wa). Ruta, minim doses, night and morn- 
ing, in dimness of vision depending on functional amaurotic condition, produces good 



662 EYELIDS — FACE — FALSE PAIN'S — FEET. 

results (P). Physostigmine, topically, to contract pupils; to reduce excessive atro- 
pinization; stimulates the third nerve (P). [Compare Amaurosis and Amblyopia, 
Asthenopia, Cataract, Conjunctivitis, Corneal Opacities, Glaucoma, Iritis, 
Keratitis, Myopia, Ophthalmia, Photophobia, Retina, Strabismus, also the lists 
of Mydriatics, Myotics and other Agents acting on the Eye.] 

Eyelids. 

Calomel, locally, or Brown Citrine Ointment, as an application in many diseases 
of the lids (B). Mercury and Morphine, the 20 per cent, ointment with Lard, applied 
outside the lid, for stye (R). Pulsatilla, internally, and externally as wash, in ophthal- 
mic inflammations; the so-called stye may often be aborted by this treatment (P). 
Cadmium, much esteemed as collyrium, gr. ij of sulphate to 5j aquae rosae (R). Zinc 
and Copper Sulphates, are esteemed applications (B). Argyrol, in 2 to 10 per cent, so- 
lutions, very efficient in several cases of dacro -cystitis, and is absolutely painless (Darier). 
Ichthyol in ointment, is very efficient for eczema of the eyelids (Id). Ergot, an aqueous 
infusion as a collyrium, in ptosis and paralysis of the eyelids (Wa). Tannin, a strong 
solution, 1 to 3 aquae, locally; or a weaker solution, 1 to 20, 30 or 50 aquae, is much 
employed; also used in pomade, or as fine powder (Wa). Veratrine, in solution, 
brushed over lids once daily in painful spasmodic contraction of the orbicularis (Wa). 
Ammonium Chloride, in solution as lotion, for ecchymosis of eyelids, vulgarly known 
as black eye. Capsicum, the tincture or infusion for a black eye (see under Ecchy- 
mosis). [Compare Blepharitis, Conjunctivitis, Ecchymosis, Ectropion, Ptosis.] 

Face. 

Amyl Nitrite, ttj> ^ to £, in 30 times its volume of spirits, for flushing of face, or 
sensation of flushing, with cold feet and hands and great prostration, occurring in 
women at change of life (R). Curare, effective in facial spasm, when other remedies 
failed (P). Blisters, behind the ear, in facial palsy, followed by warm covering to the 
part (H). Strychnine, has improved some cases of facial palsy (P). [Compare Acne, 
Freckles, Neuralgla., Odontalgia, Parotitis, Tic-douloureux.] 



False Pains. 

Tartar Emetic, with small doses of Opium and external fomentations, where evi- 
dence of congestion (L). Opiates, to allay uterine irritation, after rectifying any de- 
rangement of bowels (L). Opium, is valuable, having specific action on uterine mus- 
cular fibres, relaxing some, stimulating others (Wa). Acetanilide may be given with 
benefit. 

Feet. 

Arsenic, swelled feet of old or weak persons (R); edema of feet and ankles in the 
old, from feebleness of the heart (B). Lead, as ointment, equal parts of Emplastrum 
Plumbi and Linseed Oil spread on linen and wrapped round sweating feet, to be renewed 
every third day for nine days (R). Potassium Permanganate, solution gr. j to the 5 
as a wash, will remove fetor of feet (B); temporarily discolors the skin. Tannoform, 
with equal parts of Boric Acid and Talcum, an excellent dusting powder for bromi- 
drosis. Zinc Stearate with Salicylic Acid, for sweating feet, an excellent application. 
Picric Acid, a saturated solution locally for intertrigo affecting the interdigital spaces 
of the toes, gives good results (Milward). Boric Acid in strong solution, a good appli- 
cation for bromidrosis. Chloral, 1 in 50 of water as bath, efficient against fetor. So- 
dium Bicarbonate, a solution freely applied will remove fetor (B). Belladonna, 
will check fetid secretions (R). Salicylic Acid, in solution with Borax, the most agree- 
able and efficient deodorant for fetid perspirations (B); 5jss-iij with oiij of dried 
Alum in powder, applied freely to feet after washing and drying; Acid Salicylic 3, 



n \ I R. 



663 



Magnesium Silicate 87, is the composition of the powder used in the German army for 
iting of the feet. Iron, the Chloride, mixed with \ its wi i| paint 

to the solos and interdigital spaces, in sever iweating w 1; mould be expo 

to the air while drying; repeal after 48 hours at first, subsequent]) intervals, 

during which the feet should be washed in vinegar and water night and morning and 
powdered with salicylated talc or starch and tannin (Vignol). Alum, powdered, kx ally, 
the most satisfactory application for bromidrosis I Bayloi I. Sodium Chloride, j table 
spoonfuls to \ a pint of water, as antiseptic lotion for tender feet, answer-, perfectly in 
most eases Ice, to the spine, or heat and cold alternately, to equalize the art ulation, 
has been strongly advocated (Wa). Stockings, should be changed even day, and 
dipped in a strong solution of Boric Acid and dried, to effectually check fetid perspira 
dons. Cold Footbath, and drying with friction, for cold feet (R). [Compare Cum 

BLAINS, DHOBIE ITCH, DrOPSV.] 



B;. Ac. Salicylici gr. xv 

Amyli, cr. cl. 

Talci 5iij. 

M. et trit. Sig. — Locally. (Kohnhorn.) 



R. Ac. Borici (pulv.) 

ilati 5j, 

M. Sig. — Ointment for bromidrosis. 

(Championnitrr.) 



Fever. 

[See also the titles of the Fevers, in their alphabetical order] 

Guaiacol, applied to the surface, as antipyretic. Aconite, has the highest value in 
the eruptive fevers, also in all hyperpyrexia (B); always indicated in early stage of 
simple inflammatory fevers, pneumonia, and in most acute congestions (P); has mar- 
vellous power over sthenic fevers; the thermometer should go hand in hand with Aconite 
R |, Veratmm Viride, lias considerable power as an antipyretic; useful in rheuma- 
tism and pneumonia (P); in delirium ferox of fevers it is of value (B); strongly recom- 
mended in both sthenic and asthenic fevers (R). Belladonna, in the eruptive fevers, 
especially scarlatina (B1; in typhus, with delirium, insomnia, painful sensitiveness to 
light and sound, and in all hyperemic states of brain and spinal cord (P); is prophy- 
lactic often against scarlet fever (Pf); in delirium of fevers, also excellent in typhus 
(RV Quinine, in the eruptive fevers and all malarial, remittent and intermittent; as 
apyretic less effective and more dangerous than cold baths; useless in typhus and typhoid, 
except for hyperpyrexia (B); it is antimiasmatic, antiseptic, and antiphlogistic, and of 
great value in intermittent, septicemic, and hectic fevers (P): large closes at night to 
reduce temperature in typhoid and other fevers, are strongly urged in Germany. Cin- 
chonine is better than quinine as prophylactic against ague (R). Antipyrine the 
type, also one of the best of the synthetical antipyretics; is powerfully diaphoretic, 
moderates the intensity of the febrile movement, and is especially indicated in self- 
limited diseases with persistent hyperpyrexia, especially pneumonia, typhoid, etc. 
Acetphenetidin, the favorite antipyretic among the new synthetical compounds; effi- 
cient and safe, but strongly diaphoretic. Lactophenin, causes less depression and per- 
spiration than acetphenetidin, is efficiently antipyretic, and regarded as preferable 
to other remedies of its class (Patton). Kairin is efficient as an antipyretic, but is pro- 
fusely diaphoretic, also a cardiac and nerve depressant of great power, and highly dan- 
gerous in pneumonia and other fevers where the heart is weak; it often produces nausea 
and vomiting with headache and tinnitus aurium (P). Resorcinol has been given in 
acute rheumatism, typhoid, typhus, pneumonia, erysipelas, etc, as an antipyretic; like 
Kairin, however, its action in lowering temperature is transient as compared with 
Quinine or Salicylic Acid (P); may be used hypodermioally as it is not irritant (B) 
Aristochin is an excellent antipyretic, and being devoid of depressant action 
tally useful for children (Allaria). Acetopyrin is efficient in doses of gr. vij-xv (Braun ). 
Thermol is a safe antipyretic (Miller). Gelsemium, in remittent and typho-malarial, 
of real benefit; is antipyretic (B); in bilious remittent, of value (Pf). Arsenic, in 
prostrating acute fevers to strengthen pulse and invigorate patient; except quinine no 
drug subdues intermittents so well (R); in malarial, especially typho-malarial, it is of 
great value (B). Salicylic Acid, or Sodium Salicylate, nearly equal to Quinine as 



664 FEVER. 






an antipyretic; very useful in all forms with high temperature and in intermittents, 
especially in septicemia, pyemia, erysipelas and surgical fevers (R). Digitalis, the 
German antipyretic; very useful in scarlet fever, rheumatic and pneumonia (B); espe- 
cially in typhoid (R). Cimicifuga, as substitute for Digitalis, but less effective; good 
in hectic fever (B). Hydrastine, intermittents, typhoid with copious sweats (P). 
Arnica, is antipyretic, full doses in sthenic cases; small, njjv of tincture, in asthenic 
ones; large and small doses produce different results (B); in rheumatic fever and 
typhoid it is highly extolled (P). Camphor, subdues reflex excitability; is praised as 
stimulant in adynamic fevers (P); in adynamic fevers and there where is delirium (R). 
Mercury, large doses of Calomel, the German specific treatment of typhoid (B); small 
doses in typhoid at commencement; has marked effect on tonsils in scarlatina (R). 
Rhus Tox. , in rheumatic fever after Aconite, and in scarlatina with typhoid symptoms, 
is invaluable (P). Opium, much less used than formerly; useful in delirium and with 
Quinine in remittents and intermittents (B) ; fevers characterized by prostration, insomnia 
and delirium, noisy or muttering, with picking of bed-clothes and twitching of the mus- 
cles, — in such cases Opium, judiciously given, may save an almost hopeless case (R): 
Morphine, hypodermically, the best form in febrile diseases, being less disturbing to 
the stomach and digestive power (B). Turpentine, in typhoid, puerperal, and yellow, 
njx-xxx, as a stimulant to vaso-motor nervous system (B); as enema, 3ss-j in starch 
mucilage, with ttjjx of Tinct. Opii if pain; invaluable when in typhoid hemorrhage 
occurs with tympanites (R). Tartar Emetic, minute doses, gr. r 1 ,^, frequently repeated 
and with Opium, are of great value in many acute febrile diseases (B); as a diaphoretic; 
in ague; large doses to abort specific fevers (B). Hydrochloric Acid, useful in all 
forms, especially in typhoid and the exanthemata; relieving dryness of the mouth and 
fauces, increases digestion and restrains the diarrhea (B). Acid Drinks, such as 
raspberry vinegar, citric acid, etc., very grateful and useful (R, B); two sliced limes or 
lemons, with oij of sugar in Oj of boiling water, cooled and strained, makes an agree- 
able refrigerant beverage (Wa). Baptisia, useful in common continued fever, or in 
the first stage of typhoid; drop doses of a fresh tincture every hour. Eucalyptus, 
has given varied results in malarial fevers, some observers praising it very highly (P). 
Valerian, has done much good in fevers of a nervous character (P). Sumbul, is used 
in Russia for low fevers of typhoid type (P). Cocculus, for tympanites of typhoid (P). 
Ammonium Acetate, as a diaphoretic and in simple forms, as catarrhal; the Car- 
bonate in scarlet fever and measles (R). Purgation, by Castor Oil, Magnesium 
Sulphate, etc., before exhaustion (R). Mustard Bath, on recession of rash in eruptive 
fevers (R). Aliment, milk and beef-tea alternately, every 3 hours; milk in fevers and 
in inflammations of the digestive tract (B); Kumyss is a valuable food in convalescence 
from fevers (Brush); Alcohol in low conditions is useful when it causes improvement 
in symptoms, some of which may however become worse under it (R); Coffee is a 
better stimulant than alcohol (P). Water, especially carbonated water as a drink, is 
a valuable adjunct to remedies in the treatment of fevers; warm baths, the wet pack, 
hot and cold compresses, fomentations, moist inhalations, etc., have great value (see 
the various fever titles) : a most important agent: cold baths or cold wet pack to reduce 
temperature (B); cold affusion, baths, packing, ice and ice-bag, hot affusion and spong- 
ing, all of great value in every form (R). [Compare Fevers, Tropical.] 



R. Tinct. Aconiti 3ss-j. 

Spt. ^Etheris Nitrosi, 3ij. 

Glycerini, q. s. ad ij • 

Sig. — A teasp. hourly to an adult. 



B;. Acetphenetidini 3ss-j. 

Aquae Cinnamomi, o iv- 

M. Sig. — A teasp. every 2 hours for 
children, to control pyrexia. 



Fever, Simple. 

Aconite, in small repeated doses, the best remedy for febricula (B); in ordinary 
febrile conditions, if given early, will abate fever and induce free perspiration ; may be 
administered in conjunction with any other remedy indicated (R). Veratrum Viride, 
in small doses, as antipyretic (P).' Hyoscyamus or Belladonna, very useful in 
febricula, especially for head symptoms and constipation (P). Gelsemium, when 



i i A BUS FISTULA i i \ici i v r.c.5 

remittent or bilious symptoms (V). Arsenic, if malarial BymptC Acetphene- 

tidin, in hourly doses of gr. ij or less, in the simple continued fever of chil 
antipyretic. Hydrochloric Acid, in the continued fever of childhood, haa a benefi 
influence (West). Valerian, when nervous excitability I P). Lemon-juice, ai leu 

or with Potassium Bicarbonate, as a mild diaphoretic and diuretic (P). Pome- 
granate-juice is very grateful if mixed with sugar or honey (P). Bromides, gr. ss j 
ry quarter-hour are excellent for the febrile disturbances of children (Smith). Baths, 
warm, in simple fevers of children (R). Aliment, milk ami beef-tea alternately < 
3 hours, the most useful (B). 



11 Ac. Hydrochlor. Dil 5ss. 

eris Co., 3jss. 

Syr. Ross 5 

Aqua Camph., q. s. ad 5»v. 

M. Sig -Teasp. to tablesp., according to 
wry 6 hours. 

{Modified from Wist.) 



I>. 1'otassii Acetatis ."ij. 

Spt. AStheris Nitrosi ")iv. 

Syr. Simplicia 3j- 

Liq. Ammonii Acetatis,. . . . 3ij. 

Aqus Camphors,, .q. s. ad Sviij. 
M. Sig.— Teasp. to tablesp. doses, ac- 
cording to age. 



Fevers, Tropical. 

I'ndassed fevers of the tropics include a simple continued fever, a low fever and a 
non-malarial remittent (Crombie); also a double continued fever (Mn). Calomel 
and Quinine Bisulphate, aa gr. iv, with Rhubarb and Jalap, aa gr. vj, as in Dr. Living- 
stone's "liver rousers," has given excellent satisfaction at the commencement of such 
cases, especially when symptoms of hepatic congestion exist (Potter); purgation should 
not be actively continued, but each case should be treated on its own merits and on 
general principles (Mn). Quinine must not be continued if it has been tried without 
benefit (Id). Antipyrine, or some similar drug, for the headache, if no contra-indication 
exists (Id). Medication should be confined to some simple fever mixture, there being 
no specific treatment for any of these affections (Id). Diet, bland, unstimulating 
and fluid. Sea-voyage, is especially serviceable in low fever, which is unrelieved by 
quinine or arsenic (Mn). 

Fistula. 

Piper Nigrum, the confection, as a gentle stimulant in anal fistula (P). Iodine, 
by injection, sometimes curative, but generally fails ( YVa). Sanguinaria, as injection, 
has cured (P). Capsicum, the weak infusion, a useful stimulant in fistulous ulcerations 
(P). Glycozone, 3j in oj of lukewarm water, as enema once or twice daily, soon 
produces good effects in cases of fistula in ano (Edson). Bismuth Subiodide, after 
operation, dusted over the surface of the wound after washing, to stimulate granulations 
when the healing process is indolent, is remarkably efficient. Surgical, division of 
sphincter in anal fistula by knife or ligature, the best treatment (D) ; in fistula lachrymalis 
dilatation of passage by probing the canaliculus or slitting the canaliculus up (D); in 
vesico-vaginal or recto-vaginal, surgical methods best. Diet, should be nourishing and 
digestible; fresh air and good general hygienic conditions are necessary (R) 



Flatulence. 
Nux Vomica, will remove flatulence and intestinal indigestion (B); when consti- 
pation, heartburn, weight on head (R). Charcoal, gr. v or x, soon after or just before 
meals (R); mixed with Bismuth (R). Chloroform, pure, in drop doses, benefits (R); 
by far the best agent in flatulent dyspepsia to prevent flatulence, always given well 
diluted (Huchard). Phenol when no acidity present (R). Turpentine, gtt. iij 
-v on sugar, will quicklv relieve (B). Strontium Bromide, is excellent in flatulence 
from decomposition. Asafoetida or Valerian, quickly relieves the flatulence of hypo- 
chondriasis (P). Asaf. 5j of tinct. to Oh water, dose oj; useful for children (R). 
Sodium Phenolsulphonate, gr. xxx after eating, will be found very serviceable (R). 



666 



FLUSHING-HEATS — FRACTURES AND DISLOCATIONS. 



Phosphoric Acid, dilute, is often promptly alleviative. Anise, the Oil, also Ether, 
or any other member of the carminative group, will promote the expulsion of gas from 
the stomach and intestines. Mercury, in flatulence with clayey stools (R). Calumba, 
an effective remedy for flatulent disposition is an infusion of 5ss of Calumba and Ginger, 
5j of Senna, hot water Oj, a wineglassful ter die (P). Potassium Permanganate, 
in flatulence attendant on obesity (B). Physostigma, flatulence of women at climac- 
teric (B). Sulphurous Acid, in 5 to 10 minim doses, when flatulence due to fermenta- 
tion (R). Diet, abstain from sugar, starchy food and tea — especially sugar; eat little, 
slowly and regularly; as a general rule abstain from alcoholic drinks and from vege- 
tables, especially cabbage. Pepsin or Ingluvin after meals, to promote digestion (R). 
[Compare Colic, Dyspepsia.] 



Bf. Tinct. Illicii Anisati, 
Tinct. Gentianae, 

Tinct. Nucis Vomicae, aa. 3j- 

Chloroformi, ttjxv-xxx. 

M. Sig. — 8 to 10 drops in a winegl. of 

water, before meals. 



1$. Bismuthi Salicylatis, 

Magnes. Calcinat., aa Siv. 

Carb. Ligni (pulv.), 3 vj. 

Olei Anisi, 3ij- 

Ft pulv. Sig. — A teaspoonful before each 
meal. {Huchard.) 



Flushing-heats. 

Nux Vomica, njij of the tinct. with rijy of Laudanum in hysterical flushings of the 
middle-aged, with flatulence, weight on head and perspirations (R). Amyl Nitrite, 
Ttj T \j to \ in thirty times its volume of rectified spirits, is effective for flushing of face, 
or sensation of flushing, followed by coldness, with cold feet and hands and great pros- 
tration occurring at climacteric chiefly (R). Potassium Bromide, at climacteric, 
with mental depression (R). Zinc Valerate, or Valerian, flushings at the climac- 
teric (R). Eucalyptol, for the flushings, palpitations and flatulence incident to the 
change of life (R). [Compare Climacteric Disorders.] 



Foreign Bodies. 

In the Eye, remove by bathing, or wiping towards the lower inner corner with a 
soft, moistened handkerchief or a bent bristle, the two ends being held in the fingers; 
use tepid solution of Vinegar, 3ss to the o, for removing lime, tepid water for powder; 
then apply a weak Zinc or Alum collyrium, or instil a solution of Atropine, gr. ij to the 3, 
or of Cocaine 4 per cent. In the Ear, examine carefully with speculum before removal; 
first syringe with warm water, or instil a drop of sweet oil to drive out insects, before 
using the forceps; apply equal parts of Laudanum and Olive Oil, a few drops on cotton, 
if much pain. In the Nose, a current of tepid salt water, forced up one nostril, may 
force down the body through the other, if the mouth be held open. In the Larynx or 
Pharynx, if water can be swallowed the obstruction is in the trachea. Never push a 
body down; remove by curved forceps or blunt hook. If passed into the stomach use 
solid diet to embed the article. If all fail and the case be urgent, resort to catheterism or 
tracheotomy. In the Flesh, remove at once by forceps, or sponge and water. [Com- 
pare Asphyxia.] 

Fractures and Dislocations. 

Arnica, internally is excellent to neutralize the ill effects of mechanical injuries, 
itrv-x in a wineglassful of water every 2 or 4 hours; when used after amputations it 
certainly has the power of promoting the rapid union of the surfaces; the infusion is 
better than an alcoholic preparation for external use (P). Aconite, quickly and re- 
peatedly, if feverish symptoms ensue (P). Iodine, internally and by friction, occasionally 
useful in ununited fractures (Wa). Calcium Phosphate, promotes formation of 
callus (Wa). Opium, useless in surgical fever and may do harm (CI); for nervous- 
ness or muscular spasms after dressing, gr. \ of Morphine hypodermically as anodyne 
(Ag). Benzoin, the tincture on lint as a dressing for compound fractures and other 
severe injuries, leads to rapid and satisfactory healing (Bryant). Phenol, 1 part to 



FRE< k! is ,. wuki \i ,. \-,i B \i Gl \. 

■ ■ 1 to 40 solutions, for irrigation and in compound Fractures, obvis 

Enia and most of the other preventable causes of death (P). Lead-water and 
audanum, on lint, or a Calendula lotion to the part, after reduction of the injury, 
with morphine hypodermically and perfed quiescence. Balsam of Peru poured 
copiously into the wound before reduction, and the limb then immobilized and an 
with npregnated with the balsam, is very successful treatment of compound 

frectures (Stockum). Massage by stroking, from the first, and passive movements as 
Boon as possible, tend to a rapid and perfect cure (Jordan). Diet, should be very simple 
fox ■ week or ten days. [Compare Wounds.] 

Freckles. 
Resorcinol, as paste with Zinc Oxide, applied to the face, to promote peeling of the 
skin and removal of freckles and other superficial spots (Unna). [.See under Acne 
Ros ut v.] Iodine, the tincture or glycerite, locally (B). Liquor Potassii Hydroxidi, 
5j in oij aquae rosae, as a lotion (Todd). Benzoin, the compound tincture with 
water, to remove freckles (P). Sodium Borate, a saturated solution of Boras is a safe 
and often efficient lotion to remove freckles (B). Limewater, and Olive Oil, equal 
parts, with a little Aqua Ammonia;, as liniment (Wa). Potassium Carbonate, makes 
a good lotion for freckles, sunburn and tan (B). Mercury, the Bichloride, with Alcohol 
and Glycerin, as a lotion, has been found effective: Donovan's solution, nrdxxx to 5 viij 
of water, of which oj every three hours, has been highly successful (Wa). 



R . Potassii Carbonatis, 5 iij . 

Sodii Chloridi, 5ij. 

Aquae Aurantii Flor., 3ij. 

Aquae Rosae, 5 viij. 



R> Hydrarg. Chlor. Corr., gr. vj. 

Ac. Hydrochlor. Dil. 5 j- 

Alcoholis, Aq. Rosa?,. ... aa ^ij. 
Glycerini, 5 j, Aquae, ad 5 viij. 



M. Sig. — Face-wash. (B.) 1 Apply at night, wash off in morning. 

Gangrene. 

Salicylic Acid, pure, in powder locally, to destroy fetor and change the character 
of the morbid action (B). Phenol, acts in the same way (B); a 1 per cent. 
solution as lotion in gangrenous ulcers (Wa). Sodium Sulphate, in solution, 1 to 5 
or 10 of water, as lotion or applied on compresses, to destroy odor, soothe pain and 
restore healthy action (Wa). Ammonium Chloride, in solution as baths and fomen- 
tations, very successful in one case of senile gangrene (Wa). Cinchona, or better, 
Quinine, has often proved of value (P); generally decoction of Cinchona is best (Wa). 
Turpentine, locally, after removal of gangrenous part, a most efficient application (B); 
by stomach and inhalation from hot water in gangrene of lungs; the oil locally in dry 
and chronic gangrene (P). Sanguinaria, has been recommended (P). Oxygen, as 
gaseous bath in senile gangrene (R). Charcoal, as poultice, value doubtful (R). 
Citric Acid, Lemon-juice dropped into wound, which is then covered with lint 
steeped in a solution of Chlorine; very effective for hospital gangrene in Parisian hospi- 
tals {Lancet). Ferric Chloride, locally, is considered superior to the mineral acids 
(Wa). Nitric Acid, strong, applied carefully, until the ulcer is converted into a firm, 
dry mass (Wa); is probably the best escharotic, next to Bromine, for destruction of 
gangrenous tissue (B). Bromine, is the best escharotic for hospital gangrene (B). 
Chromic Trioxide, an efficient caustic, penetrating deeply with but little pain (B). 
Opium, to soothe the pain, and diminish restlessness and irritability (Wa). Myrtol, 
1 or 2 drops, in capsules, internally, for gangrene of the lungs. [Compare Lungs, 
Gangrene of.] 

Gastralgia, Gastrodynia. 

Resorcinol, internally, acts exceedingly well. Opium, in some form necessary to 
relieve the pain in severe cases (Da C). Morphine, is of great value (P); subcutane- 
ously in epigastrium very efficient, or in small doses with Bismuth and milk before 
meals (R). Belladonna, is useful in painful affections of the stomach (R). Atropine, 



668 GASTRIC ACIDITY. 

often relieves promptly, and is excellent in neuralgic pain of the abdominal viscera (P). 
Nux Vomica, an excellent stomachic, gtt. v-x of tincture before meals (B); gtt. j-ij 
ever) r 2 hours in many forms of gastric derangement (R). Strychnine, hypodermically 
for gastralgia and gastrodynia (R); in very small doses, gr. tAtj-jV two or three times 
daily, a very successful remedy (P). Arsenic, sometimes dissipates the pain surpris- 
ingly (B); a drop of Liq. Pot. Arsenitis before food in irritative dyspepsia and gastralgia 
with heartburn (R). Bismuth Subnitrate, when gastralgia due to irritation of mucous 
membrane, acts well alone, but is most efficient when given with aromatic powder and 
a little Morphine (R); or a combination of Bismuth and Arsenic in more chronic cases 
(B); the Subcarbonate is especially adapted to gastralgia with laborious digestion and 
putrid or acid eructations (Wa). Manganese, the Black Oxide in gastrodynia and 
pyrosis (R). Zinc Oxide, an excellent remedy when gastralgia occurs after food, gr. 
v-x with aromatic powder and Morphine before meals (B). Silver Nitrate, in solution 
to check the pain of many stomachal disorders (R) ; a pill of gr. ss, with Extr. Hyoscyami 
gr. ij-iv (Wa). Hydrocyanic Acid, often cures rapidly when gastralgia from nervous 
derangement (B); may check vomiting as well as relieve pain (R); Cherry-laurel water 
a useful form (P). Nitro-hydrochloric Acid, gtt. ij-iij of the dilute acid, is serviceable 
(Da C). Ether, a few drops or the compound spirit fljx-xx, often relieves quickly (B). 
Chloroform, imij-v on sugar, often relieves (B). Chloral, sometimes relieves pain in 
gastralgia (R). Pulsatilla, is efficient in many cases of painful dyspepsia, with coated 
tongue, headache and nervous depression (P). Pepsin, when gastrodynia from indi- 
gestion (P). Creosote, checks pain after food (R). Cocaine, in doses of itrv of a 4 
per cent, solution every hour, given by the mouth for its local action, is an efficient 
gastric sedative and anodyne. Alum, often affords relief (B). Ergot, of value in 
visceral neuralgiae (P). Alkalies, for pain in stomach, Liquor Potassse generally em- 
ployed (R). Quinine, in cases showing periodicity and those of neuralgic type (P). 
Sodium Salicylate, for gastralgia with fermentation (R). Nitroglycerin allays the 
pain speedily (B). Condurango relieves gastric pain and hyperesthesia. Carbonic 
Acid Water, in painful and irritable conditions; may be mixed with milk (R). Milk- 
cure, very efficacious in obstinate cases (B). Galvanism of the pneumogastric, and 
locally to the organ itself (B). Aquapuncture has given extraordinary relief (B). Diet 
is of the greatest importance; food should be digestible, varied and plainly cooked; 
persons of sedentary life should refrain from much animal food; meals regular and 
frequent, eating little at a time and that very slowly. Alcoholic beverages do harm 
as a rule, but may benefit particular cases. Eating should be done in as agreeable a 
frame of mind as possible and the patient should rest for a time after a meal. [Com- 
pare Acidity, Dyspepsia, Neuralgia.] 

1$. Morphinas Sulph., gr. j. 

Phenolis, 3ss. 

Aq. Menth. Pip., q. s. ad Biv. 

M. Sig. — Teasp. thrice daily. 



1$. Bismuthi Subnit., 3ij- 

Ac. Hydrocy. Dil., 3ss. 

Mucil. Acaciae, 

Aq. Menth. Pip., aa5ij- 

(Da Costa.) M. Sig. — Tablesp. thrice daily. 



Gastric Acidity. 

Acids, Hydrochloric or Phosphoric before meals; acid wine, a genuine Rhine wine 
best; Sulphurous Acid njjv-xxx well diluted, for acid fermentation of starchy foods (R); 
acids after meals for alkaline pyrosis (R). Tannic Acid, useful in pill, gr. iv with njj 
of Glycerin (B). Phenol, will often arrest eructations (B). Alkalies, after meals, 
for immediate relief, effects only temporary, Bicarbonates best (R); frequent use of 
alkalies enhances the mischief (B). Ichthyol oss-j in an equal amount of glycerin 
and oiv-viij of water, by irrigation with the stomach-tube once or twice daily before 
meals, for gastric hypersecretion with hyperchlorhydria (Stewart). Nux Vomica, njjij -ij 
of tincture before meals; is excellent in small doses (B); especially in acidity of preg- 
nancy (R). Pulsatilla, rjjv of tincture every 4 hours in acid dyspepsia (P). Silver 
Oxide, extremely useful (B). Manganese Oxide, gr. x-xx of the purified black 
oxide relieves (B). Kino, a favorite remedy (B). Ipecacuanha, in acidity of preg- 
nancy (R). Mercury, gr. ss of gray powder thrice daily, when acidity with clayey 



G \siRic nil \r\rio\ r. \si Kir t I ei R. (,<„, 

itoola (R). Atropine, the sulphate, thrice daily by mouth, save excellent results in .1 
of gastric hypersecretion of acid; after the third day pain had stopped and vomiting 
Bed. Bismuth, gives excellent results, combined with Opium or Eklorphini , 
times with Magnesia (R). Diet, the proteids should be reduced to the physiological 
minimum, and should be selected and cooked for easy digestion; Starches altered as 
much as possible, and the quantity of food should not exceed the physiologii a! require- 
ments (Russell); avoid new bread, pastry, and vegetables. [Compare Gastritis.) 

R*. Bismuthi Subnitrat. oiij. | R. Sodii Bicarbonatis, 3ij. 

Phenolis gtt. ij-v. Spt. Ammonia: Aromat., 3ij 

Mucil. Acacias ^j. 

Aqua; Month. Pip. 3iij- 

M. Sig. — A tablespoonful 3 or 4 times 
dailv for adults. 



Tinct. Zingiberis, 5j- 

Infus. Gentiana: Co. (U. S. 

P., 1870) q.s. ad gviij. 

M. Sig. — A tablespoonful or two. 



Gastric Dilatation. 
Phenol, given internally to allay fermentation, with an occasional washing by the 
stomach-pump (Da C). Strychnine, hypodermically or by the mouth, or Nux Vomica, 
the best remedy, conjointly with washing of the stomach and strict diet (Da C). Bis- 
muth Subnitrate, with Magnesia or Soda, or Lime-water frequently, for the acidity, 
which is one of the most distressing symptoms (Fenwick). Bismuth Salicylate, as an 
internal antiseptic, is highly praised. Salophen, relieves the fermentative disturbances. 
Orexin Tannate cured a case of obstinate character with hyperacidity, resisting all 
other medication (Bernheim). Lavage does good in any case, but especially when there 
is retention of mucus; stimulates peristalsis, acts beneficially on the gastric mucous 
membrane and the muscular coat (Kussmaul). Diet, should be free from all starch 
and sugar and from vegetables of any kind (Fenwick) ; milk not advisable as much fluid 
will further dilate the organ; solids better, as small quantities of dry, stale bread or gluten 
bread and underdone meat (Da C). 

Gastric Ulcer. 

Arsenic, Fowler's solution in drop doses lessens the pain and relieves the vomiting 
remarkably (B); has given relief when commonly-used remedies failed (B); gives 
good results when used in very small doses (Da C). Bismuth Subnitrate, relieves 
pain and vomiting and contributes to the cure (B). Condurango relieves the symp- 
toms by its sedative action on the stomach. Chloroform 1, with Bismuth Subnitrate 
3 and Water 150, of which 5j-ij hourly, or without the bismuth, which is not necessary, 

fives marked improvement in recent ulcer as well as in long-standing cases (Stepp). 
ilver Nitrate, in solution, to check pain and relieve the vomiting (R); is next in value 
to Bismuth, promoting cicatrization and easing the pain (B). Silver Oxide is equally 
efficient, and is not liable to produce staining (Da C). Atropine, often happily relieves 
the pain and vomiting even when given in very small quantity (B). Morphine, for the pain 
and vomiting (R); in full doses if perforation occurs, to localize peritonitis until adhe- 
sions take place (Da C). Ergotin, 1 part to 10 of water, of which gtt. xv hypodermically 
several times a day for the hemorrhage. Gallic Acid, in 5-grain pill every hour for 
hemorrhage. Lead Acetate, is sedative and hemostatic; gr. ss-ij in pill with Opium, 
very useful to check hemorrhage and allay pain (R). Turpentine, 5 to 10 drops fre- 
quendy repeated in hemorrhage (R). Resorcinol, acts very well; its analgesic property 
herein is so marked that the stomach is enabled to tolerate food (Pope). Glycozone, 
is the best of all known agents for the treatment of gastric ulcer (Edson); should be 
given on an empty stomach, one or two teasp. in a wineglassful of water. Charcoal 
is said to ease the pain by preventing formation of acid products (R). Mercury, Cor- 
rosive Sublimate an effective remedy, gr. , Tl ,- S iT thrice daily before meals (B). Pepsin, 
by facilitating digestion is useful (B). Iron, for the anemia; the Lactate or Ammonio- 
citrate if stomach irritable (Da C). Cotarnine, the Hydrochloride as a powerful 
hemostatic for the hemorrhage. Orthoform, as a differential test, gr. xv in J glass 
of water relieving the pain within 20 minutes by contact with the ulcer, but does not so 



670 



GASTRITIS. 



act in simple gastralgia (Memmi). Olive Oil internally, a valuable adjunct (Cohnheim). 
Ice-bag, to the epigastrium, for pain and vomiting (R). Nutrient Enema ta, to rest 
the stomach; (see under Enemata for formula); Brandy may be added, also Laudanum 
gtt. x-xx, if the rectum is irritable (B). Milk-cure, has succeeded admirably (B); a 
strictly skimmed milk diet with Lime-water, 2 parts of milk to 1 of Aqua Calcis (Da C). 
Diet, should be of non-irritating character, with cold or hot compresses to the epigas- 
trium, leaves little room for medicine: in bad cases nourish per rectum so as to give the 
stomach complete rest; in any case use such food as is chiefly digested in the small 
intestine, farinaceous vegetables, rice, arrowroot, etc. A nice change from milk diet is 
a warmed pancreas, chopped up with rare meat, being nutritious and well relished 
(Da C). Rest, in bed for several months is imperative (Da C). Defibrinated Blood, 
by injection into rectum, in doses of oiij-vj (A. H. Smith). [Compare Hematemesis.] 



R<. Bismuthi Subcarb., 5iij- 

Morphinas Sulph.,...' gr. j-ij. 

Pulv. Aromat., o j- 

Ft. pulv. no. xij. Sig. — One powder in 
milk before each meal. 



B> Argenti Oxidi, gr. v. 

vel Zinci Oxidi, oss. 

Morphinae Sulph., gr. j-ij. 

Ft. pil. no. x. Sig. — One pill thrice daily, 
before meals. 



Gastritis, Acute. 

Mercury, Calomel in broken doses with ice, frequently swallowed, for the idiopathic 
form, which is occasionally seen and cannot be distinguished from that due to irritant 
poisons (Da C). Bismuth, the Subnitrate or Subcarbonate in full doses after the acute 
symptoms have abated (Da C). Morphine, hypodermically for pain (B). Ice, 
internally and externally gives great relief (R). Papain gave rapid relief in several cases 
(Sittman). Condurango as a gastric sedative. Ichthoform has been used in many 
cases of acute gastro-enteritis with success (Goldman). Aliment should be adminis- 
tered per rectum; no food, except milk and Lime-water, being admitted to the stomach 
for some time (Da C). Antidotes, in cases of irritant poisoning, as Alkalies to neutral- 
ize acids, Dialyzed Iron or the Ferric Hydroxide for arsenic, Turpentine for phos- 
phorus, etc. (see Poisoning): then Oil, Albumin or milk, to protect the mucous mem- 
brane; stimulants, Opium, Ammonia, etc., to antagonize depression of the vital powers. 



Gastritis, Chronic. 

Arsenic, sometimes surprisingly curative; for the vomiting gtt. j-ij of Fowler's 
solution before meals (B). Pulsatilla, in subacute gastritis of phlegmatic tempera- 
ments, white tongue, heartburn, nausea, flatulence, little or no taste (P). Hydrastis, 
gtt. v-xv of tincture or fluidextract, daily before meals, especially for gastric catarrh of 
acute alcoholism (B). Nux Vomica, gtt. j of tincture every 5 to 10 minutes for 8 or 10 
doses, in acute gastric catarrh, with headache or sick -headache; also drop or 2-drop 
doses every 2 hours or oftener, when chronic gastric catarrh occurs in the course of 
chronic disease (R). Cinchona, to promote healthy state of mucous membrane, the 
infusion with mineral acids, or Quinine; the Red Bark in gastric catarrh of drunkards 
(B). Alkalies, either shortly before meals to stimulate production of gastric juice, or 
some hours after to neutralize the acids of decomposition (Da C). Podophyllum, in 
small doses at night, to act on upper bowel; purgation as a method of treatment stands 
at the head (Da C). Ipecac, in small doses may prove useful, njv-x of the wine (P); 
for the nausea and vomiting (R). Tannic Acid, in 4-grain doses with a drop of glycerin 
to make a pill (B). Tannalbin is useful in chronic catarrh of the stomach (Porter). 
Orexin Tannate is very efficient in chronic gastric catarrh of primary form, when 
secretion of hydrochloric acid is deficient (Kolbl). Ichthoform used successfully in 
many cases (Goldman). Bismuth Subnitrate, is very useful in chronic gastritis, 
especially that of drunkards, and the chronic gastric catarrh of children with vomiting 
(R); invaluable for its sedative, alterative and astringent action; 10-15 grain doses 
several hours after meals (Da C); the Subgallate (Dermatol) is being advertised as a 
remedy for chronic gastritis. Bismuth Salicylate, as an internal antiseptic, is praised 



GLANDERS AND l'\KC\ i.i win | \k Allli [IONS. (i; I 

in chronic gastric affections. Strontium Bromide, gave successful results in \a cases 
of gastric catarrh (See). Resorcinol, acts exceedingly well. Glycozone, is one of the 
best remedies for the chronic gastric catarrh of alcoholism, and that from othe 
(Edson). Hydrocyanic Acid, is much used (R); in subacute gastritis ii often proves 
useful given in an ordinary effervescing draught (Wa). Silver Nitrate, in J or J-grain 
doses with Opium if pain, or preferably Belladonna, is extremely useful (Da C); to check 
pain and vomiting (R). Silver Oxide, is nearly as good as the nitrate, and not liable 
to produce staining (Da C). Opium, or Morphine, to quell pain in chronic gastritis 
from alcoholic excess (R). Eucalyptus, a useful stomachic, not to be used in inflam- 
matory states (B); is used with benefit (R). Mercury, the Yellow Oxide, in minute 
doses, very useful in septic dyspepsia and chronic gastritis (Schaffer). Caffeine, when 
gastritis is complicated with migraine (B). Ammonium Chloride has much repute 
among German physicians (B). Calumba and other bitters are sometimes useful | B). 
Condurango relieves, by its astringent and sedative actions. Alum when vomiting 
of glairy mucus (B). Lead Acetate with Morphine, in chronic gastritis with gastralgia 
and pyrosis (B). Pepsin after meals, to assist digestion (Da C). Taka-diastase is 
efficient in cases distressed by farinaceous food (Meade). Aliment, such as will be di- 
gested in the small intestine; requires careful attention; the milk-cure has been very 
effective in bad cases; malt liquors are harmful (B); mineral waters of purgative type, 
to keep the portal system drained: exercise is not beneficial, better live quietly and occa- 
sionally spend a day or two in bed (Da C): Kumyss agreeable and tolerant to stomach; 
the milk-cure and buttermilk have been efficient; the farinaceous vegetables, rice, 
tapioca, arrowroot, aerated bread. [Compare Dyspepsia, Gastralgia.] 



R. Sodii Bicarbonat., 5jss. 

Tinct. Aurantii Cort., oss. 

Infusi Calumbae, q. s. ad 5viij. 

M. Sig. — Two tablesp. before each meal. 
In chronic gastric catarrh. 



R. Magnesii Sulphatis, 5j-ij- 

Sodii etPotassii Tart., 5ss-j. 

Ac. Tartarici, gr. xx. 

Sig. — Dissolve in a glass of water and 
drink, an hour before breakfast. 



Glanders and Farcy. 

Ammonium Carbonate, in water hourly, as concentrated as can be swallowed, 
followed by an opiate and preceded by an emetic of Ipecac, and an incision into each 
of Wharton's ducts; proved successful in a case of acute glanders (Wa). Phenol, 
and the Sulphites, as Sodium Sulphite, are most worthy of trial. Creosote, 
or Phenol in Glycerin, locally (Wa); or dilute Chlorinated Soda and Lime- 
water. Escharotics, to destroy the affected spot, if inoculation occurs. Iodine, 
internally, also Arsenic and Strychnine, have been recommended. Quinine, in large 
doses and Ferric Chloride, may be useful. Potassium Iodide, 5ijss daily, with 
baths in Hot Springs of Arkansas, conquered the disease in me, probably the only man 
who ever survived it (Paquin). Treatment, no drug yet tried has any marked specific 
effect on the disease (Durham). Mallein, for diagnostic purposes. 

Glandular Affections. 

Iodine and Iodides, no remedy more efficient, when simple hypertrophy; useless 
with all other medicines) when caseation or suppuration has set in; Iodine injected 
into cystic and glandular growths of neck; Syrup of Ferrous Iodide occupies an 
important place (B); Potassium Iodide for mammae and testicles, but especially for 
thyroid (R). Iodoform is equal, if not superior to Iodine, in enlarged scrofulous 
glands and other glandular swellings (Wa). Lead Iodide, as an ointment. Ung. 
Hydrarg. Iodidi Rubri, produces very striking effects in goitre, enlarged spleen (B). 
Sulphides, especially the Blue Lick water, are said to abort or to mature suppuration in 
glands (R). Calcium Sulphide, for hard, swollen glands behind the angle of the jaw, 
with deep-seated suppuration (R). Calcium Chloride, highly useful in strumous 
inflammation and suppuration (B). Potassium Chlorate internally, to limit forma- 
tion of pus in suppurative adenitis (Mastin); in the cervical adenitis of infancy (South- 



672 GLAUCOMA — GLEET. 

worth) . Pilocarpus, is curative in acute affections of parotid and submaxillary glands 
(B). Mercury, useful in acute inflammatory states, tonsillitis, parotitis; Hydr. Chlor. 
Corr. gr. ^ or Hydr. cum Creta, gr. A, every two hours (B); the Oleate of Mercury 
and Morphine in obstinate and painful tonsillitis and inflammation of lymphatic glands 
(R). Aurum Salts, have cured enlarged and indurated cervical glands. Aurum 
and Arsenic Bromide, the solution is highly efficient in cervical adenitis (Barclay); 
rendered good service in a case of adenitis with enormous enlargement of the left 
side of the neck (E. A. Wood). Belladonna, especially in tonsillitis (P). Valerian, 
with Guaiacum, in strumous enlargement (P). Hydrastis, frequently controls (P). 
Phenol, in a 2 per cent, solution injected into substance of gland (B). Electroly- 
sis, used by me to remove a number of swollen and painful lymphatic glands in the 
neck (Remak); by the use of strong and often interrupted faradic currents multiple 
indurated lymphatic tumors have been removed or diminished (Meyer); enlarged 
glands have been repeatedly cured by electrolysis (B). [Compare Bubo, Goitre, 
Lymphadenoma, Parotitis, Tabes Mesenterica, Tonsillitis, Wen.] 



Glaucoma. 

Atropine, gr. 6 V hypodermically is beneficial (Anstie); imprudently used has caused 
the disease (Graefe, Wells); should not be indiscriminately instilled into the eyes of 
persons over 35 or 40 years of age, in whom it may light up a latent or incipient glaucoma. 
Physostigmine, lowers intra-ocular tension, and with Quinine is indicated in all cases 
of threatened glaucoma, to preserve the eye from the risk of consecutive glaucoma, 
and after iridectomy or sclerotomy (de Wecker). Sodium Salicylate in large doses, 
an efficient remedy in acute glaucoma (Sutphen). Dionin in 10 per cent, solution by 
instillation, should be the ideal agent for use by the general practitioner in cases where 
it is uncertain whether the disease is glaucoma or iritis (Reber) ; in 4 to 7 per cent, solu- 
tion, with a myotic, to relieve pain and check the disease. Iridectomy, the only remedy 
for the disease, medicine being worse than useless; the operation should be performed 
as soon as a state exists which can be called glaucomatous; even when vision is lost the 
operation will best relieve the pain (C); almost a certain cure in early stages, in later 
nearly always palliative and often curative. Drainage of Eye, by gold wire or catgut, 
has proved successful (de Wecker). 

Gleet. 

Cantharis, in drop doses, when frequent desire and pain in region of prostate (R); 
of benefit in subjects of relaxed fibre and feeble circulation (B). Blisters, to the 
perineum, of undoubted benefit (R). Piper Methysticum, has cured obstinate gleet 
(Switzer). Bismuth, 1, glycerin 1, water 6 parts, as an injection, often useful in 
gleet (R). Eucalyptol, is used with benefit in chronic catarrh of the genito-urinary 
tract (R). Iron, the tincture of the Chloride, 5ss in Oss of water with 3 j of Laudanum, 
makes a good injection for gleet (R); internally for anemic subjects (St). Mercury, 
£ grain of Corrosive Sublimate in S vj of water, is a good injection in gleet, used every 
2, 3 or 4 hours (R); Donovan's solution in doses of 10 minims thrice daily, so uniformly 
successful in controlling chronic urethral discharge as to be almost a specific for gleet. 
Zinc Salts, the Sulphate or Chloride, gr. ij of the latter to a pint of water, as injection 
every hour (R). Bougies, of gelatin, medicated with astringents, are extremely effi- 
cient. Turpentine, in moderate doses, when due to relaxed condition (R). Copper 
Sulphate, a solution as injection (R); astringent injections may be used with benefit 
(Wa). Copaiba, smeared on a bougie and introduced into the urethra, will sometimes 
cause gleet to yield (Wa). Sandalwood Oil, imxv ter die (R). Glycerite of Tannin, 
with equal quantity of Olive Oil or mucilage, as injection, 3ij enough; persevere 8 or 
10 days after discharge ceases and do not use at bedtime (R). Balsams of Peru and 
Tolu, Buchu, Canada Balsam, Copaiba, Mastic, and Tannin, are used with ad- 
vantage (P, R). Gleet is often kept up by over-treatment, will some time or other come 
to an end (St). Diet and Habits important; stimulants, both solid and liquid, should 



Gl OSSITIS cum ns, EDEMA 01 GO] iki.. 5. 1 

be rigidly avoided, also coffee; Frequent ablutions, fresh air, good nourishment [Com- 
pare Gonorrhea.] 

I* Ac. Tannici gr. x. 

H ism u tin Subnit ,")ij. 

Aq. Rosa.- 5vj. 

M Sip. -Shake and use as an injection 
thrice daily. (Maury.) 



R. Cantharidis gr. iij 

Ol. Terebinth. 3j. 

M Ft. |'il. no. xij. Sip. — One thrice 
daily in obstinate gleet. If strangury occur, 
stop for a day or two. 



Glossitis. 
Bismuth, gr. xx of Subnitrate with Sj of glycerin and Svij of water, as lotion for 
erythematous inflammation of the tongue (A). Purgatives, with gargles, leeches, 
antiphlogistic regimen generally (D). Quinine and Iron, should be given internally, 
with dilute acid washes, and free purgation (CI). Alum, dry, powdered, may be dusted 
on tongue (CI). Leeches, applied beneath the jaw, if symptoms are urgent (CI). 
Abscess, should be opened, if any form. Incisions, along superior surface, followed 
by vapor of hot water, may instantly relieve congestion (A). Tracheotomy or Laryn- 
gotomy, if suffocation is apparently imminent (A). 

Glottis, Edema of. 

Ammonium Benzoate, large doses given in 5ss of whiskey every 2 hours, the 
best treatment (Seiler); checks the affection in 24 or 36 hours (Coston). Emetics, 
when edema slight (A). Inhalations, of steam with Benzoin or Conium of great 
senice (A); or of Tannin, grain viij or x to 5j of water; or Alum, gr. x to the S, or 
a saturated solution of Potassium Chlorate, all as spray (Walker). Ethyl Iodide, by 
inhalation, proved curative in one case in which it was repeated twelve times (Se"e). 
Scarification, by laryngeal lancet, of paramount value (A). Tracheotomy, if the 
above fail (A). O'Dwyer's laryngeal tubation promises well. [Compare Croup, 
Laryngitis.] 

Goitre. 

Iodine, is curative in simple hypertrophy (ordinary goitre) used both internally 
and externally: deep injection of the tincture is very successful in cystic degeneration 
of the gland (B); also in the fibrous and fibro-cystic varieties, if injection be made into 
the tumor; dangerous, if into a vein or into the surrounding areolar tissue (Wa). Mer- 
curic Iodide, as oint. assisted by the sun's rays; a piece the size of a large pea rubbed 
in daily, very successfully used in India for simple hypertrophy (R); the Unguentum 
Hydrargyri Iodidi Rubri, 1 in 10, daily (B) ; is too strong (Gross) ; gr. xv to the 5 strong 
enough for the worst cases (Wa). Potassium Iodide, internally, also externally as 
ointment, in simple hypertrophy of the gland (R). Strychnine, gr. ,',; thrice daily, 
has been successful in several cases (Holmes). Ferric Chloride, injections of the 
solution used in thirty-eight cases with curative results (Mackenzie). Ergotin, injected 
with benefit into the parenchyma of the goitre (P); also used hypodermically with 
good results (Wa). Ammonium Chloride, as an internal remedy has proved curative 
(Stevens). Thyroid Gland, 5j to ij, once a week, cured 4 children completely, and 
cured or relieved out of 12 cases so treated (Bruns); Thyroid Extract is used success- 
fully (Edmunds). Spongia Usta, was formerly considered a sovereign remedy (Wa). 
Seton, has cured. Fluoric Acid, in doses of ttjfxv to 5j thrice daily, largely diluted, 
cured seventeen cases out of twenty (Woakes). Electrolysis, has sometimes cured 
in cases of simple hypertrophy and cystic gland (B) ; 6 out of 14 test cases of goitre were 
absolutely cured by electrolysis (Duncan). Excision, is a very difficult operation, 
only to be considered in extreme cases; it has been performed successfully by Desault, 
Harris, Lane, Hedenus, Billroth and Greene. [Compare Exophthalmos.] 

R. Ammonii Chloridi, ovss. | R. Unguenti Hydrargyri Iodidi 

Syrupi Simplicis, §ss. Rubri, 5 j- 

Aq. Cinnamomi, § iv. Petrolati, 5 vij. 

M. Sig. — Teasp. thrice daily. M. Sig. — Use as directed. 

44 



674 GONORRHEA. 



Gonorrhea. 

Aconite, a drop of tinct. each hour in the acute stage (R); when inflammation 
(Pf, St). Gelsemium, serviceable, acute stage (Pf). Methylene Blue, in doses 
of gr. ij thrice daily, given in the earlier stages, will shorten the course of the disease 
(Horwitz). Alkalies, Citrates or Bicarbonates to render the urine alkaline 
Lithium Carbonate in five-grain doses thrice daily, for the same purpose: Alkalies are 
the chief factor in Otis' treatment; Potassium Bicarb., gr. x in a tumbler of water or in 
Flaxseed tea, or Infusion of Triticum with gr. xv of Potass. Bromide if great pain present; 
Vichy Water (Celestin) freely (Otis); Potassium Bromide internally, with purgatives, 
low diet, and the zinc chloride injection (Hutchinson). Tartar Emetic pushed to 
nausea, in severe cases, penis much inflamed (Id). Cubeb unlike Copaiba is given 
with good effect in the acute stage; is not irritant to the stomach (Wa). Oil of Santal 
in subacute cases (P); the best internal remedy (St); a good quality difficult to obtain 
(Pf). Copaiba in the second stage; if given too early in the disease it will aggravate 
the symptoms (P); should not be used until pain in urinating is nearly gone, chordee 
ceased and the discharge diminishing and of yellow color (Wa); does no good but is 
injurious, and prolongs the disease (Otis). Saw Palmetto, the fluidextract of the ber- 
ries of this palm, has been used with good results in doses of oj (Porter). Cannabis 
Sativa, after acute symptoms subside, a few drops 3 or 4 times a day, is fully as effectual 
as Copaiba or Sandal and infinitely more pleasant to take (Pf). Cannabis Indica, relieves 
pain, diminishes discharge (P); occasionally useful (R). Colchicum, the wine of the 
seed has frequently cured gonorrhea, and was used in thirty-minim doses nightly for the 
relief of chordee by Brodie (B). Ferric Chloride, when acute stage has passed and 
the discharge is degenerating into gleet, few remedies are more useful than this tincture 
in doses of ttjxv-xx thrice daily (Wa). Turpentine, in chronic stage when parts are 
relaxed, moderate doses are of great benefit (B). Cantharis, drop-doses may be used 
(R); in the chronic stage (B). Pulsatilla, in subacute and gonorrheal ophthalmia (Pj. 
Salol in emulsion is serviceable. Balsams of Peru and Tolu, also Buchu, Uva Ursi, 
Chimaphila and Pareira, are among the numerous internal remedies used (R). No 
member of the so-called anti-blennorrhagic drugs has the slightest virtue in acute or 
chronic urethral disease (Nelken). 

Injections, of Tannin, Copper Sulphate, Iron, Cadmium, Port-wine, Brandy-and- 
water and 1000 other agents (R); injections are very bad, especially in the acute stage; 
should never be used until the 5th week and then only if the case is not progressing 
(Otis); true gonorrhea is never cured in less than four weeks (Van Buren and Keyes); 
urethritis is a different disease entirely (Otis). Silver Nitrate, a weak solution, gr. j-v 
to the o, as injection; in vaginal gonorrhea a strong solution, 5j to the 3, through 
speculum to every part of the canal (B); as abortive injection is useless and dangerous 
(St): Silver is the only drug which has stood the test of time (Yale). Argyrol, Silver 
Vitellin, is the most satisfactory gonococcide ever used (Otis); the best and safest of 
the silver preparations (Kevin); 1 to 5 per cent, solution held in the urethra 5 minutes 
4 times daily. Protargol, Silver Protein, a few drops of a 20 per cent, solution in 
glycerin instilled into the fossa navicularis after a suspected coitus, will secure almost 
perfect immunity from infection (Kopp); in gonorrhea a 1 per cent, solution injected 
every 30 minutes during the day (Neisser); causes but little irritation and a rather 
speedy checking of the gonorrheal discharge; on the whole it presents no decided advan- 
tage over silver nitrate (Kopp). Itrol, Silver Citrate, is strongly advocated by Crede, 
and seems to possess real merit, its disadvantages are the difficulty of preparing aqueous 
solutions and the rapidity with which they decompose (Id). Argonin, Silver Casein, 
in 3 to 10 per cent, solution, a highly efficient injection (Daniel); is less irritant than 
silver nitrate and less efficient (Kopp); up to 4 per cent, strength of solution it usually 
does not irritate. Largin, Silver Protalbin, irritates about as much as the nitrate and 
possesses no marked superiority over the latter salt (Kopp). Argentamin, is markedly 
irritant even in 1 to 4000 solution; no cures resulted from its sole use (Id). Nargol, 
in 1 to 3 per cent solution, rapidly lessens the discharge (Burnet). Picratol, oj of the 
saturated aqueous solution to a quart of water as injection, or by urethral suppository 



C.ONOKKHI A. 



675 



containing gr. ss-j in chronic cases, is very efficient, the discharge ceasing in 3 or 4 days 
(Yale). Ichthargan, 1 in 2000 to 1 in 1000 (Eberson); 1 in 5000 to 1 in 3000 (Gold 
berg); is vastly superior to Protargol (Fiirst); used with great satisfaction (Lohnslein); 
promptly kills the gonococci and changes the purulent discharge to a serous one (Leis- 
tikov). Zinc Salts, a weak injection of the Chloride, gr. j to 5vj or viij of Rose-water; 
or of the Sulphate, gr. j to the 5, frequently repeated, is probably the best treatment 
(B); the best injections are those of the Sulphate or Acetate, gr. vj-xij to 3iv aqua, 
alter the acute inflammation subsides (St); the Sulphate gr. jss to the 8 oi water, as 
injection after each urination, preferred to any other local treatment (Molina); the 
Chloride has been used for 50 years, gr. j-iij to the 3 of water, as gonococcide and 
astringent injection, used in the acute stage prevents complications (Hutchinson). 
Zinol, gr. j-iij to the 3 of water, a useful injection. Potassium Permanganate, a 
solution of i to 1000, one or two quarts at each sitting, washing out the bladder as well 
as the urethra several times daily, is highly efficient; a solution of 1 or 2 per cent, as 
injection in chronic gonorrhea (Keyes); a hot solution of 1 in 2000, gradually increased 
to 1 in 1000, injected into the bladder, in chronic gonorrhea, especially posterior urethri- 
tis (Ultzmann); has proved disappointing, both as an abortive agent and for acute 
gonorrhea (K.opp). Mercury, excellent results from Corrosive Sublimate (Pf); gr. 
J-A to 3 viij aquae destill. in subacute and chronic stages, as injection thrice daily; may 
have gr. ss-j of Zinc Chloride added with benefit; is often effectual (Wa); the Oxy- 
cyanide, in solutions of 1 to 3000 or 1 to 1000, is well tolerated by the urethral mucous 
membrane; resembles Protargol in action and has no specific power in gonorrhea 
(Kopp). Mercurol is a decided advance over the old treatment by balsamics internally 
and astringent injections (Guiteras). Bismuth, the oleate, smeared on a sound, and 
inserted for 5 minutes (Shoemaker); with mucilage as an injection, excellent in chronic 
gonorrhea (Hill). Lead Acetate, the dilute solution of the Subacetate, as injection, 
may be employed at any stage (B). Chloral, a weak solution, gr. j-iv to the 3, a very 
good injection (Hill). Resorcinol, a 1 per cent, solution makes a useful injection (Wa). 
Antipyrine 100 parts, Corrosive Sublimate 1, Distilled Water 10,000, used as injection 
four times daily and retained as long as possible (Vatier). Boric Acid 3iss, Tinct. 
Iodine 3ij, Glycerin 5ij, Distilled Water q. s. ad 5iv, as injection morning and 
night, has given excellent results in both acute and chronic cases when other treatment 
proved inefficient (James). Ichthyol is superior to all other agents (Neisser); espe- 
cially valuable in females, a solution of 1 to 5 per cent, as urethral injection, and a 5 to 
10 per cent, solution applied to the cervical canal (Clarke). Acetozone locally on vaginal 
tampon, the aqueous solution is the best agent for female cases, and equally good in the 
male (McDonald). Formaldehyde in 1 to 1000 solution as wash for vulva, 2 to 3 
per cent, for vagina, 1 in 500 for cervical canal of the uterus, in gonorrhea of women 
(De Smet). Hydrastis, irjx-xx of the fluid extract to the 5, suspended in mucilage, 
often of sendee in the second stage (W); an infusion of the root, 1 to 8, as an injection 
(Pf). Alumnol in solution, 1 to 3 per cent., is reported an efficient injection. Gallo- 
bromol in 1 or 2 per cent, solution, may be used as an injection. Irrigation of the 
deep urethra is injurious in acute cases, leading to complications (Horwitz). Abortive 
Treatment is futile, the disease is not curable in less than 4 weeks (Id). Soluble 
Bougies made of Iodoform, Eucalyptus and Cacao-butter, are highly recommended 
to cut the disease short (Wa); a series of similar preparations, having a basis of gelatin 
and glycerin, medicated with the usual astringent and sedative drugs, may be obtained of 
the drug trade. Wrappings of several folds of cotton are heating and uncomfortable, 
also dirty and productive of balanitis, etc.; pin a false front to the shirt for covering 
(St). Rest, in bed is an absolute desideratum, especially during the inflammatory 
stage. Hot water, ioo° F., to the penis during urination, extreme cleanliness, milk diet; 
water freely as a beverage, flavored with a few drops of Oil of Gaultheria; or Flaxseed 
tea, or Infusion of Triticum with Potassium Bicarbonate. Sexual thoughts to be 
entirely avoided (Otis). Alcohol, or any other stimulant, must be avoided entirely 
(R). [Compare Chordee, Cystitis, Gleet, Orchitis, Rheumatism Gonorrheal, 
Urethritis, Urethral Stricture, Vaginitis.] 



676 



GOUT. 



For Internal Use. 

1$. Potassii Citratis, 5ss-j. 

Spt. Limonis, 3ss. 

Syr. Simplicis, oij- 

Aquas, gj. 

M. Sig. — Dessertsp. largely diluted, 3 or 
4 times daily. As alkali for the increasing 
stage. (Otis.) 

]$. Oleoresinae Cubebae, 5 iv. 

Potassii Bromidi, o j- 

Olei Sassafras, njfx. 

Syr. Acaciae, 5 ij • 

Aqua;, q. s. ad % vj . 

M. Sig. — Dessertsp. 3 or 4 times daily. 
(/. Wm. White.) 

1$. Phenylis Salicylatis, 
Sodii Bromidi, 

Potassii Bicarb., aa 5ss. 

Misce, et div. in chartas no. xxiv. 
Sig. — One powder every 2 hours in the 
early inflammatory stage. (Christian.) 



3. 



M. 



For Local Use. 

Resorcinolis, 3j- 

Ac. Borici, gr. xx. 

Zinci Acetatis, gr. J-J. 

Aqua; Destil., §iv. 

Sig. — Dessertsp. as injection. 



1$. Zinci Sulphatis, gr. vj. 

Plumbi Acetatis, gr. viij. 

Ammonii Chloridi, gr. iv. 

Aluminis, gr. v. 

Aquas Rosa;, §j- 

M. Sig. — Injection to be used after acute 
symptoms subside. 



Q. 



Zinci Sulph., gr. xx. 

Bismuthi Subcarb., 3iv. 

Glyceriti Hydrastis § j. 

Aquae Destill., q. s. ad giv. 

Misce. Sig. — Inject 3ij 3 or 4 times daily. 
(Christian.) 

[For Emulsion of Copaiba see the title Emulsa, and for Injection Brou see the title 
Injectiones, in Part II.] 

Gout. 

Colchicum has long been recognized as a specific, to abort a paroxysm or to lessen 
severity of the symptoms when the attack has developed (W); 3j of the wine often 
removes the severest pain in an hour or two, and soon the swelling and heat subside (R); 
it is especially useful in acute and rheumatic gout (B); is not specific, nor a lasting or 
final remedy for gout, but acts very directly on the pain and inflammation of acute 
attacks (P); is useful in the bronchitis, asthma, dyspepsia, urticaria, etc., of gouty sub- 
jects (R). Colchicine Salicylate, is highly efficient in chronic gout. Alkalies are 
among the efficacious remedies (Croftan); alkaline waters have long had a deserved 
reputation (B); alkalies are decidedly useful in chronic conditions (Haig). Lithium 
Salts are of some value in chronic cases (W); the Bromide internally and a strong solu- 
tion of Lithia to the joints (B); the Bromide is the most efficient agent in combating the 
disease (Aulde); the Carbonate, in solution, gr. v to the 5, on lint around gouty enlarge- 
ments and joints (R); Lithia clears the blood of uric acid but retains it in the body, 
driving it into the tissues (Haig). Sodium Salicylate in sufficient quantity will quickly 
relieve a typical attack of acute gout (Id); 10 grains every 2 hours internally, also oij 
in Bvij of warm water as lotion on lint covered with oiled silk, in acute gout is very 
efficient treatment. Salicylates do not cure gout, they simply aid in keeping down 
the diathesis (W). Ammonium Salicylate is much better than the sodium salt, which 
is the worst of all the salicylates; the Strontium salt acts slowly and does not derange 
the digestion like the others; it is the most efficient drug in chronic gouty conditions 
(W). Salicylates eliminate uric acid, and with proper diet will cure all gouty affec- 
tions not amenable to iodides, chlorides, bromides and mercury (Haig). Aspirin 
is one of the best salicylates, in daily doses of not less than 3j for acute gouty arthritis 
with fever (Id); is an excellent remedy (Merkel). Antiarthrin, Saligenin Tannate, 
gr. xv twice or thrice daily after meals, is a very efficient eliminator of the toxic material 
(Wilcox). Piperazin, gr. xv daily in carbonated water, as a solvent and eliminant of 
uric acid; has been largely used but has failed to sustain its first reputation (W). Phen- 
ocoll when much pain and fever; with Piperazin gr. xv of each daily, in a pint or more of 
carbonated water, is efficient in acute gout. Lysidin is powerfully solvent to uric acid ; 
used in chronic cases having exacerbations with excellent results (Grawitz). Lycetol 
as a uric acid solvent. Urotropin is an energetic eliminant of uric acid (Bardet). 
Citarin liberates formaldehyde in the blood, forming soluble combinations with uric 
acid, and is indicated in all forms of the uratic diathesis, especially gouty arthritis 



GUMS. (,77 

(Ardo). Sidonal is useful, but being patented is costly. Uricedin is used with benefit. 
Tetranitrin in dose of gr. ss, is efficient to reduce the high arterial tension (Huchard). 
Morphine, hypodermically, as close to the affected joinl as possible outside of the red 
areola, is miraculous in giving immediate relief. Antipyrine, remarkably efficient for 

relieving the pain as well as prophylactic against future atlaeks (Marshall). Aconite, 
may certainly relieve pain (P). Belladonna, the best remedy effectually ami speedily 
to soothe the pain, also in gout of the stomach; 5- njj doses efficacious (1'). Potassium 
Iodide, especially when pain is worse at night (R); Iodides, chlorides ami bromides, 
with mercury and diet, will cure most of the diseases due to excess of uric acid in the 
blood (Haig). Chimaphila is believed to check the formation of uric acid. Chirata 

irticularly useful in the dyspepsia of gouty subjects. Arsenic, to prevent disin- 
tegration of blood corpuscles (Croftan); has been highly extolled in rheumatic gout 
(W); is a standard remedy in chronic gout. Iron, to bind the decomposition products 
of intestinal fermentation, gr. ij-iv of Blaud's mass, permitting the absorption of organic 
iron, which should be administered afterwards (Croftan). Oxygen by inhalation, 
gives striking benefit (Id). Ichthyol in 25 to 50 per cent, ointment externally, abates 
the violent pains (Nussbaum); a 50 per cent, ointment by rubbing produces an immedi- 

ind remarkable effect in all forms of subacute or chronic gout (Lorenz). Guaia- 
cum, has long had high repute, and may be given for a long time without injury (Wa). 
Rhubarb with an alkali, regularly during intervals, very serviceable (Halford). Man- 
ganese, Syrup. Ferri et Mang. Iodidi, itrx-5ss, for the cachectic state (B). Cascara 
Sagrada, is said to promote the elimination of uric acid to a remarkable extent. Coffee, 
a tincture of green coffee promotes elimination of the poison of gout from the system. 
Veratrine, as ointment to painful joints (R). Cod-liver Oil, in chronic gout (R). 
Sulphides, as baths in chronic gout, or fumigation with Sulphurous Acid, and bed- 
clothes exposed to its strong fumes (R); Sulphur waters certainly benefit (B). Iodine, 
painted around joints in chronic gout (R). Strychnine, hypodermically for later stage 
of gout paralysis (R). Carbonated Water taken freely, has a very beneficial influence. 
Diet consisting chiefly of bread stuffs and cereal foods has more advantages than any 
other (Haig); avoid animal and saccharine foods, also vegetable proteids (Luff); gout 
is poisoning by animal flesh, tea and similar vegetable-alkaloid-containing substances 
(Haig). Abstinence from common salt is said to have benefited several cases. A milk 
diet has improved cases and apparently removed the diathesis (B) ; entire abstinence from 
alcoholic beverages; the most injurious wines are port, sherry and madeira. Local 
Measures, the affected limb should be raised, and surrounded by hot, moist flannels; 
wrap the hands in flannel dripping with water and cover with water-proof bag, to dis- 
solve gouty deposits. Baths, are useful, especially hot, steam and Turkish baths, but 
they do not cure the disease (W). Exercise, if there be any cure for gout it is exercise 
(W). [Compare Arthritis, Lithemia.] 



Scudamore's Mixture {Modified). 
R. Vini Colchici Radicis, 

Magnesii Sulphatis, aa o j ■ 

Magnesii Oxidi, 3ij- 

Aqua Menth. Pip., gx. hours. 

ML Sig. — Tablesp. everv hour until it 
operates on the bowels. Lattemand s Specific. 

R. Ext. Colchici Acet. (B. P.), 



R. Vini Colchici Seminis, 3ss. 

Tinct. Digitalis, 3ij- 

Liq. Potassii Citratis, S'jss. 

M. Sig. — A teasp. in water every 



R. Colchicine, gr- j- 

Ext. Colocynthidis Co., . 5ss. 

Quininae Sulphat., 3iij- 

Ft. pil. no. lx. Sig. — One pill every four 
hours. (B.) 



Ext. Opii Aquosi, aa gr. xv. 

Potass. Iodidi 3iv. 

Potass. Acetatis, 3ij- 

Aquae Destill., Biijss. 

Vini Albi, 5 ss. 

M. Sig. — 20 drops thrice daily. 



Gums. 
Myrrh, the tincture for spongy and ulcerated gums (P); 3ij-iv in 3iv of water or 
Infusion of Cinchona, is highly serviceable as a gargle or mouth-wash (Wa). Alum, 
for spongy and ill-conditioned gums, tending to recede from the teeth, whether of mer- 



678 



HAIR. 



curial or scorbutic origin (Wa). Catechu, a piece dissolved slowly in the mouth is 
often of service in similar conditions (Wa). Rhatany, the powder as a dentifrice, keeps 
gums in good order (B). Potassium Chlorate, gr. ij every four hours for a child of 
one year, for inflammation of gums in teething (Wa). Phenol, gr. iij ad 3j 
aquae, as lotion in diseases of the gums (Hilditch). Pomegranate, the bark an excel- 
lent basis for gargles in relaxed gums (P). Potassium Iodide, gr. x thrice daily, for 
periostitis of alveolar processes, marked by looseness of teeth, pain and swelling of 
gums (Graves). Sodium Salicylate, in doses of gr. xv every 4 hours, is highly efficient 
for the same condition, especially in combination with itrxv of tincture of Belladonna 
(Coley). Ichthyol undiluted to swab out alveolar cavities and as paint to the gums, is 
very efficient in alveolar pyorrhea and receded gums (Floris). Argyrol is an effective 
application in pyorrhea alveolaris, gingivitis, and other inflammatory and suppurative 
affections of the oral tissues (Fletcher). Iodine, gr. j ad 3j aqua;, applied by a brush 
after each meal to the margin of the gums, for retraction thereof with loosening of the 
teeth (S); the tincture is a good application in many morbid conditions of the gums. 
Zinc Chloride, a saturated solution applied by cotton to the margins, an excellent 
astringent tonic. Tannin, the glycerite, for spongy and bleeding gums (B). Iodized 
Phenol, when fetor exists (B). Benzoin, the tincture a good application (B). Tri- 
chloracetic Acid locally for pyorrhea alveolaris, as an antiseptic, astringent and stimu- 
lant application. Hydrogen Dioxide diluted, as a cleansing injection to pockets. 
Diet in pyorrhea alveolaris should be that of gout (Achorn). [Compare Odontalgia, 
Scurvy, Teeth.] 



1$. Aluminis, 3ss. 

Tinct. Myrrhas, 5 j • 

Tinct . Cinchonas, 3 iv. 

Mel. Rosas, oj- 

Vini Albi, 3 viij . 

M. Sig. — Mouth-wash. 



1$. Tinct. Orris, 
Spt. Rosas, 

Alcoholis, aa 3iv. 

01. Amygd. Amar., gtt. ij. 

M. Sig. — Violet Mouth-wash. 

(Piesse.) 



Hair. 

Rosemary, encourages the growth of hair, mitigates baldness, and is supposed to 
prevent uncurling in a damp atmosphere (P). Hydrogen Dioxide and other prepara- 
tions of oxygen, are used to "blonde" the hair, for purposes of fashion (Wilson). Sar- 
saparilla taken internally for 3 months, changes red hair to a light flaxen color (Teste). 
Sodium Cacodylate increases the growth of the hair (Gautier). Resorcinol is used 
in hair-dyes and caused in one case 16 attacks of erysipelas during 3 years. Hair- 
dyes include Potassium Permanganate, Pyrogallic Acid, Black Oxide of Lead, which 
are temporary, and the Black Oxide of Silver, which is permanent in its action (Wilson). 
Depilatories usually consist of powders containing Quicklime 3 parts, Sodium Sulphide 
1, and Starch 4; a powerful depilatory is Barium Sulphide made into a thin paste with 
Starch (Wilson); another contains Yellow Sulphide of Arsenic, gr. xx, Quicklime, oss, 
Starch, 5ij; a very effective one is Barium Sulphide 2 parts, Zinc Oxide 3, and Starch 
3, made into a paste with a little water (Duhring). Sulphurated Lime is an efficient 
depilatory, painless, non-irritant, and leaves no trace (Cumston). Sodium Sulpho- 
hydrate in 25 per cent, aqueous solution applied for ten minutes, removes hair as 
closely as a razor, and is excellent to prepare the skin for operation (Dawbarn). Elec- 
trolysis by needle attached to the negative pole of a galvanic battery and inserted into 
the follicles, is the only efficient method of permanently removing superfluous hair. 
[Compare Alopecia, Syphilis, Tinea.] 



B;. Sodii Boratis, 3iv. 

Aq. Ammonias, 3j- 

Spt. Myrcias, §ij. 

Aq. Rosas Sxiij. 

M. Sig. — Shampoo Hair Wash. 

B- Ac. Salicylici, gr. xl. 

Tinct. Benzoini, 3ss. 

Alcoholis, Glycerini, aa 3 viij. 

M. Sig.— Hair Wash. 



B- Ol. Ricini 5jss. 

Ol. Bergamottas, 5 jss. 

Ol. Cinnamomi, 

Ol. Caryophylli, aa TTRvi j . 

Ol. Lavandula, ttjxI. 

Tinct. Cantharidis, 3 j- 

Aq. Ammonias, 5 ij ■ 

Alcoholis, q. s. ad Oj. 

M. Sig. — Hair Tonic. 



HAY FEVER Hi \l>\. ill . 

Hay-Fever. 

Arsenic, especially valuable when disease is more of catarrhal than of asthmatic 
type. 3-minim doses of Liquor Arsenicalis (Mackenzie); as cigarettes, 2 or 3 daily. 
Iodides are very serviceable, locally and internally; large doses until iisin 

rved; may be combined with Arsenic (B). Opium, especially as Morphine, of 

it value in any stage, but great danger of the opium-habit (JB); the tincture in doses 

ij-iij every 2 hours for three doses, then nj>j every 2 hours until the di iates 

(Wa). Heroin for the cough and dyspnea. Belladonna, when nasal se< retion is very 

use (B). Euphrasia, of decided benefit for the catarrhal symptoms (I'D. Qui- 
nine, very useful after the more acute symptoms have subsided (R); iniei ted into the 
nares checks catarrhal discharge and spasmodic symptoms (P); a solution of the Hy- 
drochloride, gr. iv-viij ad 5j aqiuc, applied locally to nasal mucous membrane by a 
spray-producer or a brush, will arrest the disease if confined to the nares and fauces 
(B). Ipecacuanha, in hay-asthma (R); is of great value, though the smallest doses 
cause similar effects (P). Aconite is better than Arsenic in true hay-fever (R); has been 
used with the best results (P). Grindelia benefits cases of asthmatic type (B). Ig- 
natia, the tincture has seemed to benefit some cases, and to influence favorably the 
course of the disorder (Da C). Lobelia, has been found an efficient remedy (Wa). 
Adrenal Extract is almost specific for the symptoms and restores the normal condi- 
tion of the nasal erectile tissue (Douglas); used both locally and internally gr. v every 
3 hours. Adrenalin Chloride, the 1 in 2,000 solution locally gives immediate relief to 
all the symptoms (Sawyer). Cocaine, a 5 per cent, solution locally is a most efficient 
palliative (R); a 4 per cent, solution sprayed into the nares gives immediate relief 
(Da C); great danger of inducing the drug-habit. Zinc Stearate with Cocaine, an 
excellent insufflation. Black Coffee is highly recommended (P) Diphtheria Anti- 
toxin used in eleven typical cases with immediate benefit and rapid cure, dose from 
2,000 to 3,000 units (Rowland). Tobacco, smoking helns some and aggravates the 
symptoms in other instances; internally ad nauseam it helps, but there are better and 
safer remedies (Wa). Removal to the sea-coast or a barren, mountainous district, 
gives the only relief to some subjects; though many of the worst cases, hitherto unaffected 
by medicine, are now relieved by the local application of Cocaine. [Compare Asthma, 
Catarrh, Conjunctivitis, Influenza.] 

■t. Hvoscyami, gr. xij. 

Potassii Iodidi, 5j- 

Potassii Bicarb., 5ij- 

Ext. Glycyrrhizae ., 5iv. 

Aqus Anisi Sivss. 



R. Mentholis, 5 j- 

Phenolis, oss. 

Zinci Oxidi, oj. 

Ol. Amygd. Dulcis, 5 jss. 

Cerati Simplicis, 5ij- 



M. Sig. — Dessertsp. every 4 hours until M. Sig. — Apply thoroughly to the nos- 

relieved. (Weber.) \ trils every few hours. 



Headache, Bilious-sick. 

Antipyrine, the most valuable single remedy for headaches; an 8-grain dose for 
dyspeptic headache, in a little water, at commencement of attack, the patient lying 
down in a dark room; a second dose one hour after is generally enough, but a third or 
fourth may be required: sleep generally follows, and there are no unpleasant after-effects. 
Acetanilide, in 4-grain dose, equally effective. Acetphenetidin, safer than acetanilide, 
and equally efficient. Nux Vomica, gtt. j of tinct. frequently, when acute gastric ca- 
tarrh, with headache and nausea (R); gtt. j every 10 minutes, soon after meals, often 
gives marked relief in sick-headache not of neurotic origin (Smith); drop doses every 
10 minutes for an hour cure sick-headache, especially when accompanied by biliousness 
(M). Strychnine, with Aloin and Belladonna, in minute granules, for bilious head- 
ache from obstinate constipation, effective if given several times a day for a week or ten 
days (Roy). Belladonna, the extract in doses of gr. jV-i'o, in similar form. Iris, 
blinding headache in right supraorbital region, with nausea and vomiting, usually the 
result of hepatic derangement; TTjij every half-hour for three doses, usually relieves 



68o 



HEADACHE. 



promptly (Pf). Bryonia, ordinary bilious sick -headache with vomiting (P). Picro- 
toxin, gr. 2 \, by stomach, in periodical form (B). Chamomile, a popular remedy (R). 
Salol, is one of the most efficient remedies. Podophyllum, in sick headache, with 
dark bilious diarrhea, or when constipation with dark evacuations (R). Sanguinaria, 
in headache due to gastric derangement (P). Hydrastis, in headache with constipa- 
tion (P). Mercury, as Blue Pill, to prevent or mitigate sick headache; small doses 
of the Bichloride in headache with bileless diarrhea (R). Ammonium Chloride is 
an efficient remedy in most forms of headache (Wa). Sodium Phosphate, a useful 
laxative in so-called bilious sick -headache (B). Potassium Bromide, a large dose in 
ordinary or sick headaches (R). Ginger, in paste, as counter-irritant (P). Water, 
as cold or hot affusion, or ice-bag to head; hot sometimes best; the purgative waters, 
as Friedrichshall, before breakfast in a cup of hot water (R); a brisk saline purgative, 
or small doses of Epsom salts thrice daily, very effectual for frontal headache with 
constipation (Br). Nitrohydrochloric Acid, 10 drops of the dilute acid in a winegl. of 
water before each meal, often an effectual remedy (Br). Charcoal, two teaspoonsful 
stirred in half-glass of water, as a draught, is an efficient remedy for sick-headache 
with sour stomach and flatulence. [Compare Hemicranta.] 

]$. Ammonii Chloridi, 3iij- 

Morphinae Acetatis gr-j- !$• Podophylli Resinae, gr. ij. 

Carfeinae Citratis, 3ss. Tinct. Zingiberis, oij. 

Spt. Ammonii Aromat.,. ... 3j- Alcoholis, q. s. ad 5j- 

Elix. Guaranae, M. Sig. — Teasp. in a winegl. of water 

Aquae Rosa, aa §iv. every night at bedtime, or ever}' second, 

M. Sig. — Dessertsp. every quarter-hour third or fourth night as required. 

until relieved. (Carpenter.) (Dobell.) 



Headache, Congestive. 

Antipyrine or Acetanilide, (see preceding article). Aconite, to reduce the circula- 
tion (R). Veratrum Viride, at menstrual periods (R). Belladonna, relieves cere- 
bral congestion, and distress from light and sound (P); pain over brows and in eyeballs, 
often due to stomach or uterine derangements, especially in young women; njiij of 
tinct. every three hours (R). Potassium Bromide, gr. xv-xx, in ordinary or sick 
headaches (R); Bromides are useful when nervous system has been irritated, but when 
exhausted they do harm (Hammond). Calomel, gr. u \y> every hour for ten or twelve 
doses, will relieve the headache of syphilis occurring at night (Tr). Cannabis Indica, 
is given with uniformly good results in the headache of the climacteric. Potassium 
Iodide, throbbing, intolerance of light, pain passing from back of neck over vertex to 
brow, nocturnal, tender scalp, almost unbearable; ten-grain doses ter die will cure (R). 
Hydrastis, when constipated bowels (P). Amyl Nitrite, for headaches with severe 
flushing heats at menstruation or climacteric, tte-jV a sufficient dose (R). Mustard, 
in hot foot-bath, or as poultice to nape of neck in various forms of headache (R). Water, 
cold water poured gently over forehead, sometimes warm water better (R) ; a very hot 
foot-bath often effectually relieves (Wa). Purgatives are often beneficial, especially 
when congestive headache arises from suppression of hemorrhoidal discharge, or in 
persons of phlegmatic habit; Aloes best (Wa); or Colocynth, as derivative, when cere- 
bral hyperemia (Da C). 



B- Ext. Colocynthidis Co., gr. xij. 

Capsici, gr. iv. 

Ext. Gentianae, gr. xxiv. 

Ft. pil. no. xij. Sig. — One pill thrice 
daily; also a 2 5 -grain dose of Sodium Bro- 
mide nightly, at bedtime. (Da Costa.) 



1$. Spt. Ammonias, 5 j- 

Spt. Camphors, Sss. 

M. Sig. — For a quart of water, in which a 
handful of common salt has been dissolved. 
Cork tightly and use locally on lint as an 
evaporating lotion. 



Headache, Nervous. 

Antipyrine, is an efficient remedy for headaches generally, and is made more effective 
by Caffeine (W). Acetanilide, is very efficient in headache from fatigue (Brodnax); 
as routine remedies for the relief of headache these agents are much more valuable than 



\ri' ami rn 

bromides and caffeine (Whitla). Acetphenetidin, used with succeaa (M). Can- 
nabis Indica, ten-minim doses of the tincture thrice daily in the intervals, often cura 

tiw in l>a«l rases oi neuralgic headache; or } to \ grain doses ol the extrai I 1 1'). Caf- 
feine Citrate, one to two-grain doses in capsule every half-hour, a Vi J remedy 
for nervous and sick headache, hut causes insomnia if used in the evening. Guarana, 
a very effective palliative, gr. xx every half-hour for three dose w of the fluid 
extract every quarter-hour increased to ncxl will often relieve periodical headaches not 
of malarial origin (Smith). Sodium Salicylate, in small doses, gr. ij iij every quai 
hour, is very efficient in neuralgic headache (Br); also for gouty headache. Lithium 
Benzoate is efficient in headache of lithemic origin (Coston). Belladonna, the tinc- 
ture in doses of 3 minims every 3 hours, when pain over brows and in eyeballs, especially 
when at menstrual periods; also when from over-study or fatigue (R). Nux Vomica, 
if with gastric symptoms (R); is better than Strychnine, and should he given in quarter- 
grain doses of the extract after meals, combined with Iron and Quinine if patient is 
chlorotic (Hammond). Bromides, are useful when the nervous system has been 
irritated, but harmful when it is exhausted (Hammond). Silver Nitrate, half-grain 
doses with minute doses of Pil. Coloc. Comp., invaluable in headaches of hysterical 
women and especially stomach headaches of delicate and literary men (Wa). Ignatia, 
removes clavus hystericus (Pf). Ammonia, the Aromatic Spirit, 3ss-5ij, or the 
Carbonate, gr. v-x, in nervous headache (B); the Hydrochloride, gr. x-xx, in bilious 
and hysterical headaches, especially in hard-worked and delicate young women (Wa). 
Amyl Nitrite, inhaled, when extreme pallor of face (B). Arsenic, throbbing supra- 
orbital headache (R); as a nerve tonic stands next in value to Zinc (Hammond). Cim- 
icifuga, in nervous or hysterical women, especially at menstrual periods (R); in rheu- 
matic and menstrual headaches (P). Potassium Cyanide, locally in reflex headaches 
as gastric, cardiac, pulmonary, menstrual (B). Valerian is of great value in excita- 
ble persons (P). Camphor, a saturated solution in Eau-de-Cologne rubbed on head, 
when headache of uterine origin (R); in hysterical females, internally, with Magnesium 
Carbonate (P). Podophyllum, purgative doses often give relief when near menstrual 
periods, with constipation and dark stools (R). Zinc Oxide, two-to-five-gr. doses 
useful (R); a remedy of great value (Hammond). Bismuth, the Subcarbonate, in 
two-grain doses after each meal, often better than Zinc especially where gastric disturb- 
ance (Hammond). Ether Spray, for frontal headache, after acute illness or fatigue 
(R). Chloroform, njjxv-xxx of the spirit internally, often effective (Wa). Phos- 
phorus, as dilute Phosphoric Acid, in doses of irjjxxx well diluted, thrice daily; or Zinc 
Phosphide, gr. ^ in pill, ter die, very useful in most forms of nervous headache (Ham- 
mond). Cajuput Oil, well rubbed in tw-ice daily (P). Menthol, locally to forehead in 
frontal headache (Wa). Guaiacol, a few drops rubbed in gently, gives immediate 
relief (Brodnax). Diet in headache of gouty subjects should be that of gout, and 
should be free from tea and coffee, which are, however, useful in headache from nervous- 
ness or exhaustion (R). Galvanism, sometimes valuable; the constant current always, 
avoiding too great intensity lest amaurosis ensue (Hammond). [Compare Hemicrania, 
Neuralgia.] 

R. Zinci Phosphidi, gr. iij. 

Ext. Nucis Vom., gr. x. R Extracti Nucis Vom., gr. iij . 

Confect. Rosa?, q. s. Ferri Reducti, gr. xij . 

M. et div. in pil. no. xxx. Quirunee Sulphatis, gr. vj. 

Sig. — One pill after each meal. Ft. pil. no. xij. Sig. — One after each 

(Fordyce Barker.) 1 meal. (Hammond.) 



Heart Affections. 

Potassium Iodide, the true remedy for the heart; especially applicable in non- 
compensatory mitral or myocardial diseases, and where there is cardiac debility; re- 
storing energy and vascular tension at first; then by dilating, later on, all the arterioles, 
it frees the heart from resistance, and enables it to recover its contractile power; also 
dilating the coronary arteries it furnishes nutrition to the heart itself (Se"e). Nux 



682 



HEART AFFECTIONS. 



Vomica, gave speedy relief in several cases of heart-failure in which death was imminent ; 
small doses every i hour for four successive doses, then every hour (Bowie). Strych- 
nine strengthens the heart -beats (R); is an extremely serviceable remedy in cardiac 
diseases with weakness of muscle, and should be tried in cases of failing heart where 
Digitalis disagrees (W). Digitalis, acts as a stimulant tonic (P); small doses for seda- 
tive action; tonic or physiological doses to create hypertrophy in dilatation (Tr); irregu- 
larity of pulse its best indication (R); irritable heart (Da C); the tincture, given without 
water, is the best preparation; especially indicated in weak heart acting rapidly because 
of its weakness, and in valvular disease (Wa). Cimicifuga, safer than Digitalis in 
fatty heart (B); its action is strongly stimulating and tonic; it relieves excessive dyspnea 
when weak heart (P). Convallaria Majalis, will usually succeed in all cases in which 
Digitalis is useful, acting similarly to that drug, but with less reliability; is useful in 
aortic disease and in others where Digitalis cannot be used (Wa). Helleborein, as a 
substitute for Digitalis, is of less bulk and more definite composition. Adonidin acts 
like Digitalis as a cardiac stimulant, and much more promptly (W). Morphine, next 
to Digitalis, is in general the most indispensable remedy in the treatment of severe 
heart disease, being by far the most efficient agent for the dyspnea (Strumpell); hypo- 
dermically is employed in many cardiac disorders with marked advantage, especially 
in dyspnea and angina with diseased coronary arteries, mitral regurgitation with its 
dyspnea and insomnia and aortic disease. Dionin, promptly relieves the dyspnea and 
cough (Salzmann). Camphor in oil or ether, hypodermically as a stimulant in sudden 
cardiac failure (W). Caffeine, an excellent cardiac stimulant, and diuretic, gr. ij-v 
of the Citrate every three hours (Da C). Arsenic, for dyspnea from weak heart (R); 
in all cardiac neuroses it is especially valuable when combined with Iron and Strychnine, 
and is regarded as indispensable in all forms of weak heart accompanied by pain (Wa). 
Aconite, in the highest degree serviceable to diminish excitement or irritability; is 
more a remedy for functional derangement than for organic disease (Wa); in pericardi- 
tis (R); in nervous palpitations and hypertrophy (P); the heart seldom affected in 
rheumatic fever if Aconite be used from the start (P). Veratrum Viride, as cardiac 
depressant (B); in chronic cardiac diseases where excessive hypertrophy, i. e. when 
Digitalis is contraindicated (W). Iron, useful in various forms, especially anemic 
disorders and palpitation; also in dilatation and fatty heart, and mitral regurgitation 
(B). Hyoscyamus, in functional derangement from emotion, is specially indicated; 
requires large doses, irjrxl-lx of tinct., or gr. ^ of Hyoscyamine Sulphate hypodermically 
(Wa). Amyl Nitrite, relieves heart-pains resisting all other treatment (W). Tetrani- 
trin in dose of gr. ss to reduce high arterial tension in heart diseases (Huchard). Nitro- 
glycerin to lower arterial tension and decrease the resistance in weak cardiac action 
and cardiac failure; especially when persistency of action is desired (W). Hydras- 
tinine is an excellent subsidiary cardiac tonic when slow but permanent action is re- 
quired (Boix). Adrenalin is a powerful cardiac stimulant, and may be of sen-ice in 
heart failure during anesthesia (Miles). Cactus is highly praised in functional cardiac 
affections and in pseudo angina pectoris. Musk of good quality is a valuable cardiac 
stimulant. Chloral may be used with benefit in neurotic palpitation and in pseudo 
angina pectoris, but is generally contraindicated in heart affections, being a powerful 
cardiac depressant. Blisters, flying blisters over the precordial region, to stimulate 
action in extreme weakness (R). Alcohol, as Brandy when heart suddenly enfeebled 
by fright, loss of blood, etc. (R). Ether, n£xx hypodermically and repeated soon, is a 
very promptly -acting stimulant in sudden heart-failure; the compound spirit in 3j doses 
for less urgent cases. Schott Cure, as practised at Nauheim, is a combination of 
saline baths containing CO, in solution, and a series of graduated gentle exercises; 
the best results therefrom are obtained in cases of cardiac dilatation due to overwork 
or worry, but it is also useful in fatty infiltration of the heart (not fatty degeneration) 
accompanying general obesity (M). [Compare Angina Pectoris, Dropsy, Dyspnea, 
Endocarditis, Pericarditis, Syncope, and the five following articles.] 



1$. Fluidextr. Ergotse oiijss. 

Tinct. Digitalis, §ss. 

M. Sig. — Teasp. thrice daily in enlarged 
heart without valvular lesion. 



1$. Spt. /Etheris Comp., 

Liq. Morphinae Sulphatis, 

(gr. jadSj), aa 5j- 

Teasp. as required for dyspnea. 






HEART. 683 



Heart, Dilated. 
Digitalis, where much dilatation and hypertrophy of left ventricle without valvular 
disease; is not contraindicated when aortic disease (R); use in physiological doses 

(Trl; in simple dilatation gives most favorable results (Wa); very useful in mitral 
disease, when dilatation of the left ventricle (P); gives miraculous relief, is not suffi- 
ciently appreciated, but requires skilful administration; use the infusion in preference 
to other preparations, a tablespoon ful thrice daily, watching its effects (Da C). Sco- 
parius, the infusion (broom-tea), to maintain the kidney action if Digitalis is not 
sufficient (Da C). Purgation, brisk, free, watery stools, next to Digitalis is the best 
treatment (Da C). Morphine, hypodermically, gr. J-& two or three times a week in 
dilated heart with dyspnea (B). Amyl Nitrite, dyspnea from dilatation (R); is useful 
when great dyspnea, the cardiac asthma (P). Ether, the compound spirit an excellent 
remedy for the dyspnea (Da C). Mercury, a classical pill and a very efficient one as 
a diuretic in dropsy from cardiac disease is the combination of gr. j each of Digitalis, 
Squill and Mercury with Chalk (Foster). Schott Cure, in dilatation due to over- 
work or worry (see preceding article). [Compare Dropsy, Dyspnea.] 

Heart, Fatty. 

Strychnine, often the first remedy to do good; unduly pushed will produce nervous 
worry and be injurious (P); is the remedy with Iron, nourishing but not fat -making diet, 
and wine to keep up the tone of the blood (Da C). Ergot, in occasional doses has been 
given with apparent benefit (Wa). Iron, the tincture of the Chloride in small doses for 
a long time, has been of remarkable benefit (Wa). Cimicifuga, safer than Digitalis 
(B); the latter should not be used (Wa). Digitalis, of no value except for very tem- 
porary use and for some special indication (Da C). Chloral, must be entirely debarred 
(Id). Ether, the compound spirit for sudden attacks of pain or dyspnea (Id). Amyl 
Nitrite, for the same indications (Id). Stimulants, freely used, in an acute attack 
of any kind, afford the only chance (Id). Schott Cure, useful in fatty infiltration 
(not fatty degeneration) accompanying general obesity (M). 

Heart, Hypertrophied. 

Aconite, often better than Digitalis (R); dangerous in hypertrophy of left side with 
diseased valves, but useful in simple hypertrophy (P) ; for over-action with hypertrophy 
(B); the one remedy which can be depended on; small doses for months, say gtt. j of 
a good tincture ter die, to lower the heart gradually and keep it low (Da C). Digitalis, 
very useful in pure hypertrophy due to valvular disease or excessive muscular exertion 
(R); the primary action (small doses) required, as it creates hypertrophy when given 
in physiological or tonic doses (Tr). Veratrum Viride, as a cardiac depressant, gtt. 
v ter die, will relieve in simple hypertrophy, and irritable heart from abuse of tobacco, 
inadmissible when valvular lesions exist (B); gives the best results next after Aconite 
(Da C). Ergot in enlarged heart without valvular lesion; may be combined with 
digitalis (B). Potassium Iodide, small doses long continued benefit some cases (Wa). 
Camphor, in doses of gr. iij-xij daily for tumultuous palpitations and dyspnea of 
hypertrophy with dilatation (Wa). Iron is necessary where anemia exists (Da C). 
Quiet Life of great importance, no stair-climbing, no long walks; rest in bed for days 
at a time often of service, moderate diet, avoiding fattening foods, meat and stimulants 
(Da C). 

Heart, Palpitation of. 

Aconite, for the fluttering heart of nervous persons and nervous palpitations (R); 

for over-action with hypertrophy (B); for palpitation with simple hypertrophy (P). 

Hydrocyanic Acid, when from dyspepsia (P). Iron, when palpitation due to anemia, 

a very frequent cause; other causes are tobacco, coffee, tea to excess, dyspepsia, venery, 






68 4 



HEART. 



excessive exercise (Da C). Spigelia Anthelmia, when due to mitral and aortic disease, 
with much dyspnea (P). Digitalis, in small doses as sedative (Tr); combined with 
Iron in palpitation with valvular disease, or given alone in very severe cases (Wa); suits 
a large number of cases, especially for temporary purposes (Da C); the only remedy 
of positive service for the actual palpitation (Richardson). Lead Acetate for violent 
palpitation, is efficient in some cases (Wa). Camphor is recommended in nervous 
palpitations (R). Veratrine, as ointment to chest, when rapid, irregular pulse, hurried 
breathing, dropsy and lividity, palpitation, inability to lie down (R). Nux Vomica, 
of great value in nervous palpitation. Bromides, in fluttering heart (B); are useful 
when tolerated by the stomach (Da C). Hyoscyamus, in nervous, and violent palpi- 
tations from excited state of the brain (P); in large doses, for functional disturbance 
arising from emotion (Wa). Belladonna, in small doses, when irregularity of rhythm; 
may also be applied externally (Da C). Valerian, nervous palpitation, with dyspnea 
(P). Eucalyptus, palpitation and weak heart (B). Galvanization, of cervical 
sympathetic and pneumogastric (B). Hot Foot-bath, relieves palpitations (R). 
Milk-cure, has been beneficial in irregular action (B). Ice, to the cardiac region, 
has benefited many cases; is of chief value when patient can be kept in bed, which 
sometimes becomes necessary (Da C). 



B- Pulv. Digitalis,. gr. xx. 

Pulv. Colchici Sem., gr. xl. 

Sodii Bicarb., gr. lx. 

M. et div. in chart, no. xl. Sig. — One 
powder at first 3 or 4 times daily, gradually 
reduced to one at bedtime. For irregular 
cardiac action. (Bowditch.) 



R\ Tinct. Digitalis, 3ij- 

Sp. /Etheris Nitrosi, 3 j- 

Liq. Ammonii Acet., q.s. ad §iv. 
M. Sig. — A dessertsp. every 4 hours. If 
prolonged insomnia with palpitation add of 
Morph. Sulph. gr. y 5 to each dose. 

{Richardson) 



Heart, Valvular Disease. 

Nux Vomica, the tincture in one-drop doses every 5 minutes remarkably efficient 
in heart-failure, even with death impending (Bowie); also for the asthma (Macfarlan). 
Digitalis, in aortic regurgitation (R); most effective in mitral insufficiency (P); in 
rapid action with low arterial tension, in mitral disease; infusion best, tablesp. doses 
twice daily (B); njy of tinct. every \ hour or hour, often gives more relief than larger 
doses (Smith); when heart is weak and struggling (Da C). Cactus, is especially 
recommended in complicated aortic regurgitation, as it does not prolong the diastole 
like Digitalis, but stimulates the cardiac action. Morphine, hypodermically for the dysp- 
nea, is better in mitral than in aortic disease (R) ; the agent above all others in aortic 
insufficiency, combating the two great symptoms therein, the cerebral anemia and the 
dyspnea; is to aortic regurgitation what Digitalis is to mitral (Dujardin-Beaumetz). 
Aconite, useful for the palpitation, but dangerous in hypertrophy of left side with 
diseased valves (P) ; for cases presenting excessive growth and strong action, diminishes 
the blood-pressure in the arterial system, and gives great relief (Da C). Veratrum 
Viride, has similar applicability, but is more apt to nauseate; an admirable sedative, 
and one which does not sicken, is a mixture of Tinct. Aconiti, ttjjj, Tinct. Veratri Vir., 
Ttjjiij, Tinct. Zingiberis, njjvij (Da C). Strophanthus, is a cardiac tonic like Digitalis, 
but does not contract the vessels nearly so much (Br). Nitroglycerin, is the best of all 
remedies when actual cardiac pain; it lessens blood-pressure and diminishes the resistance 
the heart has to overcome (Da C). Adrenal Extract, is a powerful cardiac stimulant 
and may be used cautiously. Caffeine, as a tonic and diuretic, of especial value in' 
cases where urine is scanty, with cardiac pains, headache and dyspnea, and weak 
heart; gr. ij of the Citrate every three hours (Id). Adonidin in doses of grs. T V to \ 
thrice daily, acts excellently as a cardiac regulator (Id) ; is useful in the same class of 
cases as Digitalis, is more prompt in action, and has no cumulative tendency (W). 
Barium Chloride, gr. yV in pill three or four times daily, is diuretic, lessens cardiac 
pain, increases tone in the vessels, and is a good general and cardiac tonic (Id). Purg- 
ing, with Jalap, etc., in engorgement of right side of heart (R); occasionally useful 
(Da C). Treatment is directed chiefly to the dilatation or hypertrophy resulting from 
the valvular disease; the simplest rule is to use one's best judgment as to when 



HECTIC FEVER — HEMATEMESIS. 68j 

heart needs strengthening by the use of Digitalis or reducing by the administration of 
Aconite or Veratrum Viride (Da C). [Compare Dropsy, Dyspnea, I 

Hectic Fever. 
Quinine, in large doses, gr. xv-xx daily, if stomach and intestines do not rebel 
given before the paroxysm, to limit it (Roberts). Antipyrine, is better than 
Quinine, but must be used in much smaller dosage than ordinarily employed, say gr. 
iv or v about J hour before fever rises, than doses of gr. ij hourly as long as temp. 
remains above 100.5°; this daily, will give excellent results in the hectic of phthisis 
(Pibram). Acetphenetidin, safer and equally efficient. Phenocoll, as antipyretic, 
is used with marked success. Aconite, in small doses, a remedy of much value in 
the irritative fever of phthisis (Da C). Morphine and other anodynes, are of especial 
value, given in full doses toward bed-time (Gross). Prunus Virginiana, the bark 
has been found useful, especially when irritable cough (P). Calcium Phosphate, 
is especially useful (R). Calumba, excellent for tonic effects (P). Digitalis, the 
tincture, combined with Tinct. Ferri Chloridi, abates the temperature and diminishes 
the sweats (B). Iron, the Mistura Ferri Composita has obtained great celebrity, 
especially when much debility and anemia (Wa); the Sulphate and Tincture of the 
Chloride are of especial value in the treatment of hectic (Gross). Ipecacuanha, a 
few grains of Dover's powder at bed-time, will stop the profuse perspirations (Wa). 
Salicin, for profuse perspirations (Wa); as antipyretic. [Compare Perspiration, 
Phthisis.] 

R. Tinct. Digitalis, 5iij- I B^. Quininas Sulph., OJss. 



Tinct. Ferri Chloridi ov. 

M. Sig. — 15 drops 3 or 4 times a day. 

(B.) 



Elix. Taraxaci, §iv. 

M. Sig. — Teaspoonful every hour for six 
hours. 



Hematemesis. 

Iron, the Subsulphate (Monsel's solution) or Pernitrate, the best remedies; gtt. j — Ij 
frequently, diluted with ice-water (B); the Chloride, in a mixture with glycerin and 
pounded ice, a teasp. every hour, gave excellent results in 'two cases of very severe hemat- 
emesis (St. George Reid). Lead Acetate, especially when gastric ulcer, gr. ss-v (B). 
Tannic Acid, gr. x-xx, when hematemesis from gastric ulcer or obstructive disease of 
the liver (B). Gallic Acid, an extremely useful agent; is best used in combination 
with dilute Sulphuric Acid (Wa). Ergot, has often cured when other means failed 
(P); most valuable; in urgent cases Ergotin in 2 to 5 gr. doses hypodermically (R). 
Ipecacuanha, is decidedly effective in small doses, also when hematemesis is vicarious 
of menstruation (P, Wa). Hamamelis, njj-ij of tinct. every 2 or 3 hours (R); effec- 
tive from its Tannin (B). Alum, serviceable in passive hemorrhage; Iron better (B). 
Turpentine, especially in passive hemorrhage with debility (R); and in hemorrhagic 
transudations on the free mucous surfaces, hematemesis, etc. (B). Adrenalin Chloride, 
the 1 to 1000 solution, of which njxxv internally, very effective in two cases (Mills). 
Adrenal Extract in tablet form chewed, said to effectually arrest gastric hemorrhage. 
Hydrastinine as a vaso-constrictor, may be of service. Cotarnine is a powerful 
hemostatic. Vinegar diluted with 1 to 4 of water, a very grateful drink and effective 
in arresting the flow of blood (W). Ice, in small pieces swallowed, a most useful agent, 
with perfect rest for stomach; when hematemesis from that organ, nutrient enemata 
must be employed; iced champagne to arrest faintness, if persistent; when moderate 
the bleeding need not give cause for alarm. [Compare Hemoptysis.] 



IV Olei Terebinth., oiij- 

Fluidextr. Digitalis, 5j- 

Mucil. Acacia:, oss. 

Aq. Menth. Pip., oj- 

M. Sig. — Teasp. every 3 hours. 



R. Ac. Gallici, 5j- 

Ext. Ergotas, 

Digitalis, aa gr. xx. 

M. et div. in pil. no. xx. Sig. — One every 
4 hours. 



686 



HEMATOCELE, PELVIC — HEMATURIA. 



Hematocele, Pelvic. 

Opium, or Morphine, if needed for pain, with absolute rest in bed, and a moder- 
ately tight abdominal bandage (E). Hemostatics, as Gallic Acid, Lead, Turpentine, 
etc., to arrest the hemorrhage, if it be still going on, combined with opiates, and the use 
of ice-bags or cold lotions to the abdomen or per vaginam. Tonics, as Iron and Quinine, 
while resolution of the extravasation is going on. Bromides and Iodides, to quiet 
the action of the ovaries, if the hemorrhage recurs at different periods. Potassium 
Iodide, as an absorbent, may be given with Quinine (Braxton Hicks). Iodized Cotton, 
an excellent application to the cervix uteri in cases of hematocele (Wa). Leeches, 
should be applied early in cases of peri-uterine hematocele; later, except to check 
inflammation, they are inadmissible (Wa). Mercury, gr. ^ of the Bichloride thrice 
daily, with Iron and Ergot, conjoined with vaginal injections of hot water morning and 
evening; later in lieu of the mercurial the Syrup of Ferrous Iodide in 20-drop doses 
thrice daily, was thoroughly efficient treatment in one very bad case of retro-uterine 
hematocele (Hengst). Surgical interference has many advocates, but is criminal in 
a large majority of the cases (E). If the case does not end in resolution it will terminate 
in pelvic abscess. 

1$. Iodi, 5j. Mix and saturate 8 oz. of cotton with the 

Potassii Iodidi, §ij. mixture; then carefully dry, and label "Io- 

Glycerini, 3 viij. dized Cotton." [See above.) 



Hematuria. 

Turpentine, when with constitutional debility (B); in very small doses (R); is 
often very efficacious (P); in absolutely passive hematuria (W). Gallic Acid, the 
most uniformly successful remedy (B); gr. x-xx every hour or two (Da C). Sulphuric 
Acid, alone or with Gallic Acid, is an efficient remedy (Da C). Acetic Acid, in a 
case of alarming hemorrhage from the bladder, which occurred after an operation for 
vesico -vaginal fistula, and resisted all other means, an injection of apple-vinegar and 
ice-water, equal parts, succeeded in arresting it (Ghent). Quinine, large doses neces- 
sary; cures when intermittent or from malarial infection (B); useful in some cases of 
intermittent hematuria (R). Myrtol, has been used with success in hematuria not due to 
acute congestion (B). Iron, the tincture of the Chloride, ttjjx-xx several times daily; in 
this affection the best form of Iron for internal use (Wa). Ipecacuanha, exercises a 
powerful influence (Wa). Hamamelis has arrested it in severe cases (R). Chima- 
phila often controls hematuria (P). Cotarnine is a powerful hemostatic. Ergot, by 
stomach or subcutaneously; may be combined with Ipecac, Krameria, or other astrin- 
gents (B). Ergotin, hypodermically, is far superior for efficacy and rapidity of opera- 
tion (Wa). Matico, the infusion, in doses of oij every 2 or 3 hours, is fully equal to 
Gallic Acid, Lead, etc. (Thompson). Ammonium Benzoate, in 5-gr. doses every 2 
hours for the albuminuria and hematuria of scarlatina (Hillier). Cannabis Indica, 
is especially indicated in dysuria and strangury when there is bloody urine (R). Cam- 
phor, in 2 to 5 grain doses is said to promptly remove the renal hyperemia with bloody, 
coagulable urine, caused by Cantharis, Turpentine, Oil of Mustard, Copaiba, etc. (R). 
Gelatin 2 per cent, in normal salt solution, of which ovj subcutaneously injected 
below the clavicle, conquered the hemorrhage in a case of hematuria with recurrent 
nephritis, in which all other measures had failed (Schwabe). Ice in rectum or to peri- 
neum, for vesical hemorrhage (Thompson). Endemic hematuria, due to the bilharzia 
parasite, can only be palliated; as yet we know of no means by which the bilharzia can 
be destroyed (Mn). 



B;. Acidi Gallici, 3ss. 

Acidi Sulphurici Dil., 

Tinct. Opii Deodor., aa 3j. 

Infusi Digitalis, §iv. 

M. Sig. — Tablesp. every 4 hours or 
oftener. In hematuria, menorrhagia, pur- 
pura hemorrhagica, and the hemorrhagic 
diathesis. (D.~) 



R. 



Fluidextr. Ergotae, 

Tinct. Krameriae, aa. 5 j- 

M. Sig. — A teasp. every hour or two. 



R. Ext. Ergotae (Squibb), 3j. 

Aquae, 5j- 

M. Sig. — For hypodermic use; njx con- 
tain gr. j. 



HEMERALOPIA VND NYCTALOPIA HEMICRANIA. 

Hemeralopia and Nyctalopia. 
Strychnine, for night-blindness; small doses gradually increased, of service (Wa). 
Mercury, Ilydrarg. Chlor. Corr. gr. ij ad 3j aquae, dropped into the eye twice daily, 
with blister on each temple, and mild aperients, has cured hemeralopia (Smith). Qui- 
nine, in as large doses as can be borne, after cathartic and emetic, for night- and day 
blindness (Howard). Blisters, small, i\ inches in diameter, close to external canthus 
of the eye (Bampfield). Electricity, occasionally useful (Wa). Rest, protectioi 
eyes from bright light, constitutional remedies as indicated by state of the general 
health, and change of climate, speedily cure hemeralopia. It is sometimes mererj a 
symptom of pigmentary degeneration of the retina, or a feature of scurvy. 

Hemicrania. 

Antipyrine, the most valuable single remedy for headache, especially in migraine and 
those cases for which Ergot and Amyl Nitrite are indicated; 5 grains at beginning of the 
attack often sufficient (Birdsall); of great value in true migraine, employed in twenty cases 
with unfailing benefit; less useful in the malarial or dyspeptic forms, and useless in uremic 
(Thompson). Acetanilide and Antipyrine, the striking powers of these two agents are 
. best demonstrated in severe migraine (Whitla). Acetphenetidin, is given with 
great benefit, in doses of 2 grains with \ grain of CalTcine Citrate, for migraine. Bella- 
donna, when due to vaso-motor spasm, the face being pallid (B); the tincture in small 
and repeated doses if the disease be of reflex character (H). Iris, in blinding form, 
from hepatic trouble, right supra-orbital region; ntlj every half-hour for 3 doses, usually 
relieves promptly (Pf). Cannabis Indica, one of the most valuable remedies for 
megrim or sick headache, apparently acting on the nervous centre whence the disorder 
springs; is most useful in the intervals to prevent the attacks, and especially when the 
paroxysms are becoming more frequent; in the congestive form, the tincture in re- 
peated doses until some physiological action is induced (H); gr. J of the extract before 
each meal, increased gradually to \ or § grain, in the intervals, kept up for 3 months 
(Seguin). Camphor, gr. iij-v, with a 20- or 30-grain dose of Magnesium Carbonate, 
is very useful, especially in hysterical females (P). Croton-chloral, in milder forms 
without severe vomiting, headache being predominant; the Bromides are useful after 
it (PO; rarely of any use, but if given it should be in 20-grain doses twice daily (H); 
Guarana, is useful (B), a very effective palliative; gr. xx every J hour for three hours 
(P); its efficacy diminishes by degrees, attacks usually becoming longer (Tr); 5ij of 
fluidextract in course of an hour or two, to anticipate the attack when expected (Seguin). 
Caffeine, in typical migraine; gr. j hypodermically (P); is especially adapted when 
chronic gastric catarrh, gr. j every half-hour (B); the Citrate in grain doses every hour 
for some time before a paroxysm (Wa); gr. j every half-hour often gives marked relief 
(Smith). Valerian, of especial value when hemicrania in excitable temperaments, 
and after profuse or painful menstruation (P). Ammonium Chloride, is exception- 
ally serviceable; seldom failing to cut short an attack (Austin); 10- to 15-gr. doses (R); 
as a diffusible stimulant is very efficient, gr. xx up to oj every hour during the attack 
(H). Sodium Chloride, in small doses, proved very efficient in six positive cases 
attended by gastric distress (Rabon). Podopbyllin or Mercury, when of bilious 
origin (R). Bromides, for true migraine; Raspail's Eau Sedative locally, gives great 
relief (B); when due to uterine disorder (R). Potassium Bromide, very serviceable 
in the paroxysm, also in the continuous form (R). Potassium Iodide gr. v-x thrice 
daily, caused immediate improvement and absolutely eradicated it after 2 or 3 weeks in 
many cases, this drug being given by reason of the increased arterial tension and the simi- 
larity between migraine and the headache of cerebral syphilis (Clemens). Eucalyptus 
when migraine is due to cerebral anemia (B). Phosphorus, is strongly recommended (R). 
Amyl Nitrite, by inhalation, in migraine with pallor of face (R). Sanguinaria, a 
few doses very successful, when migraine is due to gastric derangement (P). Ignatia, 
removes clavus hystericus (Pf). Nux Vomica, when of gastric origin (R). Cimici- 
fuga, is strongly recommended (P). Arsenic, for cerebral congestion and hemicrania 



688 



HEMIOPIA — HEMIPLEGIA — HEMOGLOBINURIC FEVER. 



(B); for throbbing pain in one brow (R); often has the best effect: Watson believed 
that gtt. iv-vj of Liq. Arsenicalis, 3 or 4 times a day, with due attention to the bowels, 
would cure 9 out of every 10 cases (Wa). Aconitine or Veratrine, ointment over brow 
(R); Aconitine internally is of great sendee (Seguin). Piscidia is recommended (Wa); 
efficient in doses of 3ij of the fluidextract (Ford). Digitalin, gr. ,;'„ bis die in granules 
for congestive hemicrania (B). Ergot, if due to miliary aneurisms of intercranial arteri- 
oles; also in congestive migraine and in nearly all kinds (B). Menthol, locally in 
frontal headache due to migraine, is said to be very efficient (Wa). Diet in lithemic sub- 
jects must be free from meat, tea, coffee, etc., the diet for gout (Haig). Rubber Band- 
age, applied tightly from eyes up, protecting the temporal arteries by pads, or a dry 
muslin bandage wetted after being put on (Weir Mitchell). Acupuncture, the needle 
run down to the cranium will give relief in clavus hystericus, when nothing else will do 
so (Pancoast). [Compare Headache, Bilious Sick and Nervous.] 



R% Quininae Sulphatis, 3ss. 

Belladonnae Fol. (pulv.) gr. x. 

Ext. Digitalis, gr. xv. 

Ext. Valerianae, §ss. 

Mellis, q. s. 

Ft. pil. no. xl. Sig. — 2 to 10 pills daily, 
gradually increased, during three or four days 
before the expected attack. 



1$. Ammonii Chloridi, 3yj. 

Ammonii Bromidi, 3 iv. 

Spt. Athens Nitrosi, Bj- 

Syr. Pruni Virgin., §iij. 

Aquas, q. s. ad 5yj. 

M. Sig. — Dessertsp. 3 or 4 times daily, 
conjoined with the use of Raspail's Eau Seda- 
tive locally. 



Hemiopia. 

When established, hemiopia offers little hope of cure, though it has no tendency to 
progress. In hemiopia scintillans, Potassium Bromide, gr. xl-lx daily, or a band 
of such metal as idiosyncrasy of the patient may decide, with stimulants to ward off the 
aura; Quinine, Iron, Hydropathy, when Potassium Bromide fails (De Wecker). 

Hemiplegia. 

Strychnine, is most useful when the muscles are relaxed; hypodermically, when 
paralysis incomplete and the muscles flaccid but not wasted (B). [See Paralysis for 
formula.] Potassium Iodide, gr. x-xviij daily, occasionally proves effectual (Wa). 
Galvanism, constant current to the brain or cord, faradic to the muscles opposite 
those contracted (Hammond). Physostigma, prevents muscle wasting, and hence is 
given with benefit to hemiplegics; gr. -^s~tt5 oi tne extract repeated frequently (R). 
Massage, in hemiplegia and other forms of paralysis due to intercranial lesions, when 
cold and blue skin, wasting and contracted muscles, ulcerations (B). Cocculus, in 
hysterical, epileptic and choreic hemiplegia, acts well; also in hemiplegia from cold (P). 
[Compare Paralysis Facial.] 



Hemoglobinuric Fever. 

Antipyrine, Acetphenetidin, and similar antipyretics, are dangerous (Mn). Qui- 
nine, is less efficient in this than in any other form of malaria (Mn) ; as it conduces to 
hemoglobinuria its use is deprecated (Plehn); should be given in this affection if the 
malarial parasites are found in the blood, but not if they are absent (Bastianelli). Salo- 
quinine in daily dosage of gr. xl- 5 j did excellent service after quinine had failed (Fitch). 
Calomel in doses of 20 to 30 grains, is the favorite remedy in Africa (Mn) ; Calomel and 
Jalap, separately or combined, to keep the bowels well open (Copeman). Chloroform, 
in small doses internally; Chloroform 3j, Pulv. Acaciae q. s., Sweetened Water, ad oviij, 
of which oss every ten minutes until a certain degree of chloroform intoxication is pro- 
duced, the effect to be kept up by enemata of Chloral; of 22 cases so treated none died 
(Quennec). Chloral, with perhaps small doses of Pilocarpus, if uremic convulsion 
or coma supervene (Copeman). Tannic Acid, gr. xv well diluted, every 2 hours for 
4 or s times, repeated on the third and sixth days to the extent of two doses each day 



HEMOPTYSIS HEMORRH U.i . 



689 



Transfusion of blood has been successfully practised in high degrees of anemia 
in some of these cases (Id). Hot Water, in bottles in the bed, if the temperature should 
i.ill below normal (Copeman). Diuretics must not be given if urine suppressed, bul 
hot fomentations to the loins, diaphoretics and plenty of bland diluents internal!) (Mn) 
Milk Diet exclusively until all albumin has disappeared from the mine (Id), Care 
necessary at all times to avoid getting wet or chilled or over-fatigued, for those who 
have suffered once from this affection (Id). [Compare Malaria, INTERMITTENT 
Fever, Remittent Fever.] 



Hemoptysis. 
Atropine, gr. ,,',„ hypodermically. is remarkably efficient in stopping the bleeding 
in phthisical hemoptysis (Squibb). Gallic Acid, exceedingly effective (P); may be 
combined with Ergotin and Digitalis. Lead Acetate, with Opium (B); proves 
signally useful (Wa). Ergot, the fluidextract in 30 to 40 minim doses, every 3 or 4 
hours, or hourly in severe cases; or Ergotin hypodermically for urgent cases, in 2 to 3 
grain doses (R); is harmful in arterial hemorrhage (Fenn). Opium should be used 
freely for the attendant excitement (W); to diminish anxiety and reduce blood pressure 
(Tirard). Cotarnine gives satisfaction being powerfully hemostatic, also anodyne and 
sedative (Lavialle). Aconite to quiet the circulation and reduce blood pressure (Fenn). 
Chloral, is used with benefit, its vaso-dilator power probably acting as a derivative, 
and its sedative influence allaying excitement. Ipecacuanha, has been highly praised 
(R); in emetic doses arrests hemoptysis (Tr), though in poisonous doses produces it 
(P); a well-founded case is recorded where Ergot and Gallic Acid utterly failed, and 
Ipecac was effectual; but it must be pushed to the nauseating point, in order to effect 
the control (Squibb). Turpentine, in drachm doses every 3 hours, may cause un- 
pleasant symptoms which soon disappear on its discontinuance (R); has proved very 
efficient (P); after other hemostatics fail it is worthy of trial (Wa). Alum is serviceable 
in purely atonic hemorrhages (Wa); in 10 grain doses every 2 hours (B). Oil of Eri- 
geron, is very efficient when no fever or other signs of constitutional irritation (Wa). 
Hamamelis, njjj-ij of tincture every 2 or 3 hours (R); wj-x of fresh tincture several 
times a day (Pf). Ferric Acetate, a little added to water so as to taste, this constantly 
sipped (R) : Iron spray will often arrest (B). Ferric Subsulphate as Monsel's solution, 
njv-xx to the 5, by atomization and inhalation for 5 to 20 miuntes, often acts well (W). 
Gelatin 2 per cent, in normal saline solution, of which oss hypodermically, is efficient 
but painful (Tickell); a sterilized 5 per cent, solution, Six by rectal injection thrice 
daily, is equally efficient and harmless (Hettinger). Adrenalin Chloride, the 1 to 
1,000 solution internally, 20 drop doses every 2 hours for 4 doses, then less frequently, 
proves highly efficient (Robinson). Digitalis, has undoubted power over hemoptysis 
(B); small doses daily (P): infusion in large doses (R). Arnica, of great service, 
if from violence (P). Sodium Chloride, half a teaspoonful of common salt, taken 
dry, repeated till nausea (R). Sulphuric Acid, the dilute acid a useful adjunct to 
other treatment (Wa). Spinal Hot-water Bag, to cervical or upper dorsal vertebra? 
(R). Auxiliaries, Cold externally, acidulated drinks, perfect rest, and antiphlogistic 
diet (Wa). [Compare Hematemesis.] 

IV Plumbi Acetat., gr xx. R<. Aluminis, 3j- 

Digitalis (pulv.), gr. x. Sacch. Alb., 3ss. 

Opii Pulveris, gr. v. Pulv. Ipecac. Comp., gr. xx. 

M. ft. pal. no. x. Sig. — One every 4 hours. M. ft. pulv. no. vj. Sig. — One powder 

(B.) every 2 hours. (Skoda.) 



Hemorrhage, Hemorrhagic Diathesis. 

Iron, when hemorrhagic diathesis due to anemia; the tincture of the Chloride pre- 
ferred (B); this tincture as a styptic (Wa); 1 or 2 teaspoonfuls of the concentrated 
solution in a glass of water an excellent hemostatic (Tr); the Acetate, just enough to 
make water taste, in hemorrhage of lungs and kidneys (R). Ergot, in uterine hemor- 

45 



690 HEMORRHAGE. 






rhage of any kind, and many forms of hemorrhage, Ergot or Ergotin of great value (P); 
not to be relied on alone (B); is harmful in arterial hemorrhage as it increases blood 
pressure (Fenn). Hydrastinine is a powerful vaso-constrictor, and especially efficient 
in arresting uterine hemorrhage (W). Hydrastine, a salt of this alkaloid in doses of 
gr. $-$ hypodermically when a speedy action is required (W). Opium freely, to allay 
excitement and reduce blood pressure. Cotarnine is a powerful hemostatic, also 
anodyne and sedative, and is efficient in many forms of hemorrhage. Adrenalin 
Chloride effectual in six cases of severe hemorrhage (Lange) ; is powerfully angiosteno- 
tic and efficient in hemorrhages generally. Adrenal Extract locally for hemorrhage 
following operations on the nose, etc.; internally has rendered good service in nasal, 
gastric, and pulmonary hemorrhages. Antipyrine, is a most efficient hemostatic; a 4 
per cent, solution checks general oozing from a bleeding surface; as a styptic it constricts 
the small vessels without causing an external clot to break down (Park). Gelatin, 
as a styptic and hemostatic is efficient; used by subcutaneous injection of a 2 to 5 per 
cent, solution, also by rectal injection; and by the mouth in hemophilia, Bvj daily of 
a 10 per cent, solution (Hesse). Ipecacuanha in toxic doses causes hemorrhage, but 
has great energy in arresting it (P) ; exercises a powerful influence on internal hemorrhage 
generally, and in exhaustion therefrom; gr. j-ij every \ hour (Wa); in emetic doses 
serviceable (Tr). Turpentine, few agents more useful in the passive forms (B); 
small doses in hematuria (R); for serious hemoptysis, and hemorrhage of typhoid (P). 
Belladonna, hemorrhage from rectal ulcers (P). Digitalis, in uterine, and many 
other forms, of great value (P) ; with restoratives has undoubted power in the hemor- 
rhagic diathesis (B). Aconite to reduc; the circulation in epistaxis, hemoptysis, etc. 
(P); to quiet the circulation and lower blood pressure, in profuse hemorrhage from the 
lungs (Fenn). Calcium Chloride in doses of gr. vij ever)' 2 hours, increases the 
coagulability of the blood and is efficiently hemostatic in uterine hemorrhages and 
hemophilia (Gross). Thyroid Extract has completely controlled hemophilia (Fuller). 
Gallic and Tannic Acids in all passive hemorrhages, especially in that of the bladder 
(P); Tannic Acid for local use, Gallic for systemic effects upon remote parts: when 
hemorrhage occurs in relaxed and debilitated constitutions, Gallic Acid may be com- 
bined with Ergot and Digitalis (B). Matico, proves useful in many cases, especially 
menorrhagia, hematuria and hemoptysis (Wa). Nux Vomica, in hemorrhagic diathe- 
sis, especially when occurring in anemic subjects; also the Syrup of Iron, Quinine and 
Strychnine Phosphates; no prescription more generally useful (B). Cinchona, 
internally very efficient in some forms of hemorrhage (Tr). Copper Sulphate, in 
stick, solution or ointment, to arrest hemorrhage from small vessels (R). Arnica, in 
ecchymoses from mechanical violence (P). Rhatany, the extract, one of the most 
powerful hemostatics (Tr). Hematoxylon, is devoid of irritant qualities and is there- 
fore well adapted to check the diarrheas and hemorrhages of young children. Sul- 
phuric Acid, the dilute acid an excellent internal hemostatic, sometimes very effective 
in uterine hemorrhage (B). Dilute Vinegar to leech-bites, piles, cuts, etc. (R). Apple- 
vinegar as injection for vesical hemorrhage. Alum, is sanctioned by high authority 
(B); dusted on in slight cases (R); in uterine and traumatic hemorrhage, when small 
vessels open (Tr). Hamamelis, iTjj-ij of tincture every 2 or 3 hours, effective in 
many forms (R). Bone-marrow is efficient in hemophilia due to anemia. Grape- 
cure, as tonic for convalescents (P). Alcohol, in hemorrhagic diathesis, to elevate the 
arterial tension (B); Brandy, Wine, when heart suddenly enfeebled by hemorrhage 
(R). Venesection, will promptly arrest pulmonary hemorrhage (B). Styptics, are 
either needless or inefficient, hence practically useless in general surgery; hemorrhage 
should be controlled by either pressure or ligation (Roberts). Hot Water, sponged 
over a bleeding surface, is the best agent to stop hemorrhage (Gross) ; left in the peri- 
toneal cavity after operation thereon, is in part a true transfusion, being soon absorbed 
(Keetly). Hypodermoclysis to replace fluid lost in severe hemorrhage (Kemp). 
Transfusion of blood is unsatisfactory, the blood escapes into the cellular tissue outside 
the circulation (Wooldridge) ; normal saline solution is much better, raising the blood 
pressure. Ice, internally in wounds or hemorrhage of lungs, or from stomach; small pieces 
frequently (R). Rest, perfect rest is often indispensable, especially in hematemesis, in 
which nutrient enemata may be required. [Compare Dysentery, Ecchymosis, Epis- 



in MORRH USE. ,„,, 

i wis, Hematemesis, Hemoptysis, Hemorrhoids, Hematuria, Hemorbhag: P 
pakitm and Intestinal, Menorrhagia, Metrorrhagia, Pi mm ra, v, 

Ej Potassii Carbonal ,~>ij. 

Saponis Jj 

Alcoholis giij, 

Mi\ and use .1- ■< itypti illy for 

operations about the face. (Jos. Paneoast.) 



ifusi Digitalis 3ij- 

Fluidextr. Ergots, 

Tinct. Krameriae, Sa 5 j • 

\I Sig. — A tablesp. as required in hem- 
orrhagic conditions generally. (B.) 



K. Tinct. Benzoini T>viij. 

Aluminis lb. j. 

Aqua II). x. 

Hull hours, adding hot water and keeping 
well stirred; filter, and put up in stoppered 
bottles. (Pagliari's Styptic.) 



R. Fluidextr. Ipecac ,~>ij. 

Fluidextr. ErgOtffi .~iv. 

Fluidextr. Digitalis, ,~)ij. 

M. Sig. — Half teasp. to a teasp. at a dose, 
repeated as required. An excellent anti- 
hemorrhagic combination. (B.) 



Hemorrhage, Intestinal. 
Gallic Acid, gr. xv with gtt. iij-iv of Laudanum, in a winegl. of iced water every 
2 or 3 hours in the hemorrhage of typhoid (Jenncr). Opium, a valuable adjunct to 
astringents, allaying the nervous excitement (Wa); most useful (Da C). Tannin, 
one of the most serviceable remedies for the intestinal hemorrhage of typhoid fever (B). 
Hamamelis, very effective in intestinal hemorrhage, owing to its large proportion of 
Tannin (B). Ergot, is most valuable; may be given hypodermically in urgent cases 
(R). Turpentine, the oil in capsule containing njiij-iij (Tirard); should be used (B); 
especially in the hemorrhage of typhoid (P). Lead Acetate is often of great service, 
especially in enema (Jenner). Belladonna, for irritable and bleeding rectal ulcers 
(P). Iodine, in passive form, gtt. j-ij of tinct. frequently repeated, of great sendee 
(B). Sulphuric Acid, is serviceable (B); is much less efficacious than other remedies 
(W). Copper Sulphate, gr. J-j as a pill (Tirard). Ice over the abdomen is recom- 
mended; contraindicated in typhoid by the amount of depression (Id). Diet, con- 
centrated meat juices with iced water in small quantity; secure rest for the intestine by 
giving no food by the mouth, and using enemata containing opium (Id). [Compare 
Dysentery, Hemorrhoids, Typhoid Fever.] 



Hemorrhage, Post-partum. 

Ergot requires 15 to 20 minutes for action when given by the mouth, so is best used 
hypodermically when flooding has set in (\V) ; a full dose of the fluid extract as soon as 
birth is completed, as a prophylactic (Playfair); hypodermically in urgent cases, gr. 
ij of Bonjean's Ergotin deeply into the tissues of the arm (Wa); 5ss doses of the fluid 
extract every- 2 to 4 hours in secondary hemorrhage. Cimicifuga, will check post- 
partum hemorrhage, especially when tediously prolonged (P). Atropine hypodermi- 
cally in profuse flooding after abortion, is very efficient (Squibb). Ipecacuanha has 
been given with advantage (W); in flooding after delivery (R). Hamamelis for 
persistent oozing (R). Ferric Subsulphate as Monsel's solution, diluted 1 to 3 of 
water, is strong enough for injection and safe (B) ; the solution of the Perchloride diluted 
as a uterine injection (R). Amyl Nitrite by inhalation has stopped the bleeding 
promptly and permanently (Kerr). Hydrastinine is a powerful uterine vaso-con- 
strictor, and efficient in uterine hemorrhage (W). Cotarnine is a powerful uterine 
hemostatic (Sartig). Ferropyrin is remarkably efficient as a hemostatic (Toff). Digi- 
talis, the infusion best; a tablesp. bis die, or in urgent cases every half hour for 4 doses 
(B). Nux Vomica, the tinct. gtt. xx; Fluidextr. Ergotas gtt. xxx; each hour for 2 or 3 
doses (B). Opium, the tincture oj with Brandy, in profuse flooding (R). Vinegar, 
a handkerchief soaked in vinegar and carried into the uterus, will often check a severe 
hemorrhage (Landis); is antiseptic, astringent and sufficiently irritating to produce 
contraction, yet not so irritating as to cause subsequent mischief, and always acts 
promptly (Penrose). Tamponade, by absorbent cotton or plugs of linen, is indicated 
in hemorrhage from abortion or placenta praevia (Parvin); never tampon after delivery! 



692 HEMORRHOIDS. 

you might as well hang the woman by the neck (Wallace). Auxiliary Measures of 
importance are firm pressure on the uterus, compression of the abdominal aorta, the 
plug, and if necessary intra-uterine injections (Wa). Hot Water, uo° to 122° F., 
injected into uterus, extremely successful in checking post-partum hemorrhage 
(Atthill); the most prompt and certain method, and the least unpleasant to the patient 
(Parrish). Ice, to abdomen or within the womb (B); into womb or rectum (R); as a 
prophylactic against hemorrhage and to secure firm contraction of the uterus, a good 
method is to grasp the womb through the abdominal parietes with a hand kept cold by 
frequent immersion in a pan of broken ice, while waiting for the expulsion of the pla- 
centa; while one hand is kept on the uterus the other may be immersed in the ice. 
Transfusion of milk into veins may be necessary in cases of collapse (Thomas). [Com- 
pare Abortion, Metrorrhagia.] 

Hemorrhoids. 

Galls, as ointment, very useful; the official Unguentum Gallas, or Galls combined 
with Lead and Opium (R). Tannic Acid as ointment locally (W). Ferric Subsul- 
phate in solution as wash to bleeding piles, which should then be well oiled (B); as 
ointment gr. xv or xx to the o , locally night and morning, gives excellent results. Ham- 
amelis, by mouth, also as lotion or injection in bleeding piles (R); is employed with 
satisfaction; njuj-x of tincture several times a day; also as enema or suppository (Pf). 
Sulphur, gr. v-x, with 5j Confec. Sennae, as laxative (R); exercises a most soothing 
influence (Wa). Sulphides, especially Blue Lick water (B). Podophyllum, as 
cathartic, for hemorrhoids of recent formation, bleeding from stasis in portal circulation 
(B). Aloes, causes congestion of pelvic viscera, yet Fordyce Barker shows it to be 
curative in piles, especially in recent ones, as after deliver}' (B); to greatly relieve bowels 
(R); cures by removing constipation (P). Hydrastis, as lotion or ointment to external 
piles, of great value; tyy of tincture ter die internally at same time (P). Ergot, with 
or without Nux Vomica, in dilated hemorrhoidal veins without new tissue, given by 
the stomach and used locally will often cure (B). Nux Vomica internally, is decidedly 
beneficial (P). Cocaine locally for inflamed hemorrhoids, is invaluable as a palliative 
(W). Stillingia, will remove permanently when due to constipation, and temporarily 
when from hepatic obstruction (B). Senna, to produce soft and easy evacuations use 
the Confectio Sennas at bedtime, gr. cxx in a bolus (B). Iodoform, the ointment, and 
in suppository (B); gr. v-x in suppository for painful hemorrhoids (W). Ichthyol 
lUjv-xv internally after each meal, seldom fails to relieve the congested capillaries of 
the lower rectum and anus if not too aggravated (Bulkley). Adrenalin Chloride, 
the 1 to 1,000 solution on tampon locally, very effective for irreducible hemorrhoids 
threatening strangulation (Mosse). Nitric Acid, as caustic, followed by free use of 
Olive Oil (B); oss-Bj ad Oss aquas as lotion for bleeding piles (R). Hyoscyamus 
or Stramonium, leaves bruised or ointment, locally for pain (P). Linseed Oil, 
boiled, in doses of oij twice daily, has quite a reputation as a remedy for piles (W). 
Alum, to painful bleeding piles, a crystal trimmed and passed into rectum, or as an 
ointment (B). Ice, to painful, bleeding piles, or cold water injected daily (B); locally 
for pain after operation (R). Leeches, directly to swollen, irreducible, and painful 
piles (B). Alkaline Mineral Waters, excellent (B). Saline Purgatives, especially 
Epsom salts, with Sulphuric Acid, will often stop the bleeding (B). Phenol, 
3 parts to 1 of Olive Oil, a few drops injected into the tumor; a favorite and successful 
treatment by itinerants (Andrews); uncertain in all cases and in many fraught with 
danger (Gross): a good procedure, use 4 drops each of pure Phenol and Glycerin, 
and inject one tumor at a time (Hunt); 1 or 2 drops injected into each tumor once a 
week, treating not more than two tumors at a time, and only internal ones, the method 
is not applicable to external piles (Gay); has a distinct field in selected cases of non- 
inflammatory internal piles, when an anesthetic is contraindicated or when operation 
is refused (Brick); cases so treated are liable to recur in about 4 years (Cook). Diet, 
etc., avoid stimulants, indigestible food and over-eating; during an attack use little 
animal food. Petroleum soap when piles protrude, with cold or tepid water ablutions. 
Injections, Oj of cold or tepid water, are very useful. Stool should be at night. Sur- 



HKI'WU ci \ HEPATIC aRRHOSlS. 






gical Methods, the ligature for internal hemorrhoids, ex< ision forexternal ones. Liga- 
tion, is the proper treatment for internal piles, all other methods oi i ally 
being now discarded as unsurgical and dangerous to life (Gross); t 1 nut b 
superior to excision or cauterization (Ehrich). Clamp and Cautery operation has 
many advantages, and is efficient in the worst ( ases ( Brick); is used by Smith of London 
and many other surgeons, but is apt to leave behind fissures and ulcers, wliiv h arc with 
difficulty healed. Prevention, soft seats favor the production of piles, as also of uti 
disorders, by pressure on the arteries as they emerge from the pelvis, tending to drive 
the blood into the interior of that cavity (Holden). 

I}. Ext. Colocynth Co., gr. xx.\. 

Ext. Nucis Vom. gr. vj. 

Hydr. Chlor. Mitis, 

Ext. Hyoscyami aa gr. xij. 

M. et div. in pil. no. xij. 
Sig. — One pill as required for sluggish 
bowels. (Barker.) 



H. Iodoformi 5j- 

Balsam. Peruv oij. 

Magnesii Oxidi oj- 

Cetacei 5ss. 

01. Thcobromae q. s. 

M. et fiant suppositoria xij. Sig. — One 
daily. (Potter.) 

B- Gallae (pulv.) gr. xx. 

Opii Pulveris, gr. x. 

Ung. Plumbi Subacet., gr. xl. 

Ung. Simplicis oj- 

M. et ft. unguentum. Sig. — Ointment for 
piles. (CEsterlen.) 

IV Phenolis, (Calvert) oij- 

Ac. Salicylici, 5ss. 

Sodii Biborat., 5 j ■ 

Glycerini (steril.).. .q. s. ad 5j. 
M. Sig. — S to io drops by injection into 

the pile. (Shujord.) 



I}. Ext. Opii, gr. x. 

Stramonii, 3j< 

Tabaci oss. 

Ung. Simplicis, 3 ss. 

M. Sig. — Ointment for piles. 

(Shoemaker .) 



R*. Phenolis, oij. 

Ac. Tannici, 3j- 

Alcoholis, 3iv. 

Glycerini, 5 ij . 

M. Hypodermic injection for piles. 

(Girard.) 



Hepatalgia. 

Ammonium Chloride, 20 to 30 grains every 4 hours, is highly efficacious (Anstie). 
Bryonia, worthy of commendation in many liver affections (P). Nux Vomica, has 
been found of much benefit; dose should be small, gr. T ,\;,- to 55 two or three times a 
day (P). Quinine, would naturally be thought of for malarial subjects, but does not 
afford any relief (Anstie). [Compare Calculi, Colic, Hepatitis.] 



Hepatic Cirrhosis. 

Iodides, are the best remedies for the first stage (B); Potassium Iodide is highly 
recommended by some authorities (Da C); the great measures in the treatment of this 
affection are Potassium Iodide, hydrotherapy, and a milk diet (Lancereaux). Stillin- 
gia and Alkaline Mineral Waters, are important in the first stage (B); Alkalies early, 
especially Carlsbad water, with total abstinence from alcoholic beverages (Legg). 
Mercury, Corrosive Sublimate in small doses, gr. f B thrice daily, for a long time, does 
benefit the condition and has possibly cured a few cases (Da C). Nitric Acid in 
chronic liver diseases, as it promotes the flow of bile (R); mineral acids do not benefit 
(B). Nitro-hydrochloric Acid in the early stages while the liver is still enlarged, 
has apparently benefited some cases (W). Mercury and Potassium Iodide, in cases 
having a syphilitic history (Tirard). Arsenic, small doses perseveringly, give good 
results in improving the nutrition of the organ (B). Aurum, the Bromide of Gold and 
Arsenic has been used with benefit (Barclay); the Chloride of Gold and Sodium, in 
doses of gr. -.} lU as an hepatic alterative, may be used conjointly with Sodium Phosphate 
(B). Sodium Phosphate is said to produce good results (Da C); has power to retard 
sclerosis, and may possibly arrest the changes and restore a state of comparatively 
normal function (B); when cirrhosis has been fairly established no drugs can control 
the new growth of fibrous tissue or lead to the formation of fresh glandular tissue (Tirard). 



694 HEPATIC CONGESTION. 

Diuretin has removed the ascites. Theocine is an efficient diuretic for the ascites 
(Meinertz). Tapping becomes necessary for the dropsy, though purgation and diuresis 
may help to lessen it (Da C). Diet, should be of easy digestibility, especially milk, 
avoiding starches and fats and quitting alcohol (Id). [Compare Ascites, Dropsy.] 



Hepatic Congestion. 

Nitric Acid, in chronic congestion, will augment flow of bile after liver has struck 
work from excessive use of mercury (R). Nitro-hydrochloric Acid, is found useful 
in India, with the nitric acid bath, Siij ad gall, j, to hypochondrium (B); formerly 
held high rank but is superseded by Ammonium Chloride; the acid baths being now 
rarely employed (Fayrer); renders most excellent results in habitual congestion of 
the liver (W). Sulphates, in natural purgative waters, small doses often repeated 
(R) ; in the shape of some bitter water or of Carlsbad salts, generally give prompt relief 
(Mn); a good substitute for Carlsbad salts is Sodium Sulphate 2, Sodium Bicarbonate 
1, Sodium Chloride 1 (Id); Potassium Sulphate is occasionally poisonous (R). Cheli- 
donium, as deobstruent (S); energetically affects the liver (Pf). Iodine, tincture 
internally, and ointment locally for hepatic engorgement after malarial attack ; also Am- 
monium Iodide in moderate frequent doses, for functional derangement from malarial 
disease (B). Sodium Phosphate, 5j-ij, 3 or 4 times daily, in plenty of water, as a 
purgative (B); seems to have specific action on the liver and is used with great advan- 
tage in chronic hepatic torpor (W). Ammonium Chloride is an effective remedy 
in chronic torpor and chronic hepatitis (W); in passive congestion, and chronic torpid- 
ity, is well worthy of attention; gr. xx every 4 hours (Wa); an excellent remedy (Da C). 
Turpentine, epithems, hot, often found very beneficial (Wa). Quinine, gr. xv-xx with 
Morphine, gr J-J, in the acute congestion due to climatic or malarial causes, no remedy 
so efficient (B). Bryonia, is worthy of commendation in liver affections of various 
kinds (P). Iris, really serviceable when stools clay-colored and skin jaundiced (B); 
is one of the best aperients in hepatic derangement (P). Mercury, valuable only as 
a purgative; its use restricted to cases where there is deficiency or excess of bile (B); 
a full Calomel purgative is of utility in cases of congestion (Wa). Podophyllum, 
the resin in congestion of the portal circulation, is especially useful (B); gr. £-£ every 
six hours will speedily relieve symptoms (P). Sanguinaria, is useful in hepatic 
engorgement without organic disease (P). Colchicum, in hepatic congestion and 
dropsy; an active remedy in congestion of the liver (B). Resin-bearing Purgatives, 
as Rhubarb, Podophyllum, Iris, Euonymus, are all actively cholagogue. Ipecacu- 
anha, decidedly stimulant to the flow of bile (B); is the Indian treatment now for 
the local liver, given in large doses for a week or two (Da C); Taraxacum, has had a 
reputation, but I cannot recommend it (Id); if of any service at all it is in cases of 
dyspepsia with habitual torpor of the liver and constipation, but must be given very 
freely and continuously for weeks before good is to be looked for (W). Aliment, no 
starches or fats; give milk, eggs, oysters, beef -broth, whitefish, etc. (B); in chronic 
hepatic congestion (tropical liver), alcohol must be forbidden in every' shape, animal 
food used very sparingly, especially beef and mutton, fruit and farinaceous substances 
may be more freely taken, but over-eating in every form must be avoided (Mn) Exer- 
cise should be taken twice daily, and should provoke perspiration (Id). Cold Water 
Belt around the abdomen, covered with oiled silk, gives great comfort in chronic cases 
(Da C). [Compare Biliousness, Jaundice, Hepatitis.] 

1$. Sanguinariae gr. viij. \ 1$. Potass. Bicarb., 

Podophyllini, gr. iij. Potass. Citratis, . , aa oj- 

Ext. Hyoscyami, gr. iij. Syrupi Simplicis, 5 vj. 

Saponis, gr. viij. M. Sig. — A teaspoonful to a tablesp. 

M. et div. in pil. no. xx. i with a similar quantity of lemon-juice, in 

Sig. — 2 to 4 pills daily. In hepatic torpor I \ glass of water; the whole to be drank 

without organic disease. {Phillips.) ' while effervescing. {Wood.) 



HEPATIC DISEASES m PATITIS 695 

Hepatic Diseases. 

Ammonium Chloride is highly serviceable in all cases of liver disease, whether 

duo to organic changes or to functional derangement; especially indicated after the more 
acute symptoms have abated (Wa). Nitro-hydrochloric Acid, formerly held high 
rank, but is superseded by Ammonium Chloride (Wa); even the acid baths, so long COD 
sidered of great importance, are but little, if ever, used in India (1'avrer). Nitric 
Acid acts in some way beneficially on long-standing liver-diseases, as in chronic con- 
gestion and cirrhosis (R); with vegetable bitters, long continued, useful in waxy liver 
\\ a). Podophyllum has a high reputation in a variety of liver diseases (P) ; is actively 
cholagogue (R). Mercury, mercurial purgatives are used for both deficiency and 
excess of bile; harmful in many acute forms of hepatic disease, and generally are of 
doubtful propriety in liver affections (B); in hepatic congestion a full Calomel purge 
is of great benefit (Wa). Red Mercuric Iodide, as ointment, gr. j to ov, gives best 
results in malarial enlargement of the liver (W). Calomel is used in inflammatory 
disorders of the liver, but is less suited to parenchymatous than to serous inflammations 
(Da C). Ipecacuanha promotes the flow of bile (B); may be used in small doses 
with great advantage in functional derangement of the organ (Wa). Resinous Pur- 
gatives, as Leptandra, Iris, Euonymus, Rheum, are decidedly cholagogue (B). Euony- 
min is of great value in torpid liver and its accompanying headache (W). Bryonia 
is worthy of commendation in liver affections of various kinds (P). Chelidonium 
powerfully affects die liver (Pf). Taraxacum is highly recommended in all chronic 
affections of the liver, especially in indolent enlargement and incipient scirrhus (Wat- 
son). Sodium Phosphate is cholagogue, and extremely useful in liver affections, 
especially the jaundice of children and hepatic calculi (Thudicum). Phosphorus 
specifically affects the liver, and used early in acute yellow atrophy may have an action 
of antagonism upon the disease (B). Potassium Salts, as depuratives, are of decided 
value, especially the Citrate, in hepatic torpor and other affections (W). Sulphur, 
the sulphurous mineral waters, prolonged, give excellent results in liver disorders (B). 
Alkaline Waters are very serviceable (B); especially the sulphur waters; Glauber's 
salt in their place (Da C). Chlorine Water has been employed with benefit in chronic 
hepatic affections, in doses of 5ss-ij in oiij or iv of water (W). Iron preparations, 
long continued, in amyloid degeneration (Da C). Gentian, and other bitter tonics, 
in functional disorder; also Nux Vomica occasionally, but use Mercurials and Podo- 
phyllum sparingly (Da C). Iodine and Iodides in waxy enlargement, simple hyper- 
trophy and chronic congestion, of great value (Wa); Potassium Iodide alternately with 
Ferrous Iodide in waxy liver (Frerichs); a few drops injected into hydatids (B). San- 
guinaria is of great value in hysteria from chronic hepatitis, and in hepatic engorge- 
ment without organic disease (P). Stillingia for torpid liver and jaundice following 
ague, in the first stage of cirrhosis, and in ascites from hepatic changes (B). Malt 
Liquors are harmful in all chronic affections, especially in fatty liver (B). Galvano- 
puncture for hydatids, the negative needle into the hydatid (B). [Compare Bilious- 
ness, Calculi, Cancer, Hepatalgia, Hepatic Congestion, Hepatic Cirrhosis, 
Hepatitis, Jaundice.] 

Hepatitis and Hepatic Abscess. 
Ammonium Chloride, is almost a specific in hepatitis and abscess of the liver 
(Stewart); often preventing the latter disorder, and in many instances curing it (Wa); 
20-grain doses thrice daily, are usually prescribed (Mn). Ipecacuanha, in full doses, 
repeated once or twice daily for 2 or 3 days, if dysentery be present (Id). Quinine, 
in large doses for the acute parenchymatous inflammation (Da C); in medium doses 
persistentlv for a long time has done excellent service in chronic suppurative hepatitis 
without abscess, but with frequent exacerbations. Tartar Emetic, gr. J-J, every two 
or three hours, with Opium or Calomel as indicated by symptoms; of especial value 
early in the acute attack (Wa). Mercury is used, but is better suited to serous inflam- 
mations than to parenchymatous ones (W). Chelidonium has been used with benefit 



696 HERNIA — HERPES. 

in both acute and chronic hepatitis (P). Alkalies and Colchicum, when the affection 
is of a gouty nature (Wa). Sulphites are recommended in chronic forms (Da C). 
Sinapisms and Linseed poultices over the hepatic region in acute hepatitis (Wa). 
Saline Purgatives, as the Sulphate of Sodium or Magnesium, to increase the watery 
exudation from the mucous membrane of the intestines, in acute hepatitis (Wa); free 
purging by the Sulphates, massive hot poultices, low diet and rest in bed, the treatment 
for hepatitis which has not proceeded to abscess formation (Mn). Nitro-hydrochloric 
Acid, for some time, in the chronic form tending to abscess (Da C); used with great 
success in the hepatitis of hot climates, especially in the chronic form which normally 
ends in enlargement and induration (W). Leeches to the margin of the anus to unload 
the portal circulation (Wa); in the acute type (B). Incision and evacuation are 
demanded early in tropical abscess to avoid the dangers of spontaneous discharge, 
which leads to prolonged and exhausting suppuration (Tirard). Aspiration when 
pus has formed, has induced many recoveries; early operation the rule of practice 
(Da C). [Compare Jaundice.] 



Hernia. 

Opium, or Morphine hypodermically to narcotism, often obviates the necessity of 
an operation in strangulated hernia (Wa). Chloroform, of evident benefit (Wa); in- 
haled to assist reduction (R) ; has superseded the use of Tobacco and Lobelia in strangu- 
lated hernia (P). Coffee, large doses, has certainly a remarkable influence in aiding 
or causing reduction of strangulated hernia (Wa). Thyroid Extract, causes hernia 
to vanish in a few weeks or months when due to accumulation of myxedematous or 
fatty material in the abdominal cavity, and should be tried in hernial protrusions from 
any part of the abdomen before resorting to surgical means (Parker). Oak Bark 
extract, as injection into the tissues, for a radical cure by stimulating the occlusion of 
the rings (Heaton's radical cure): a similar operation was patented by Dr. Gage in 
1840, the Oil of Cloves being the injection used; Professor Pancoast injected tincture 
of Iodine for the same purpose. Ice Poultice is of use if no strangulation of gut or 
omentum (Wa). Sternutatory, as snuff or Ipecac, to cause sneezing while patient lies 
on his shoulders with elevated hips and legs over the back of a chair, frequently suc- 
cessful after taxis has failed to effect reduction; in this position the action of gravity, 
aided by the sudden action of the diaphragm, tends to draw inward the posterior portion 
of the escaped gut, which is the part most difficult to manage by taxis. Cold Douche, 
with taxis properly performed and the position above described, will reduce 90 per cent, 
of the cases of strangulated hernia within a few minutes (Raiford). Truss, properly 
adjusted, is the best remedy for a reducible hernia, often curing the disease by the 
pressure of its block (Gross). Surgical, Bassini's operation for the radical cure, or 
Halstead's modification thereof, produces very satisfactory results. 



Herpes. 

Ferrum Arsenate, in doses of gr. A daily, will effect the cure of a herpetic affection 
in the adult, however extensive or long established (Duparc). Mercury, Calomel 
ointment, 3j to the B, is one of the best mercurial preparations (Pereira). Potassium 
Carbonate, as lotion, gr. xxx to Oj, to allay irritation (Wa); or as ointment, gr. xx to 
oj, smeared over eruption at night, and washed off in the morning with a solution, gr. 
xxx to Oj (Neligan). Sodium Salicylate in large doses, with Iodine locally, very 
efficient in herpes of the cornea (Gifford). Myrtol, is curative of herpes (B). Gly- 
cerin, diluted, is a serviceable application in herpes labialis (Wa). Ergot, the Oil 
prepared by the action of Benzin upon Ergot, which, upon evaporation of the solvent, 
makes a valuable application in herpes genitalium and other skin affections (Shoe- 
maker). Alum, in herpes praeputialis, a solution of 5j to oj aquae, applied on lint to 
the glans penis, is generally effectual (Wa). Collodion, the flexible form, is applicable 
to various kinds of herpes (Wa). Magnesium Citrate, as a cooling laxative, with 
soothing and protective lotions and ointments, and the Liquor Picis Alkalinus, 



□ RPES ZOSTEB HICCOl CH. fjOl 

diluted io to 20 times, for the itching (Bulkley). Astringent Lotions, oi I'.mmn or 
Zinc Sulphate, in herpes praeputialis, to render the parts less sensitive 1 Da C), Naphthol 
2 per cent, in soap, alternated with a Sulphur soap to avoid absorption of the former, 

- excellent results (. Kaposi). [For Herpes Circinatus see Tinea Ctronata | 

K. Tragacanths, oij-iv. 

Liq. Calcis oiv. 

Glycerini 7> j ■ 

Aquae Rosa 5 iij . 

M. Sig. — Ointment. 



B- Phenolis gtt. v \\ 

Pulv. Calamine Praep., 

Zinci Ozidj U oss-j. 

i 5j. 

M. et ft. unguentum. 



Herpes Zoster. 

Rhus Toxicodendron, very readily subdues, especially when burning or itching (P). 
Aconite and Opium, locally for pain (Wa). Morphine, the oleate externally without 
friction (R); hypodermically to mitigate the pain (Anstie). Celandine has been 
recommended (P). Dulcamara, has an old reputation (P). Silver Nitrate, painted 
on the warning patch of erythema, before or as soon as vesicles begin to form (R); as a 
local application is reported on favorably (Wa). Veratrine, as ointment, gr. x.x-xl to 
the 5, in neuralgia following shingles (R). Zinc Phosphide, gr. J every 3 hours, is 
said to control the pain and abort the eruption (Hughes). Grindelia, is reputed to 
relieve the pain (Stille). Mercury, the Ung. Hydrarg. Ammoniat. is said to relieve the 
pain and irritation remarkably (Wa). Quinine Salicylate relieved the pain and 
proved successfully tonic in a severe case (Moore). Blistering for the subsequent 
neuralgia (R). Hot Fomentations will often disperse (R). Baths daily, exercise 
out of doors, abundant nutritious food. Flexible Collodion, constantly reapplied 
to exclude air (Anstie). Galvanization of the affected intercostal nerves, the positive 
pole over their points of emergence, the negative brushed over the terminal filaments 
of the skin (B). Starch, dusted over the eruption, and on a muslin band sewed tightly 
around the body to protect it from the friction of the clothes, gives the greatest relief 
(Bulkley). Rest, absolute, when eruption is extensive (Fournier). 



B- Zinci Phosphidi, 

Ext. Nucis Vomicae aa gr. x. 

M. et div. in pil. xxx. Sig. — One every 
2 to 4 hours, as a nerve tonic. (Bulkley.) 



B- Liq. Sodas Chiorinat, 5iv. 

Aquas, gij. 

M. Sig. — Wash for ulcerated vesicles fol- 
lowed by a dusting powder. (Fournier.) 



Hiccough. 

Morphine, hypodermically, often arrests hiccough (R); an injection of Morphine 
and Atropine together has stopped a most violent hiccough in which morphine alone 
and other agents had proved unavailing. Apomorphine gr. .. 1 ,, hypodermically, 
stopped a severe case in a man of 76 years, lasting six days (Shannon). Atropine is 
serviceable (W). Duboisine employed in many cases with uniformly good results 
(Rowell). Chloral is the standard remedy (W). Musk has been considered a specific 
(W). Sulphonal has been used with good results (W). Pilocarpine has cured bad 
cases resisting all other means (Ortille). Zinc Valerate, gr. f, with a small portion 
of Ext. Belladonna?, cured a severe case of fifteen days' duration (Danet). Ether, as 
spray to the epigastrium for ten minutes, then to the site of the phrenic in the neck 
(Regoni); or the spirit, njjxx-xxx in some aromatic water, given internally, will often 
arrest the spasm immediately (Wa). Nux Vomica, in 5 or 10 minim doses of the 
tincture, with itjjxv of dilute Nitric Acid; a short course frequently curative (P). Chlo- 
roform, combined with Opium (R). Pepper, gr. ij-x, to stop hiccough (P). Laurel- 
water, a useful remedy, nj>v (P). Camphor, has been recommended (R). Mustard, 
oj infused in 5iv of hot water has cured most obstinate cases (R). Nitroglycerin 
sometimes arrests it (R). Inspiration deep, holding the breath as long as possible, in 
mild cases; or a firm belt around the epigastrium (t). Tongue-traction maintained 
for several minutes, removed hiccough of 4 days' duration (Lepine). 



698 hydrocele — hydrothorax. 



Hydrocele. 

Iodine, injection of the tincture i, water 2, into the sac to excite obliterative inflam- 
mation, the usual procedure for radical cure after tapping the sac (Wa); may be used 
full strength, or with equal part of water; the latter the safest method in ordinary cases, 
but relapses are not infrequent (Gross). Phenol, 3ss, with a minute quantity 
of water or glycerin to render it fluid, injected into sac and manipulated to bring all 
portions under its action, after which rest in bed and support to scrotum (Levis); a very 
efficient method for radical cure, but may cause erosion of vessels and hemorrhage into 
sac (Gross); Truij or iij are just as good as njjxxx, and is by far the best method of radical 
cure, though some few cases will require resection (Coley). Ammonium Chloride, 
as discutient lotion to the scrotum in hydrocele of children (Wa). Galvano-puncture, 
a current of 20 to 40 elements, by two needle electrodes, will invariably cure (B). Oper- 
ations for radical cure include that by iron-wire sutures to excite adhesive inflammation 
(Simpson), and the incision of the hydrocele under antiseptic precautions (Volkman); 
the same end may be obtained by the simpler methods of injection noted above (Gross). 
[Compare Dropsy, Orchitis.] 

Hydrocephalus, Chronic. 

Mercury, holds a high place in the opinion of many; Calomel gr. £-£ twice 
daily, with mercurial inunction to the shaved head, or the latter alone; child to wear a 
woolen cap; this treatment for 30 or 40 days (Wa). Ferrous Iodide, with Cod-liver 
Oil, always gives good results among the poor (Wa). Iodine, as lotions to the scalp, 
or inunction of iodine ointment (Id). Potassium Iodide, may arrest progress (Wa); 
is of value certainly; appears to have power of promoting absorption (W). Cod-liver 
Oil, sometimes improves the condition, especially in scrofulous children (Wa). Aspira- 
tion with the finest needle, in the coronal suture, a few ounces of fluid only to be taken at 
a time ; also firm but gentle compression of the cranium with strips of adhesive plaster 
during the escape of the fluid and afterwards. [Compare Dropsy, Meningitis, tuber- 
culous.] 

Hydrophobia. 

Belladonna, in all hyperemic states of the brain and spinal cord, is one of the very 
best remedies (P). Stramonium, is used in India with apparent success. Nitro- 
glycerin, may be of benefit (Wa). Nicotine, rightly used, will probably prove to be 
our best remedy (B). Amyl Nitrite, should be fairly tried (B). Hydrastinine, is used 
with benefit, in grain doses of the Hydrochloride, hypodermically. Curare, is en- 
couraging, gr. £ injected, 7 doses in 5 J hours, dispelled the symptoms, but replaced 
them by paralysis of the limbs continuing for over 2 months (Ros); has seemed to 
antagonize the convulsive phenomena (B). Morphine, chiefly palliative; for deep 
injection into the tetanized muscles (B). Coniine, is indicated; has not succeeded (B). 
Cauterization, with hot iron or Caustic Potash after cleansing wound, which should 
be kept open by Unguentum Basilicon for 5-6 weeks (Ros); with Silver Nitrate sharp- 
ened to a point, and applied freely to every sinuosity of the wound as preventive (Wa). 
Excision, the safer practice (Wa). Baths, warm and hot, produce calm (Ros). Rabies 
Toxin, the Pasteur inoculation with a modified virus, protects the bitten person from 
the disease. 

Hydrothorax. 

Diuretin, has been employed with benefit. [See under Dropsy.] Digitalis, in 
the purely dropsical form, also in passive pleuritic effusions; used as a diuretic, 3j-ij 
of infusion bis die or oftener, of great value (R). Elaterium, unquestionably of value 
as a derivative, though many fear it (P). Pilocarpus, produces good results (B). 
Iodine, 3j of tincture injected in returning hydrothorax (B). Sanguinaria, has been 
used with the best effects (Wa). Blisters, when effusion has taken place, certainly 



HYPOCHONDRIASIS HYSTERIA. 690 

seem to stimulate the absorbents to action (Wa). Dry Cupping, over the dust, gj 
relief (Da C). Thoracentesis, if much distress. [Compare Dropsy.] 

Hypochondriasis. 

Arsenic, in the aged, gives great comfort, especially when combined with Opium 
(B). Ignatia, is useful, the tincture best (P). Cimicifuga, of singular value in 
puerperal hypochondriasis, and that accompanying spermatorrhea (P). Aurum, the 
Chloride, gr. ; .\, to .,'„ ter die gives excellent results, when depression, vertigo, cerebral 
anemia (B); Gold is an efficient remedy in hypochondriasis accompanying hepatic or 
testicular disease. Valerian, quickly relieves the flatulence of hypochondriacs 
Asafcetida, especially indicated in cases marked by flatulence and gloom (B). Potas- 
sium Bromide, especially among female town-dwellers, but also in male (R); effects 
are variable; relieves some, not others (Wa). Hyoscyamus, when syphiliphobia (P). 
Opium, stimulant doses of the tincture are of great importance (B). Caffeine, the 
Citrate, gr. j-v, has been used as a cerebral stimulant with advantage (B). Alcohol, 
gives temporary relief in hypochondriasis; should never be given for its narcotic or 
stimulant effects in these cases (W). Cocaine, especially useful in cases marked 
by debility and nervousness, and in mental affections accompanied by depression; the 
fluid extract of Coca may be used, either alone or in wine (Br). Turkish Baths, are 
useful for town-dwellers, with soft, flabby tissues and mental depression (R). [Com- 
pare Melancholia.] 

Hysteria. 

Antipyrine, for the painful affections of hysteria. Aurum, the Bromide is of decided 
benefit, in doses of gr. \ to $ (Rosenbach). Arsenic, lessens mobility of the nervous 
system and improves nutrition (B). Opium, gtt. j of Laudanum with gtt. ij of the 
tincture of Nux Vomica, 3 or 4 times a day, for the flushes, weight on the head, depression 
(R); Opium is a useful agent if its identity be concealed from the patient, otherwise the 
opium habit is sure to follow. Apomorphine gr. ./ lT hypodermically, is particularly 
effective in hysteria and hystero-epilepsy (Fancher); is to be recommended in the latter 
form of hysteria (Gowers). Chloroform as an anesthetic, is of high value in hystero- 
epilepsy (Brown-Sequard). Valerian* has great value, 5ss doses of fluidextract (B); 
useful in most cases, especially those of hysterical dyspepsia (P). Zinc Valerate, 
especially at the climacteric age, for hysterical symptoms which can be traced to no 
particular cause (R). Ergot, with Iron and tonics in cases depending on sub-involution 
of the uterus, with indigestion and anemia (B). Nux Vomica, of great use in middle- 
aged subjects, when flatulence, weight on head, flushing and perspirations (R). Atro- 
pine, for hysterical aphonia, gr. T | w to ^ morning and evening (B). Ether, for the 
flatulence, and for the hysterical paroxysm in sudden seizures (B). Ignatia, useful 
in many forms of hysteria, with feeling of suffocation, sensation as of a ball rising to 
the throat, convulsive crying, flatulence (P). Camphor, in hysterical excitement (P). 
Musk, for many anomalous and distressing symptoms (R). Chamomile Oil, in the 
spasmodic and pseudo-neuralgic affections of hysterical women, a very excellent remedy 
(P). Cimicifuga, in hysterical chorea, is rapidly curative (P); for the headache (R). 
Asafcetida, in hysterical convulsive affections, with flatulence and cough (P); arrests 
paroxysm, valuable for flatulence (B); removes headache, peculiar sensations in head, 
and flatulence (R). Ammonia, the aromatic spirit for the acidity and eructations (B); 
the fetid spirit for flatulent colic, may be given with great advantage in doses of 5ss-j 
(Wa). Potassium Bromide, gives control and prevents paroxysms; when verging 
on nymphomania large doses required (R). Iron, a course often useful, especially 
when anemia or uterine obstructions (R). Phosphorus, in hysterical paralysis (R). 
Orchitic Extract, is used with benefit. Cerebrinin, is employed with good results (Paul). 
Ovarian Compression, has in many cases relieved recent hysterical contractions, and 
many other similar phenomena (Bourneville). Electricity, for aphonia, paralysis and 
anesthesia, and to educate the nervous control; is the sworn enemy of hysteria. Ac- 
cessory Measures, occupation of mind and body; removal from influence of friends; 



700 ICHTHYOSIS — IMPETIGO— IMPOTENCE. 

complete abandonment of the use of alcohol; the shower-bath or cold-bath, as an edu- 
cator of the will as well as to invigorate the body; excitement to be avoided. The 
word Hysteria should never be applied to the case in the patient's hearing. Disorders 
of vision are often found at the bottom of hysteria; look for hypermetropia and astig- 
matism. 

1$. Ext. Ergotae, 5j- 

Ferri Sulphatis, oss. ' 1$. Tinct. Asafoetidae, 

Ext. Nucis Vomicae, gr. viij. Tinct. Valerianae Ammon., 

Hydr. Chlor. Corros., gr. ss. Tinct. Castorei, aa 3ij- 

Fiant pil. no. xxx. Sig. — One pill thrice Aquae Camph., 5vij. 

daily. For the indigestion and anemia of M. Sig. — A tablespoonful or two every 

hysterical subjects. (B.) | hour. 



Ichthyosis. 

Zinc, the ointment or glycerite of the Oxide, especially the latter with a little Cam- 
phor added to it, is a most useful application (Wa) ; an ointment of the Sulphate, 5 j to 
oj, found very efficient (Wilson). Sodium Bicarbonate, as ointment, gr. xv-xxx to 
the o, or lotion, 5ij-iij to the pint (Devergie). Copper Sulphate, gr. x ad 5j of 
Unguentum Sambuci, a useful application (Wilson). Ichthyol pure, applied after a 
warm bath thrice weekly, also internally nj>vj gradually increased to ttjjxvj daily, cured 
a very severe case which had resisted other treatment for several years (Klonk). Ulmus, 
in decoction, used internally, has cured the disease (Wa). Cod-liver Oil, applied 
locally with friction, has proved promptly curative. Warm Baths, may generally be 
employed with benefit (R); alkaline and vapor baths, with Sapo Mollis; and inunctions 
of oil or simple ointment to prevent fissuring of the new skin (Duhring); frequent 
alkaline baths, with internal and external use of oily preparations, as Linseed and Cod- 
liver oils, yield the best results (Bulkley). Thyroid Extract, has been given with 
benefit. 

Impetigo. 

■^ Salol, locally, as an antiseptic and deodorant powder. Arsenic, is very useful 
(see under Eczema) ; the Iodide in doses of gr. yjy has been employed with great success; 
or Donovan's Solution, njv-x (Wa). Nitric Acid, internally, frequently benefits (Wa). 
Glycerite of Tannin, an excellent application (B); during the day, with poultices at 
night to remove scabs (R). Quinine, and Mineral Acids, when from imperfect 
digestion (R). Zinc, the ointment of the Oxide, after subsidence of inflammation (R). 
Sulphur, internally, serviceable (R). Calcium Chloride, gr. xv-xxx, daily in some 
vegetable infusion, is well spoken of (Wa). Mercury, Citrine Ointment diluted, 
locally, is an excellent application (Wa); a very weak White Precipitate Ointment 
answers best in impetigo contagiosa, with a little Phenol lotion, i in 20, if it does 
not yield (Bulkley); Calomel to cover the floor of the pustules, after opening, evacuating 
and washing them out (Da C). Laurel-water, relieves the itching (P). Grape-cure, 
has proved excellent (P). Flexible Collodion, or Liquor Guttse-perchae, to cover the 
pustules, if located where they are liable to irritation (Da C). [Compare Eczema.] 



Impotence. 

Phosphorus, no remedy more efficient; the pill of Zinc Phosphide the most con- 
venient form (B); gr. T V thrice daily. Phosphoric Acid, full doses, with gr. ss of 
Pulvis Cantharidis, an effective combination, especially in impotence of old age (B). 
Aurum Chloride, prevents decline of sexual power (B); Gold salts are highly praised 
by several authorities for decline of sexual power in men. Kola, as a general tonic. 
Cantharis, with Iron is beneficial (B); in large doses, gtt. xx-xxx, with Iron and Phos- 
phoric Acid or Nux Vomica (R); of doubtful efficacy (Wa). Cubeb, removes func- 



IM I \\!M \l JON. 

tional trouble (B). Nux Vomica, drop doses of tincture in atonic impotence (B); 
in large doses when spermatorrhea (R). Sanguinaria, has decided aphrod 
ntiee, but is useful only in the functional form (It). Serpentaria, in relaxati 
feeble erections, will often restore power; 5ss closes of tincture twice daily (B). Ergot- 

in, hypodermieally about the dorsal vein of penis, when its enlai . rapid 

emptying is the cause of impotence (B). Cannabis Indica, is a useful remedy; the 
best combination for functional impotence would be one of Cannabis, Nuv Vomica and 
Bigot (B). Yohimbin, a 2 per cent, solution in doses of iTRviij daily, gradually in- 
i to njxvj, is very reliable in neurasthenic impotence (Eulcnberg). Polygonum 
Hydropiperoides, is a useful remedy in the functional form, erections feeble, semen 
watery and testes soft (B). Ferrum Arsenate, acts as a tonic to the organs, and in 
full doses often benefits cases of functional form (B). Damiana, has been brought 
forward as a genital stimulant and a remedy for impotence, but there is probably no 
ground for any confidence in such claims (Stille). [Compare Emissions, Spermat- 
orrhea.! 



B- Quininae Sulph., gr. xxx. 

Strych. Sulph., gr. ss. 

Ext. Ergota;, gr. xv. 



1$. Phosphori, gr- ss. 

Ext. Nueis Yom gr. vj. 

Mas. Ferri Carbonat., gr. xi. 



Mas. Ferri Carb., gr. xlv. Ext. Gentiana.' gr. xxx. 

M. Ft. pil. no. xxx. Sig. — One pill 2 or I M. Ft. pil. no. xxv. Sig. — One pill 2 or 
3 times daily. I 3 times daily. 



Inflammation. 
Aconite is especially indicated in inflammation of the respiratory organs and in 
all inflammatory states of high temperature and sthenic reaction (B); always indicated 
in early stages of simple inflammatory fevers, in all inflammation of serous membranes, 
pneumonia, tonsillitis, acute rheumatism, erysipelas; is especially adapted to the uses 
for which bleeding was formerly employed (P). Veratrum Viride to reduce arterial 
excitement in sthenic cases, a prompt, efficient, and safe remedy (W); when much 
delirium and arterial excitement, useful at beginning only (B); in pneumonia, Vera- 
trine is most valuable, also in acute rheumatism and generally as an antipyretic (P). 
Tartar Emetic in frequent minute doses, gr. T V, renders incontestable service (B); in 
pneumonia, tonsillitis, pleurisy, bronchitis, and other inflammatory affections (R); 
gr. £, frequently repeated, has the power of completely dissipating early local inflamma- 
tions (Spender); quite as useful in arresting local inflammations as Quinine is in malarial 
fever (Lawrie). Pulsatilla, in acute and subacute inflammations with muco-purulent 
discharges, especially of eyes, ears, and nasal passages (P); also with Aconite in epididy- 
mitis (Pf). Mercury, in acute glandular inflammation of throat and neck, in ileo- 
colitis, iritis, syphilitic inflammations of serous membranes, laryngitis (R); clinical 
evidence establishes its antiphlogistic power, particularly in iritis and inflammations of 
serous membranes with tendency to fibrinous exudations (W). Arnica large doses, 
5ss of tinct., in sthenic, small doses, n^x, in asthenic inflammation (B); in inflamma- 
tion of serous membranes it has given good results (P). Belladonna, in many forms 
no remedy more useful, notably scarlet fever, erysipelas, low fevers; for inflammation 
of the eyes, boils, carbuncles, Atropine externally, Belladonna internally; when much 
fever, may be combined with Aconite (B); both locally and internally in inflammation 
of the eye; is effectual in inflammation which threatens to end in abscess (R); in ery- 
sipelas, inflammatory sore throat, encephalitis, gouty and rheumatic inflammation, 
cystitis, pneumonia (P). Gelsemium, especially for inflammation of lungs and pleurae, 
and in pneumonia, njv-x of fluidextr. every two hours (B) ; in acute stage of gonorrhea is 
valuable (P). Bryonia, exceedingly valuable in pleurisy and other serous inflamma- 
tions, especially pericarditis; after the aconite stage (P). Opium, is important in 
most inflammations, but especially those of serous membranes; a full dose, gr. J of 
Morphine, at first, smaller doses after; is especially curative in inflammation of intestines 
and peritoneum, and in cerebro-spinal meningitis and arachnitis (R); affords relief in 
most cases of inflammation by allaying irritation and pain, and in some varieties does 



702 INFLAMMATION. 

much more than this (W). Digitalis internally and locally is useful in inflammations, 
especially those of the joints, of breast, erysipelatous and varicose; a fomentation of a 
teasp. of the dried leaves in half a pint of boiling water, or 5j of tincture to the same 
quantity of water, applied by flannels to the part, will quickly subdue (Fairbank). 
Quinine, in peritonitis (Tr); is indicated in most acute forms, unless objections occur 
(P); has power to arrest inflammation in formative stage; with Morphine and in full 
doses, gr. xv-xx, may suppress many forms (B). Chloral, excellent when temperature 
is high, much delirium; gr. v every 3 hours (B). Salicylates the standard remedy in 
all forms of rheumatism (W) ; that of Sodium in large doses is the most important remedy 
for all non-specific inflammations of the eye-ball, whether rheumatic or not (Gifford). 
Colchicum, in many acute inflammations occurring in gouty subjects (P). Pilocar- 
pus gives good results in the exudation stage of pleuritis, iritis and keratitis (B). Sul- 
phides, especially that of Calcium, gr. ^-, u appear often to arrest suppuration; after 
formation of pus they hasten maturation and circumscribe inflammation; in boils, 
abscesses, and deep-seated suppuration, they improve the condition and promote heal- 
ing (R). Ichthyol internally, as an aid to absorption in deep-seated inflammations 
(Slevin); locally a valuable antiphlogistic and analgesic, especially suited to cases of 
inflammatory enlargement and pain (W). Antipyrine and other antipyretics, for the 
fever (see under the title Fever). Saline Purgatives are useful as part of the denutri- 
tion treatment of inflammation, also to lower arterial tension (B). Alkalies, especially 
Ammonium and Potassium salts, in the stage of exudation (B). Phenol, in a 2 
per cent, solution by parenchymatous injection, to combat deep-seated inflammations 
(Hueter); in chronic synovitis, glandular inflammations, phlegmons etc. (Id); the 
method is both safe and effective (W). Cocaine locally in commencing inflammation 
of mucous membranes, to constrict the blood-vessels (R). Astringents, locally in 
inflammations of mucous membranes (R). Lead, the Liquor Plumbi Subacetatis 
Dilutus as a soothing and astringent application to inflamed and erysipelatous surfaces 
(Wa); to eczema and other inflammatory diseases of the skin (Pf); the official dilute 
solution is too weak to be of value, better is the strong solution Bj-iv to a pint of water 
(W). Silver Nitrate, locally in strong solution, gr. clx to oj of distilled water, painted 
over surface and beyond, after thorough cleansing and drying; no agent so safe, power- 
ful or efficacious in subduing external inflammation (Higginbotham) ; a strong solution 
in Nitrous Ether is a most efficient application to check inflammation in superficial 
parts, as boils, felons, orchitis, synovitis, erysipelas, erythema, eczema (B). Iodine, 
as liniment in vicinity of local inflammation to produce vesication (R). Blisters are 
especially useful in inflammation of serous membranes, and are often serviceable in 
parenchymatous inflammations, also in those of joints and nerves (W). Cold, by Ice 
in bags, or cold water, a very useful agent. Ice, in small pieces in a bladder, applied 
to inflamed part (R). Water, cold and hot baths and packing very useful in all inflam- 
mations (B). Alcohol, is constantly prescribed, and is of value in low states, if symp- 
toms after its administration are ameliorated (B). [See under Fever.] Poultices, 
useful in many inflammatory states, but often abused (B) ; to check formation of pus and 
assist in maturation (R). Glycerin, as in the official Cataplasm of Kaolin, a very 
efficient application in many forms of inflammation. Heat, by hot water, fomenta- 
tions, etc., often much better than cold applications. Dry Heat, applied by the Taller- 
man apparatus, of great value in tendinous inflammations, traumatic synovitis, sub- 
acute rheumatism (W). Venesection, when the pulse is hard, strong, full and frequent, 
a plethoric state of the system and great intensity of morbid action; if required, the 
earlier it is done the better (Gross); Leeches very useful in many forms where sthenic 
reaction and plethora; value of bloodletting probably due to derivative and counter- 
irritant effects (B); a remedy of great power for good or evil, now much neglected 
(Wa); local bleeding by leeches, cups, scarification, etc., should generally be precede( 
by some form of general depletion (Gross). Aliment, when no inflammation of the 
digestive tract use milk and beef-tea alternately every 3 hours; no starches or fats; 
in intestinal inflammation milk, eggs, animal broths, oysters, fish, but all food must be 
used with great caution; skim-milk treatment (B); Cod -liver oil in many chronic 
inflammations, as of heart, lungs, kidneys, etc. (R). [Compare the various titles, as 
Bronchitis, Pleuritis, etc.] 



IMM 1 \/A. 703 



Influenza. 
Menthol, dissolved in Chloroform, as inhalation, to abort an attack of influenza; 

Was a spray, in 5 to 10 per cent, solution; is highly efficient as a prophylactic (W'uns, he). 
Quinine, the Hydrochloride, gr. viij daily as prophylactic, has specifi* action, 
by experience with hussars at Bonn during the epidemic of 1889 90 (Graeser); the Hj 
drobromide in S to 16 grain doses, if the fever is high (Hue hard); Quinine is used with 
benefit throughout the disease, and especially for the neuralgic pains following the acute 
stage (Wa). Cocaine, a 4 percent, solution snuffed up the nostrils or sprayed into them, 
ry efficient in the early stage (R). Eucalyptus, the Oil, sprinkled on blotting- 
paper placed around a large room, was considered an efficient prophylactic during tin- 
London epidemic of 1891, and was much used in offices, shops, etc. Salol, and Sali- 
pyrin, as internal remedies, were highly extolled during the epidemic of i8ot. Acet- 
phenetidin, is used with benefit, both as a prophylactic and a remedy. Phenocoll, 
the Hydrochloride has been used with marked success in epidemic influenza and for 
the neuralgic pains thereof. Acetanilide, 2, with Salicylic Acid and Ammonium Bro- 
mide, each one part, forming the mixture called Antinervin, was used with much success 
during the epidemic in Scotland. Cinnamon is a valuable remedy, if used early the 
patient will return to his usual avocations within 3 or 4 days (Ross). Potassium 
Bicarbonate, is more nearly specific than any other remedy; gr. xxx with nuxx of 
Glycerin and Liquor Ammonii Acetatis oss, every three hours; it prevents complica- 
tions when given in time and also prevents sequelae (Calvert). Sodium Salicylate in 
doses of gr. v every half hour for six or eight doses, then every hour until all pain has 
vanished, then every two hours for a day or two, is very efficient (Parker). Ammonium 
Salicylate, is even better than the sodium salt; add Liquor Ammoniac Fort., 5j to 
Ac. Salicylic, gr. Lxxx, to make an 8 ounce mixture for tablespoonful doses (Id). Salo- 
quinine has proved a valuable remedy. Ichthyol, its fumes inhaled from hot water 
are very beneficial (Unna); promptly alleviates the symptoms and abates the cough 
(Lorenz). Alstonia Constricta, the tincture is useful after the most acute stage has 
passed (Sharp). Strychnine, for the underlying weakness and depression, the real 
enemy to fight against in the grippe, Strychnine is the best remedy we have (Huchard). 
Digitalin, crystallized, in dose of gr. n'o, in grippal pneumonia, in which, though the 
disease is in the lungs, the danger is to the heart (Id). Sodium Benzoate, with Qui- 
nine and Caffeine (formula below) in the simple form of grippe (Id). Ammonium, 
the Liquor Ammonii Acetatis, combined with Nitric or Chloric Ether, is often of great 
service (Wa). Sanguinaria, is used with much benefit (Wa). Cimicifuga has been 
given with much success (R). Camphor, in solution, hypodermically (formula below), 
2 to 4 times daily, with 3 to 6 of Caffeine and 2 or 3 of Ether, for grippal pneumonia 
(Huchard). Camphoric Acid, in one dose of gr. xx-xxx, dry on the tongue, not over 
2 hours before the expected time for sweating, is remarkably efficient to prevent it. 
Agaricic Acid, gr. T?~h by mouth, is efficient against the sweating of influenza. Bis- 
muth Salicylate, or Naphthol, Betol, Salol, or Benzo-naphthol, as intestinal antiseptics, 
when such are required (Huchard). Sulphurous Acid, by fumigation or inhalation, 
a few drops on boiling water, or as a spray, often controls influenza (R). Benzol 
vapor, is a reliable pulmonary antiseptic, and has been employed with very favorable 
results (Robertson). Benzoin, the compound tincture, 5ss-j, inhaled from a pint of 
hot water frequently (Da C). Tartar Emetic has been recommended strongly, but 
is too depressant (Wa); has extraordinary power of aborting inflammations oi the 
respiratory apparatus (Spender). Nitrous Ether, the spirit in doses of 5j-jss, in 
any convenient vehicle, is a popular and efficacious remedy (Wa). Cubeb, 5ss or ~>\ 
doses of the tincture in § glass of Linseed-tea thrice daily, for the subsequent cough, 
often curing like a charm (R). Opium, best avoided in early stage, but later for the 
cough, with Ipecac, gives great ease (Wa); Heroin or Dionin may be used for catarrhal 
symptoms and cough. Citrophen is employed with benefit (Kornfeld). Potassium 
Nitrate, largely diluted as lemonade, 3 j — i j in the course of the day, proves highly- 
useful (Wa). Boric Acid, as gargle, also borated ointment or vaselin to the nasal 
cavities, and great care taken to maintain a clean mouth; antisepsis of the nose, mouth 



704 INSANITY AND DEMENTIA — INSOLATION. 

and pharynx is very important and does much to prevent complications and perhaps 
broncho-pneumonia (Plicque). Coca and Kola, the tinctures, a mixture of equal 
parts of each, for the nervous depression (Id). Hot Fomentations, for the headache 
(R). Turkish Baths, have been used with marked advantage (Wa). 



R. Quininae Hydrobromidi, 
Sodii Benzoat., 

Caffeinse, aa gr. xxx. 

M. et ft. pil. no. xxx. 

Sig. — One pill thrice daily. (Huchard.) 



JJ. Camphors, 3 ijss. 

Ol. Olivae (steriliz.), 5"j. 

M. Sig. — 5ss hypodermically twice or 
thrice daily, for grippal pneumonia. 

(Huchard.) 



Insanity and Dementia. 

Hyoscine, has strong power as a mental alterative; is particularly useful in that 
form of mental disturbance which renders the patient violent and abusive, restless and 
domineering, a nuisance to every one who has anything to do with him (Weatherlv). 
Duboisine, gr. T ^j to J- s hypodermically twice daily, is highly efficient in the treat- 
ment of the mental excitability of the insane, inducing quiet and refreshing sleep, and 
is not dangerous (Massant). Atropine, produced a permanent cure after bromides 
failed, in a case of periodic insanity with delusions of persecution (Hitzig). Opium, 
especially Morphine, is injurious in mania, but is useful in melancholia and for climac- 
teric and senile cases. Chloral, does as much harm as good, is best suited to wildly man- 
iacal and erotic patients. Chloretone is a safe and efficient hypnotic for the insane 
(Wade). Potassium Bromide, is almost discarded, except for epileptic cases. Co- 
nium, is useful, sparingly, for noisy patients. Colchicum, for gouty cases, which are 
numerous; cure the gout, and you may cure the insanity. Shower-bath, suitable for 
cases due to self-abuse; the wet pack in the mania of hystero-epilepsy. Stimulants 
rank high, next to quiet and absence from home. Thyroid Extract, is a powerful 
alterative and of great service in the treatment of insanity (Elliott); especially in that 
of the adolescent, climacteric and puerperal periods (Bruce). Splenic Extract is use- 
ful in cases of insanity dependent on physical exhaustion (Clark). Tonics and Hyp- 
notics, should be employed in cases requiring them. Food of good quality is essential 
to the treatment. Kumyss, is an excellent food in hysterical dyspepsia and anorexia 
simulating that of insanity. Moral Treatment, is now successfully carried out in 
many asylums, but is expensive, requiring a large staff of trained attendants. With 
correct management from the start, nearly all cases of insanity unattended by paralysis 
or physical decay may be cured (Savage); this can be best administered in a well-con- 
ducted asylum or hospital for the insane, where security and the prospect of recovery 
will be better than in the best home; the total abolition of any one plan of treatment 
in favor of another would be a great mistake; more than half of first attacks of insanity 
are recovered from under good management, which is best attained under the direction 
of persons trained in this specialty (H). Recently, efforts have been made at the im- 
provement of the condition of the insane by requiring them to attend school daily, 
with remarkably good results. [Compare Delirium, Hypochondriasis, Mania, 
Melancholia.] 



Insolation. 

Quinine, in all fulminating fevers, including siriasis, occurring in warm climates, 
if malaria be suspected and especially if its plasmodium is discovered in the blood; 
gr. vij of the Hydrochloride hypodermically at once and repeated 3 or 4 times at inter- 
vals of 4 hours (Mn). Morphine to control the convulsions (Bevan). Chloroform, 
by inhalation cautiously, for the convulsions (Mn). Strychnine, must be avoided in 
heat-stroke, there being a tendency to convulsions in this affection (Chandler). Digi- 
talis, lrjyd of the tincture hypodermically as soon as possible in siriasis, preceded by a 
small bleeding in plethoric cases showing high arterial tension (Chandler). Veratrum 
Viride, also Gelsemium, as sedatives in sunstroke, when the pulse is full and strong 



tNSOMNIA. 7 os 

I. Bromides, for restlessness and insomnia (Mn); courses of the Bromides and 
iodides, with repeated blistering of the neck and scalp, also careful dieting and general 
bygiene, for persistent headache and other signs of chronic meningitis (Id nun 

•rale in cold water, by enema in sunstroke. Antipyrine and other antipyretic 
drugs are to be avoided in all serious cases of siriasis, as they are dangerous by their 
depressant action on the heart (Id). Alcohol in every form, must be stri( fly forbidden 
in any case of heat-stroke in which the cerebral symptoms suggest meningeal congestion 
or inflammation (Id). Stimulation is indicated in the syncopal form, gt died 

"heat-exhaustion"; Ammonia held to the nostrils and a stimulant given by the mouth 
or rectum or hypodermically (Id); external Stimulation in asphyxia] cases to the pre 
cordium by mustard, also to the feet by hot bottles, and hypodermics of nitro glycerin, 
atropine, brandy, camphor or ether (Anders). Cold by ice-bag applied to the shaven' 

p for a time in heat-stroke, the bowels kept free, trie food light and non-stimulant 
(Mn); Ice packed around the head and body, iced water dripped on the body from 
an elevation of 5 to 10 feet for 30 or 40 minutes, a fine iced spray on the forehead for 
only t or 2 minutes; a thermometer in the rectum and the cold application to be discon- 
tinued in hyperpyrexial cases when the rectal temperature reaches 104" F., and in cases 
of simple thermic fever when it has fallen to 102 F., as dangerous collapse may ensue 
from a longer application; then wrap the patient in a blanket and apply hot bottles 
to the limbs and trunk (Chandler). Artificial Respiration, when the breathing 
threatens to become suspended, has given marvellous results in some cases (Id). Cli- 
mate should be changed; as soon as the subject of heat-stroke is able to be moved he 
should go to a cold climate and should not return to the tropics while the slightest evi- 
dence of cerebral trouble remains (Mn). [Compare Cerebral Congestion, Menin- 
gitis CEREBRAL.] 



Insomnia. 

Hydrated Chloral, is quite unrivaled, being the most direct and generally useful 
hypnotic (B); acts best in cases of purely nervous type (Wa); in doses of 20 to 30 
grains is by far the best hypnotic for many forms of insomnia (R); is dangerous in old 
drunkards, in whom the heart and vascular system have undergone fatty and calcareous 
degeneration (B); in combination with Opium or Morphine it acts splendidly in small 
dose, each ingredient intensifying the hypnotic action of the other (Brodnax); children 
bear it well, especially when given with Paregoric. Chloralformamide, 30 grains in 
5j of whiskey in simple or idiopathic insomnia, or that from nervousness, hysteria, 
chronic alcoholism, but not when due to excitement or severe pain. Croton-chloral, 
is feebler than Chloral and less toxic; as a hypnotic 5j may be given (R). Dormiol is 
a mixture of chloral and amylene, and acts well. Somnal is a combination of chloral, 
urethane and alcohol, and is very efficient in the insomnia of convalescence from acute 
disease (Myers). Chloralose is more prompt than chloral, and equally efficient in 
smaller dosage (Tyson). Chloretone is a safe and efficient hypnotic for the insane 
I Wade). Paraldehyde in doses of oj-ij, is one of the most efficient and safe hypnotics, 
being free from depressant action on the heart and other unpleasant by-effects. Sul- 
phonal, 15 to 30 grains in milk, 2 hours before effect is desired; an admirable hypnotic 
in many cases, but its efficacy decreases with use, and it is of no value in insomnia due 
to pain. Trional, is markedly hypnotic and sedative, acts surely and promptly in the 
insomnia of neurasthenia and organic brain affections; is better than Sulphonal or 
Chloral in many respects (Schultze). A mixture of Sulphonal and Trional, gr. x-xv 
of each, is an admirable hypnotic, the latter producing early sleep and the former later 
sleep. Tetronal, is somewhat less hypnotic than Trional, but more of a sedative; 
the sleep from either lasts 6 to 8 hours, and is generally dreamless; neither is of any 
use when insomnia is due to pain. Veronal gr. viij-xv, is efficient, safe, and devoid 
of by-effects (Fischer); gr. x with gr. v of Trional is very effective (B). Potassium 
Bromide for insomnia due to cerebral overaction (B); it increases the hypnotic effect 
of belladonna, hyoscyamus, cannabis, ether and chloroform (R). Bromipin gives 
good results in nervous insomnia (Frieser). Opium, 15 to 20 minims of the tincture, 
46 



706 INTERMITTENT FEVER. 

or i to J grain of Morphine, the most effective hypnotic when insomnia is due to pain; 
in combination with Chloral (see above) smaller doses of each are efficient. Opiates 
should rje given so as to act at the natural time for sleeping (R). Codeine and Nar- 
ceine are hypnotic in proper doses. Apomorphine, gr. ^V hypodermically is the aver- 
age hypnotic dose, should be given when the patient is ready for bed; its action lasts 
from one to two hours, but it often starts the patient to a good night's sleep (Douglas) ; 
is very efficient for the insomnia of acute alcoholism (Shannon). Hyoscyamus, an 
effective substitute for Opium in children, 3ij-oj of tinct. necessary, and without 
danger (B); when Opium disagrees (R). Hyoscine, produces sleep after a brief 
period of excitement; gr. ^^ of the hydrobromide hypodermically is excellent for the 
insomnia of the insane. Duboisine, is even more calmative and hypnotic than Hyos- 
cine, and is especially useful when high mental excitement exists; gr. T J ff to ^a or J g 
hypodermically, may be combined with gr. £ to \ of Morphine. Belladonna or Atropine, 
is hypnotic in some conditions, especially when prostration, low arterial tension and 
contracted pupils. Ignatia, for sleeplessness from nervous erethism, better than 
Morphine (Pf). Gelsemium, in simple wakefulness (B); and in that of drunkards, 
mania and over-excitement (R). Coffee, insomnia from lowering of nervous power, 
and from chronic alcoholism (P). Sumbul, 30 to 40 minims of the tincture, with a little 
Chloric Ether, is very efficient in the insomnia of chronic alcoholism (P). Tartar 
Emetic, with Opium, is effective when insomnia is due to cerebral congestion and when 
Opium stimulates (B). Hypnal is credited with simultaneous hypnotic and analgesic 
action. Methylal is an efficient hypnotic. Hypnone is of moderate hypnotic power, 
but is said to be especially useful in the insomnia of acute alcoholism. Hedonal has 
greater hypnotic value than either sulphonal or trional, its effect is not as long continued 
as that of chloral or paraldehyde, but it is safer than any of these agents (Hills); is 
generally considered to be a feeble hypnotic. Ethyl Carbamate is a mild and safe 
hypnotic, especially useful for children. Isopral gr. viij-x, is prompt and efficient, 
and safer than chloral (Impens) . Pellotine is hypnotic in doses of gr. f hypodermically 
(Jolly); gr. i r of the Hydrochloride produced dangerous collapse in one case (Langstein). 
Digitalis, is of great use as a soporific in sleeplessness at night with drowsiness during 
the day, both symptoms depending on want of tone in the vessels (Br). Resorcinol, 
produces quiet sleep in general nervous excitability, and in the insomnia of typhus 
and pulmonary tuberculosis. Ether or Chloroform, in full dose (R); may be used 
by inhalation when other means of producing sleep have proved unsuccessful. Phos- 
phorus, when nutrition is inactive, and in the insomnia of the aged (B). Humulus, 
a hop-pillow is said to be effective in many cases (P); the tincture of Lupulin, 3ss-3ss, 
as a cerebral sedative. Myristica, the pulp of the nutmeg in large dose is a powerful, 
prolonged and safe hypnotic (Famsworth). Chamomilla, nj>j of the tinct. every 
quarter-hour, an excellent sedative for children (Smith). Cannabin Tannate, in 
8-grain doses, a good hypnotic (Fronmiiller) ; very inefficient (W). Cannabis is very 
uncertain in its action (R). Alcohol, if from cerebral anemia, a full dose of whiskey 
or brandy; in some a glass of ale or beer answers better (B). Water, a tepid bath 
just before retiring often effective; when head is hot apply cold to it, and a tepid bath 
to the body (B). [Compare Nervousness.] 



R. Paraldehydi, 3ijss. 

Alcoholis (99 per cent.), ojss. 

Tinct. Vanillae, 3ss. 

Aquae, gj- 

Syr. Simplicis, q. s. ad giv. 

M. Sig. — A teasp. or two every hour until 
sleep is obtained. 



(Yvon's Hypnotic Elixir.) ' teria. 



Intermittent Fever. 



R. Potassii Bromidi, 3iv. 

Chlorali Hydrati, oiij. 

Tinct. Asafoetidae, 3iv. 

Syrupi, 3 vj. 

Aquae, q. s. ad 5 vj. 

M. Sig. — Tablesp. every 2 hours until 
sleep is induced. In the insomnia of hys- 



Quinine, as prophylactic, gr. v-x each morning in black coffee; begin with gr. v, 
add gr. j each week (R) ; in ordinary intermittents give 6 or 10 grain doses up to 20 or 



i\ rrwMi ill a r FEVER. 



707 



30 grains, so as to have ii all in 4 or 5 hours before the expected paroxysm; give the 
Sulphate and in solution to get its full action (Da C); a fever lit, once begun, cannol 
. ut short by quinine, and to give it during the early stages aggravates the headache and 
general distress; gr. x, preferably in solution, should be administered at the commence 
rnent of sweating, and thereafter gr. v every 6 or 8 hours for the next a or 3 days (Mn). 
Chinoidine may be used as a substitute for Quinine in doses twice as large (B). Cin- 
chonine, Cinchonidine, Quinidine, the Sulphates of these alkaloids are scarcely, if 
at all, inferior to Quinine as therapeutical agents (Report of the Madras Commission). 
Cinchonidine Salicylate, promises well as an antiperiodic (B). Euchinin is fully as 
efficient as quinine, gr. viij daily as a prophylactic used successfully among the laborers 
on the Pontine marshes (Celli). Saloquinine does excellent service in doses one-half 
larger than those of quinine (Fitch). Aristochin is fully as effective as quinine, and is 
well tolerated by the stomach (Allaria). Arsenic is the best remedy next to quinine, 
and especially useful in chronic agues of quartan type (R); useful as adjunct to quinine 
daily to prevent relapse; with Iron, most important in chronic ague; also as prophy- 
lactic small doses of Fowler's solution (B). Hydrastin, stands next after Arsenic; 
indications same as for quinine (B); in doses of gr. ij-ix is strongly recommended (P). 
Opium or Morphine not only lessens the chill, but aids the action of the antiperiodic; 
is to be strongly urged (Da C); is useful in the pernicious variety in combination with 
quinine (B). Narcotine, gr. ij-v ter die, is eminently antiperiodic; no other drug, 
except quinine, cures intermittents so rapidly and surely, or with more freedom from 
disagreeable effects (Wa); said to be superior to quinine (R). Capsicum, the resins 
of black and red pepper, as adjuvants chiefly (B) ; promotes action of quinine (Pf). Nux 
Vomica, has been used with success, but is now used as adjunct to quinine (B); good in 
convalescence (P); has antiperiodic value not inferior to that of quinine; gr. T ' n of 
Strychnine equals gr. j of Quinine Sulphate (Wa). Strychnine Arsenite, is an effi- 
cient remedy in cases which are rebellious to the action of quinine. Methylene Blue 
is not as efficient as quinine (Moore); is an efficient antiperiodic, and has many advan- 
tages, especially for very young children (Ferreira). Sodium Chloride, in large doses 
during the apyrexia, 3viij-xij, may occasionally prove efficacious (Wa). Eucalyptus, 
during convalescence (B) ; has been successfully used in treatment of ague, 5 j-ij of a 
tincture (Wa). Phenol, in 4-grain doses, cured a series of 8 cases which had long 
resisted quinine (Wa) ; its value established ; ltjjss-ij in mint-water or gr. J in njjxx of 
water, hypodermically (Tessier); combined with Iodine is of great value (B). Mer- 
cury, uncalled for in ordinary cases; but Hydrarg. cum Creta, Quinine and Rhubarb 
are of service in the obstinate intermittents of children in tropical regions (Wa). Tannic 
Acid, enjoys a certain reputation in malarial fevers which have resisted quinine, and 
especially in hemoglobinuric fever (M). Pilocarpine, gr. J of the Hydrochloride, in 
the cold stage, is strongly recommended by high authority to excite profuse perspira- 
tion and thus lessen the attack (Da C). Apiol, when prejudice exists against quinine; 
gtt. xv during an hour, in divided doses, 4 hours before paroxysm (B); is one of the 
minor remedies which often prove successful in mild cases (Wa). Salicin, as substitute 
for quinine, but inferior (B); grs. x-xl, in mild cases (P). Chloroform 3j-ij of the 
spirit internally before the chill, to prevent an impending attack, or by inhalation (B); 
will usually abort it (W). Ammonium Picrate, has proved wonderfully effective in 
India, where 10,000 cases were treated therewith (Clark). Lemon, in decoction, 
exceedingly efficient in preventing recurrence of the paroxysms after they have been 
broken up by the use of quinine (Crudeli). Emetics, may cure many cases; one 
each morning will assist the action of quinine; Ipecacuanha preferred (R); only at 
commencement, inadmissible if gastric irritation (Wa). Antimony, at the onset and 
continuously in mild, uncomplicated cases; Tartar Emetic, gr. $— & every 2 hours, has 
been followed by complete cures (Moore). Warburg's Tincture, is a remedy of great 
power, but produces such severe diaphoresis as to be dangerous to adynamic subjects 
I Maclean). Purgatives, in the intermission, before using the antiperiodic, is good 
practice; Podophyllum, Colocynth or Jalap (Da C). Iron, is valuable in chronic 
cases; the system should be thoroughly saturated with it (Da' C). Ergot, for the 
enlarged spleen (Da C). [Compare Hemoglobinuric Fever, Malaria.] 



708 



INTERTRIGO — INTUSSUSCEPTION. 



1$. Quininae Sulphatis, gr. lxxx. 

Ac. Sulphurici Diluti, q. s. 

Spt. Athens Nitrosi, 5iv. 

Syr. Tolu, Aquae, .. .q. s. ad 5ij- 
M. Sig. — A teasp. contains gr. v. of Quin. 
Sulph. (Da Costa.) 

R<. Phenolis, 3j- 

Tinct. Iodi Comp., 5iij- 

M. Sig. — 4 drops every 4 hours in suffi- 
cient water. (B.) 

1$. Quininae Sulphatis, gr. xl. 

Ferri Sulph. Exsiccat., .... gr. xx. 

Arseni Trioxidi, gr. j. 

M. Ft. pil. no. xx. Sig. — One pill thrice 
daily. (B.) 



1$. Quininae Sulphatis, 

Pulv. Acaciae, aa 3ss. 

Syr. Zingiberis, 3 iv. 

M. Sig. — A teasp. contains one grain of 
Quin. Sulph. A good formula for children, 
the quinine being suspended, not dissolved. 

1$. Massae Ferri Carb 3 j- 

Arseni Trioxidi, gr. j. 

M. Ft. pil. no. xx. Sig. — One pill thrice 
daily in chronic ague. (B.) 

1$. Quininae Sulphatis, gr. xxx. 

Capsici, gr. xv. 

Opii Pulveris gr. iij. 

M. Ft. pil. no. xx. Sig. — One to five 
pills as required. (Pifiard.) 



Intertrigo. 

Acetanilid and Boric Acid, equal parts, dusted thickly over the surface, in the 
intertrigo of infants or adults, separating the surfaces which rub by absorbent cotton 
(Brodnax). Bismuth, the Nitrate or Carbonate, as dusting powder (R). Tannin, 
the glycerite, is excellent (P). Camphor, added to dusting powders, to allay heat and 
itching (R). Lime-water, to obviate results of irritating urine (R). Soap, with free 
ablution when intertrigo caused by acid secretions; use greasy applications afterwards 
(R). Boracic Acid, as ointment, 3jss to 5 j of vaselin, a very useful application (Wa). 
Ichthyol by inunction, is of great value in excoriations of children (Lorenz). Picric 
Acid in saturated solution locally, greatly benefits some cases (Milward). Zinc Stear- 
ate makes an excellent dusting powder for abraded or inflamed surfaces. Calomel, 
as ointment, 3j to Bj, is especially useful (Wa). Zinc Carbonate, as Calamine, 
a good dusting powder; so also is the Oxide, or Fuller's Earth. [Compare Erythema.] 



Intestinal Obstruction. 

Opium, ^-grain doses every 4 hours, for 2 to 4 days, arrests dangerous symptoms, 
and brings a painless purgation (Brinton, P). Morphine, is the best drug in paralytic 
obstruction (Greble). Atropine cured a case of paralytic obstruction (Aronheim); 
also one due to gall-stone (Pritchard) ; its use is a grievous mistake in cases of mechani- 
cal obstruction (Greble). Belladonna, often successfully employed (P); gr. £-$■ even- 
few hours, when from want of tone and partial spasm (Tr). Strychnine, occasionally 
beneficial; cautiously in acute cases (Wa). Mercury, a full dose of Calomel, followed 
in a few hours by Castor Oil and a Turpentine enema, affords relief (Wa). Caffeine 
acts upon the muscular tissue and often proves of the utmost value (Wa). Senna, 
the infusion, in doses of 5j-iij, is an efficient purgative (Wa). Purgation to be re- 
frained from (Brinton); is of no service and may be dangerous when the obstruction 
is due to malignant disease (Tirard). Olive Oil oiij-iv by rectal injection, followed 
after 12 hours by a copious enema of warm water and soap, in cases due to fecal impac- 
tion (Id). Surgical interference the only reasonable method in all cases other than 
paralytic, when enemata, olive oil, and other simple measures have failed (Greble). 
Diagnosis of the cause is frequently obscure, and measures for relief are largely surgi- 
cal (Tirard). [Compare Appendicitis, Constipation, Intussusception, Hernia.] 



Intussusception. 
Belladonna, gr. ivof the extract in enema, has been successfully used (Wa). Opium, 
in full doses carried to narcotism, has been successful in many cases (Wa); must be 
used freely to prevent inflammation (Macleod). Effervescent Enemata, have been 



IRITIS IRRITABILITY. 709 

employed with success (B). Tobacco Enema, may overcome, and has prove. I ex 
ceedingly effective, but is dangerous; produces most depressing nausea; not 
use more than 5iv of an infusion o\ , ~> j in Oj (B). Inflation, of intestines with air 
(Hippocrates), seems a most reasonable mechanical remedy, bul is not recommended, 
as a [xirtion of the intestine may remain unreduced, and the trouble may return (Tirard I, 
Irrigation, by hydrostatic pressure, is resorted to with success; requires car 
gentleness (B); hot water (Wa); Ox-gall, gr. x-xxx in the solution used, is especially 
efficient in cases arising from partial paresis of the bowels (Hawkins); is preferable to 
inflation (Tirard); the knee-chest position is the best posture during either irrigation 
or inflation. Treatment is chiefly surgical. [Compare Appendicitis, Hernia, In 
testinal Obstruction, Typhlitis.] 



Iritis. 
Belladonna, locally and internally (R); njjv every 3 hours, also as lotion, 3j of 
extract to 5iv aquae, is of great value (P). Atropine, solution, gr. iv to the 5, has a 
w.de field of utility as mydriatic (B); should never be omitted (C); is essential in the 
treatment of every form, should be applied early in the case and persevered in through- 
out its continuance (Lawson). Duboisine, as substitute for Atropine, is more rapid 
for effecting dilatation, less irritating to the conjunctiva, and has less permanent after- 
effects (B). Dionin in 5 per cent, solution by instillation, gives remarkable results 
(Reber). Sodium Salicylate in large doses, the most efficient remedy in non-specific 
iritis (Gifford). Mercury, when of syphilitic origin, as it usually is (B); the Bichloride 
is of great service (R) ; in plastic iritis of original severity, or in cases aggravated by 
improper treatment, Mercury is imperative, gr. ij of Blue Pill twice a day, until blue line 
appears on gums (C). Aurum, the Bromide of Gold, Arsenic and Mercury has been 
administered with evident advantage (E. A. Wood). Turpentine, in so-called rheu- 
matic iritis is very 7 successfully used; small repeated doses (P). Opium, when much 
pain, an indispensable adjuvant, or Morphine hypodermically (C). Copaiba, 5ij in 
mucilage, thrice daily, gives excellent results in iritis and sclerotitis, diminishing pain 
in 24 to 48 hours and restoring sight (Hall). Quinine and Iron, when the patient is 
feeble or anemic. Irritants or astringents should never be employed (C). Surgical, 
paracentesis when increased tension, corelysis when only one or two adjacent adhesions; 
iridectomy; complete functional rest to the eyes, by Atropine and a bandage with com- 
pression pad, an absolute necessity during the whole period of treatment (C). [Com- 
pare Syphilis.] 



R. Ol. Terebinth. 5iij- 

Syr. Acacia, o jss. 

Aqua? Cinnamomi 3 ss . 

M. Sig. — Teasp. 4 times daily. 



R, . Hydrarg. Chlor. Corr gr. j. 

Potassii Iodidi, 3 j • 

Tinct. Calumbae, o ij • 

Aquae Destil., q. s. ad ovj. 

M. Sig. — A dessertspoonful, in a wine- R/. Extracti Belladon. Fol. 5j- 

glass of water, 2 or 3 times daily. Ung. Hydrargyri ovj. 

(Lawson.) M. Sig. — For inunction to brow. 



Irritability. 
Ignatia, in small doses diminishes, in large doses excites irritability of cerebro- 
spinal axis; the remedy par excellence (Pf). Chloral, gr. v, 2 or 3 times a day, in irrita- 
bility with nervousness and restlessness (R). Chamomilla, is an excellent sedative for 
children, in doses of ttjj of the tincture every J hour (Smith). Opium, gives calm to the 
nervous system if used in medium doses, but its identity should be concealed from the 
patient lest the opium-habit be formed. Potassium Bromide, gr. x-xx or more, with 
the same amount of Potassium Bicarbonate, will often control the irritability of gouty 
subjects (Tirard). Strychnine, in functional irritability of the nervous system. [Com- 
pare Insomnia, Nervousness.] 



JAUNDICE— JOINT AFFECTIONS. 



Jaundice. 

Salol, is one of the most efficient remedies in catarrhal jaundice. Mercury, in 
attacks with depression, sickness and coated tongue, gr. £-$ of Gray Powder taken 
at onset, and repeated three or four times a day, very valuable (R); as purgative in 
jaundice from both deficiency and excess of bile, singularly enough (B); Gray Powder 
with Ipecac, followed next morning by Castor Oil, is well adapted to the jaundice of 
infancy and childhood (Wa); Mercurials and Podophyllum are better avoided, espe- 
cially in obstructive jaundice, unless very marked indications for them exist (Da C). 
Ammonium Chloride is a standard remedy for catarrhal jaundice (W); in doses of 
gr. xx every 4 hours (Wa). Ammonium Iodide, gr. j-iij every 2 or 3 hours in catarrhal 
jaundice (B). Sodium Phosphate is often used with great advantage (W); no remedy 
superior in catarrhal form, 3j every 4 hours for adults, gr. x-xx for children (B). Man- 
ganese Sulphate gives excellent results in jaundice of malarial origin and that from 
catarrh of the biliary passages (B). Nitro- Hydrochloric Acid, internally, and acid 
bath to right hypochondrium; temperature of bath 96 , oiij to gall, j (B); when jaun- 
dice depends on torpor of the liver, or is catarrhal in origin (W); during convalescence, 
ttjjv-x of the dilute acid in 3j of a compound elixir of Taraxacum before each meal 
(Da C). Quinine, when due to malaria, or when periodic (B). Euonymin, an hepatic 
stimulant of especial power (B). Podophyllum, in catarrhal and malarial jaundice 
(B); when stools exhibit no trace of bile, one dose has cured (Wa); is best avoided 
unless markedly indicated (Da C). Potassium Salts, the Sulphate is the most useful 
saline purgative in jaundice (Wa); the Bicarbonate to increase the liquidity of the bile, 
but is so disagreeable to the taste that the Acetate or Citrate are preferred for continu- 
ous use (W). Saline Purgatives, as Rochelle salt, to depurate the upper bowel, with 
alkaline baths, diaphoretics and diuretics (Da C). Rhubarb for children, stools being 
white or clay-colored and pasty (B). Aloes for simple atonic! jaundice (B); when 
hypochondriasis is prominent (P). Celandine, was formerly employed as deobstruent 
(P); energetically affects the liver (Pf). Hydrastis, useful if continued for some time, 
in jaundice from catarrh of ducts (B). Arsenic, used with success in jaundice from 
catarrh of bile ducts after catarrh of duodenum; better for jaundice of malarial origin 
(B). Stillingia, relieves jaundice and torpid liver following intermittent fever (B). 
Dulcamara, employed with advantage (P). Iris, in malarial jaundice and that from 
duodenal catarrh (B). Alkaline Mineral Waters, especially in catarrh of duodenum 
or bile-ducts (B). Diet, no starches or fats; use milk, eggs, oysters, beef broth, broiled 
or raw beefsteak, or whitefish (B): plenty of green vegetables at each meal; use cold 
water freely, avoid high seasoning in food and all liquors. Compare Calculi, Duo- 
denal Catarrh, Hepatic Cirrhosis, Hepatic Diseases.] 



Joint Affections. 

Acetphenetidin, for the pyrexia of polyarthritis; efficiently antipyretic and safe. 
Ichthyol pure, or a 50 per cent, ointment rubbed in, produces immediate and remark- 
able benefit in rheumatic or gouty joint affections (W) ; a 50 per cent, ointment instandy 
relieved severe joint pains and soon removed them entirely (Nussbaum). Aconite, 
for pains in inflamed joints (R); the liniment locally in chronic arthritic swellings 
(Wa). Mercury, the oleate in chronic inflammation of the knee (R): Ung. Hydrarg. 
Ammoniat., diluted, 1 to 4 at first, then 1 to 8, by gentle friction 2 or 3 times daily, 
in chronic articular inflammations, by far the best application (P); Mercurial plaster, 
or the plaster of Ammoniac with Mercury, as a resolvent for enlarged and chronically 
inflamed joints (W). Thiosinamin is useful to aid absorption of fibrinous deposits 
in joints due to rheumatism (Upson). Iodine, oiij— vj ad Glycerini oiij, Aq. destil. 
oiv, in numerous obstinate cases of joint affections consequent on rheumatism (Wa). 
Ferrous Iodide, with Iodine, locally, in scrofulous affections of the bones and joints 
(Wa). Iodoform has been used with satisfactory results, in scrofulous affections of 
the joints and bones, by many continental authorities (Wa); used locally has produced 



K I K \ i i I ' 



7" 



many cures of tuberculous joints (W). Salicylic Acid in paste locally, is ol pi 
value in many obstinate eases of stiff knees, pains from so called rheumatism, painful 
ankle and wrist joints, etc. (Aulde). Arsenic, often serviceable in rheumatoid arthri 
tis and nodosities of joints; large doses continued are necessan (R) Alcohol, and 
water, equal parts, an excellent evaporating lotion (B). Silver Nitrate, a strong solu- 
tion in Nitrous Ether is the most efficient application to check inflammation in small 
joints if applied early to adjacent vascular parts (B). Cod-liver Oil, in Btrum 
Subjects (R); the remedy on which most reliance may be placed in scrofulous joinl 
affections (Wa); is almost specific in chronic tuberculous inflammation of the joints 
(W). Rhus Toxicodendron internally and as a lotion, is invaluable for Bubai ! 
stillness and aching of the joints after recovery from acute rheumatism (1'). Digitalis, 
•mentation, T>j of tincture to Oi boiling water, applied on flannel, has proved very 
efficient in acute inflammations of joints (Fairbank). Turpentine, the linimenl a 
serviceable application in chronic enlargement of the joints (Wa). Sulphuric Acid, 
as irritant ointment, 5j of acid to 5j of lard, very beneficial in chronic diseases of joints 
(Wat. Massage is of great value in chronic inflammation of the joints (\V). Blis- 
tering repeated, is often of service in chronic joint inflammation, and is better than 
keeping one blister sore by irritant applications when the affection is rheumatic (W). 
Heat, the actual cautery is a valuable method of treating various forms of chronic 
arthritis (W); dry heat is of great service in many forms of synovitis, and more prompt 
and marked in cases of small joints than in those of large ones (W). Cold Douche, 
also galvanism and Turkish baths, for stiff joints (R). [Compare Arthritis, Bursitis, 
Ooxalgia, Gout, Rheumatism, Synovitis.] 



IJ . Aeidi Salicylici, 5j- 

Adipis Lame, 5iv. 

Olei Olivse, q. s. 

M. et fiat unguentum. Sig. — Apply lo- 
cally or by rubbing once daily for 3 or 4 
days. (Aulde.) 



1$. Ichthyolis, Jij. 

Athens gj. 

Glycerini, 5j- 

M. Sig. — Apply to the affected joints in 
gouty swelling of the same. (Charles.) 



Keratitis. 

Atropine, renders great service by contracting the vessels (B); by instillation, 
with enforced disuse, and a protective bandage, should be regarded as measures of 
course (C). Mercuric and Ferric Chlorides, with Cod-liver Oil, will accomplish 
all that medicine can do for interstitial keratitis in syphilitic subjects (C). Calcium 
Sulphide, proves most useful in doses of gr. T \y to J, thrice daily, in sugar-of-milk trit- 
uration (Snell). Sodium Salicylate is almost specific in non-specific interstitial keratitis 
(Gifford). Ichthyol undiluted, a minute quantity into the conjunctival cul-de-sac, 
gave very good results in cases of strumous vascular keratitis resisting all other treat- 
ment (Darier). Collargol as ointment, is of value in parenchymatous keratitis with 
or without vascular formation (Wolffberg). Arnica, Potassium Iodide or Bromide, 
Iron, Quinine, for their constitutional effects in vascular keratitis; also counter- 
irritation by Iodine painted on the temples until soreness (C). Ferric Chloride, 
successfully employed in panniform keratitis; a large drop of the solution dropped 
from a quill every second or third day (Wa). Physostigmine, lowers intra-ocular 
tension (B). Astringents or Irritants, as Alcohol in any form, Zinc Sulphate, Silver 
Nitrate, etc., are entirely inadmissible (C). Iridectomy, is often beneficial in severe 
vascular keratitis (C). Pressure-Bandage, in severe suppurative forms, limits extent. 
Water, cold when inflammatory symptoms marked; hot, oo°-ioo° F., in non-inflam- 
matory form, to excite inflammatory reaction; should be discontinued when marked 
injection occurs. [Compare Corneal Opacities.] 



B. Hydrarg. Chlor. Corros.,. . . gr. j. 

Ammonii Chloridi, gr. vj . 

Tinct. Belladonna Fob, .... 5ij- 
Aquae Destillatae, 5 viij. 

M. et fiat collvrium. 



Sig. — A teasp. in a wincgl. of tepid water, 
to be applied frequently with a pledget of 
lint on the closed lids. In phlyctenular 



keratitis of children. 



( Turnbull.) 



712 LABOR — LACTATION. 



Labor. 

Ergot, only when uterine inertia, and after the first stage has passed; is dangerous 
if any obstacle in front; dangerous to child by paralysis of fetal heart (B); is best given 
when the head has passed the brim of pelvis (Wa) ; should never be given for uterine inertia 
when there is much resistance, either in the bony or the soft parts of the mother (W); 
in full dose when the head is well down on the perineum, to prevent flooding | \\ 
Quinine is used instead of Ergot to strengthen uterine contraction (R); given in the 
early stage to increase expulsive power and lessen the danger of septic invasion (Ham- 
mond) ; gr. viij followed by gr. iv in an hour to correct inertia and prevent hemorrhage 
(Mackness). Opium, facilitates dilatation, promotes expulsive power of uterus, lessens 
hemorrhage, stimulates longitudinal and oblique fibres of the os (Wa); a full dose of 
Morphine, gr. £, in tedious labors, with severe pains, will aid patient greatly and pro- 
mote progress of the child; no bad results ensue; for relief of pains and after-pains, 
or painful complications (Wa); hypodermically in rigid os and cervix (R). Cimici- 
fuga, exercises special action, similar to that of Ergot; is less dangerous to life of child 
and soft parts of mother (Wa); for mental disturbance and suppressed lochia (R); as 
partus accelerator in lieu of Ergot, also to allay nervous excitement after labor, and to 
check post-partum hemorrhage (P). Cannabis Indica, the tincture gtt. xxx, as stimu- 
lant to uterine contractions, more prompt, less lasting, than Ergot (Wa). Ipecacuanha, 
after delivery; to promote natural functions (R). Cotton-root, as excitant of uterine 
contractions, may be more energetic than Ergot (P). Althaea, the decoction, as vaginal 
injection in difficult labor (P). Sodium Borate, excites activity of the uterus, and is 
well employed in tedious labor, where there is deficiency of uterine action (Rigby). 
Amyl Nitrite, has acted admirably in a case of hour-glass contraction of the uterus; 
seems to antagonize the action of Ergot (Barnes). Guaiacol, a few drops rubbed in 
gently, gives immediate relief to the pains (Brodnax). Belladonna, the extract locally 
to the uterus of great service in long-protracted labors from rigidity of os and cervix 
(H). Gelsemium, quiets the nagging pains of the first stage; requires physiological 
doses (B) ; relaxes spasm in rigidity of the os (Wa). Acetanilide, eases pain and brings 
on profuse sweat which helps to relax muscular rigidity (Brodnax). Phenalgin is effec- 
tive to overcome a rigid os (Con diet). Anesthetics, in protracted and painful labor; 
cautiously with primiparae (B); increase the risk of post-partum hemorrhage (W). 
Chloroform, not to complete anesthesia, lest uterine action be interrupted; usually 
begin its inhalation when os is dilated (Simpson). Chloral, of great value to relieve 
pain; does not interfere with the exhibition of chloroform; should be given in 15-grain 
doses every J-hour till effect produced (Wa) ; the best of all remedies for rigid, undila- 
table cervix, gr. xv every 20 minutes for 3 doses, perhaps a 4th after an hour's interval 
(Playfair). Ethyl Bromide, a rapid, sure and safe anesthetic, particularly suited 
to labor cases (Levis). Cocaine by spinal injection as an analgesic, used in 40 cases 
with great satisfaction (Marx); in 50 cases (Doleris). Eucalyptus, the Oil is a valu- 
able antiseptic in midwifery ( Wa) . Hydrogen Dioxide, for disinfection of the passages, 
irrigation of the uterus, and other obstetric uses (Cassier). Creolin in 1 per cent, 
solution, for washing out the uterus (W). Mercury Bichloride is the worst of all 
antiseptics for use in labor, being too dangerous. [Compare Abortion, After-Pains, 
False Pains, Hemorrhage Post-Partum, Lactation, Puerperal Convulsions,— 
Mania, — Fever, — Disorders.1 



Lactation. 

Pilocarpine, as a galactagogue, gr. \ in brandy on retiring, the patient to be covered 
well in bed; is efficient in direct proportion to its diaphoretic and sialogogue effects, 
these being evanescent, but its galactagogue power remains for weeks, an occasional 
dose only being required to spur up the secretion when flagging (Minges) : is a galacta- 
gogue, and probably the only example of this class we possess (M). Antipyrine, is an 
anti-galactagogue, 4-grain doses every 2 hours have proven highly efficient. Bella- 
donna, internally or externally or both, in excessive lactation (R); Atropine gr. iv to 



LARYNGISMUS STRIDULUS LARYNGITIS. 711 

?,') Aquae Rosoe on lint around the breast to arrest secretion of milk; remove when 
fauces become dry and pupils dilated (B). Camphor, locally to arn-st the secretion; 
■ saturated solution in Olive Oil or Glycerin, is more efficient than Belladonna (Wa) 
Potassium Iodide, in 25 to 30 grain doses internally, for the same purpose, is very 

ctual (Rousset). Calcium Phosphate and Hypophosphite, in debility from 
over-lactation (R, Wa). Ammonium Chloride, for the intercostal neuralgia of 
nursing women; gr. x-xx, every 3 or 4 hours (Wa). Quinine, Tannin, are used to 
arrest the secretion (R). Alcohol, as beer or porter, often useful for women weakened 
by suckling— not always (R). [Compare Abscess, AGALACTIA, MASTITIS, Nipples.] 

Excreted in the Milk, when taken by the nursing woman are: the Oils of Anise, 
Cumin, Dill, Wormwood and Garlic, Turpentine, Copaiba, the active principles of 
Rhubarb, Senna, Scammony and Castor-oil, Opium, Iodine, Indigo, Antimony, Arsenic, 
Bismuth, Iron, Lead, Mercury and Zinc. Acids given to the mother cause griping in 
the child. Natural salts, as a rule, and the purgative agents above-named, act as 
purgatives to the child, and Potassium salts as diuretics. Turpentine, Copaiba and 
Potassium Iodide given to the mother, can be detected in the urine of the child. Opium 
given to the mother may narcotize the child, and Mercurials in the same manner may 
salivate it (Br). Atropine, Hyoscyamine, the Salicylates and Potassium Sulphide, have 
been found in the milk after their ingestion by the woman. 



R . Tinct. Aconiti, ttjj xx. 

Antim. et Potass. Tart.,. . . . gr. ij. 

Spt. /Etheris Nitrosi, 

Syr. Simplicis, aa § j • 



Aqua? Aurantii Flor., §ij. 

Misce. Sig. — A teaspoonful in a wine- 
glassful of sweetened water, every two hours, 
for milk fever. (Fordyce Barker.) 



Laryngismus Stridulus. 

Aconite, checks the spasm and relieves the croupous breathing (R). Antipyrine, 
has proven very serviceable. Belladonna, promises to be of value (Wa); Atropine, 
gr. TTJxy in a goblet of water (60 doses), of which a teasp. every hour or i-hour will give 
prompt relief (Smith). Bromides, when uncomplicated except with convulsions (R); 
full doses will suspend an attack, and moderate doses steadily continued will prevent 
recurrence (B). Ipecacuanha, an emetic dose to cut short an attack (B). Lobelia, 
has been employed (R). Chloroform, quickly cures the paroxysm, a few drops on a 
handkerchief sufficient (B); may often be used with advantage (W). Nitroglycerin, 
will speedily allay the spasm (B). Chloral, gr. v-xv to prevent or arrest (B). Qui- 
nine, given between attacks to prevent (B); a most valuable remedy, in small, repeated 
doses (P). Emetics, Tartar Emetic; Mercuric Sulphate, gr. iij-v, safer and better 
(R). Conium, is valuable, carried to a point of physiological effect (B). Water, 
wet pack to neck (B); cold sponging twice or thrice daily more successful than any- 
thing else, with out-of-door exercise; cautiously if hoarse voice indicates laryngitis (R). 
[Compare Croup, Laryngitis.] 

Laryngitis, Acute Catarrhal. 
Aconite, very valuable (R); especially indicated in inflammatory states of respira- 
tory parts; gtt. ss-j every half-hour till an impression is made on the fever, then every 
hour or two (B). Antimony, Tartar Emetic, gr. F V> a ver >' excellent remedy internally; 
larger doses in edematous laryngitis, gr. T V with gr. iij of Dover's powder every 2 or 3 
hours (Da C). Iodine, inhaled, also as counter-irritant painted over neck (B). Mor- 
phine, small doses to allay cough (A). Sulphurous Acid as spray is vaunted (Wa). 
Argyrol in 10 to 50 per cent, solution locally, has given good results (Sauer). Pro- 
targol in 2 per cent, solution as spray, has proved efficient in severe cases. Ichthyol 
in 2 per cent, solution as spray, is excellent treatment. Rumex internally, has selec- 
tive action on the laryngeal mucous membrane, and gives relief in laryngeal irritation 
with catarrhal symptoms. Iron Subsulphate 1 part of Monsel's solution to 3 of water 
and glycerin, an excellent local application (Da C). Zinc or Copper Sulphates, as 
emetics, in large quantities of warm water, where edema slight (A); a solution of Zinc 



714 LARYNGITIS. 

Sulphate, gr. xx to the 5 on sponge to larynx with aid of the laryngoscope if possible 
to use it (Da C). Leeches to the throat in sthenic cases, or cupping at the nape of the 
neck, valuable as auxiliary to general treatment (Wa). Scarification, by Mackenzie's 
laryngeal lancet, of great service in the edematous form (Da C). A Purgative and 
Diaphoretic, with mucilaginous drinks, if given at the start may be sufficient (Da C). 
Heat, by poultices or fomentations (A); hot-water stupes may succeed (Wa). Inhala- 
tions of hot steam, with Benzoin, the comp. tinct. gtt. x-xv to the §, with gtt. x Tinct. 
Opii, or Hops, or Conium, of great service (Da C). Tracheotomy ought not to be 
delayed, if inhalations, leeches, and fomentations fail (Wa); is especially indicated in 
sudden attacks of edematous laryngitis, as those occurring in Bright's disease (Da C). 
Ice, steadily applied in bags over the larynx, if tracheotomy refused, has succeeded in 
bad cases; small pieces may be slowly swallowed (Da C). [For Croupous Laryngitis, 
see Croup membranous; for Spasmodic Laryngitis, see Croup catarrhal; for 
Edematous Laryngitis, see Glottis edema of. Compare also Laryngismus stridu- 
lus, Pharyngitis.] 

Laryngitis, Chronic. 

Iodine, painted over neck as a counter-irritant, and inhalation of its vapor (B) 
Sulphur, as Sulphurous Acid by spray in syphilitic laryngitis, or a solution of Sodium 
Sulphite, 3jtothe o of water (B); by inhalation, spray, or fumigation (R). Phenol, in 
cases where long-standing hyperemia with diminished secretion, 3j-ij to the 5 of 
glycerin is a most successful application (Mackenzie). Silver Nitrate, powdered or 
in solution to chronically inflamed larynx (R) ; a solution of gr. x or xx to the 3 , applied 
with a brush by the aid of the laryngoscopic mirror (W); formerly much used, but is 
objectionable (B); should be used with great caution, and only when a particular point 
can be seen for it with the laryngoscope (Da C). Ferric Chloride, a solution of oj-ij 
in the o of glycerin, as a local application (A). Zinc Chloride, gr. xx-xxx to the 5 
of glycerin; alternation of topical remedies is of great value (A). Copper Sulphate, 
gr. xx to the 5 of water, locally twice a week (Da C). Bismuth Subnitrate, by 
insufflation, is highly recommended in the worst forms of laryngitis (Tr). Guaiacum, 
as lozenges, is useful in mucous laryngitis (A). Althaea, as pectoral lozenges to relieve 
laryngeal irritation (P). Cubeb, the berries chewed are very efficient in relaxation of 
the larynx following a cold or prolonged speaking (Wa). Cocaine, a 20 per cent, solu- 
tion by spray, mop, or brush, is efficient in many laryngeal affections (James). Ben- 
zoin, in strumous laryngitis (Wa); in chronic, Benzoin on hot coals, or inhaled from 
boiling water, is of great service (Tr). Tannin, in chronic catarrh and ulcerations, a 
solution, gr. x-xx to oiv, applied by hand-ball or steam atomizer (A). Thiocol, a 10 
per cent, solution gives satisfactory results in chronic laryngeal catarrh, in doses of 
gr. xv-xx 3 or 4 times daily (Frieser). Nargol in 5 to 10 per cent, solution, painted 
over the affected surface, is of great benefit (Burnet). Inhalations, or spray, of the 
best agents very grateful (B) ; air loaded with vapors of Ammonium Chloride by inhaler, 
said to be used successfully (W); vapors from boiling Tar, Turpentine, placed on hot 
water, or better by steam atomizer (Da C); Chloroform, Hops, Benzoin, by atomiza- 
tion (Walker). Insufflation, substances to be in small quantity, mixed with some 
bland powder (B). Functional Rest of the voice often requisite, especially in phthisi- 
cal and syphilitic laryngeal ulceration (A). Chronic Laryngitis, includes many dis- 
orders of the larynx, which of late years have been differentiated as thickened vocal 
cords (chronic laryngitis proper), laryngeal ulcers, polypi, cysts, cauliflower growths, 
tubercular and syphilitic laryngitis, in all the voice being similarly affected. Dysphagia, 
as a concomitant symptom is indicative of tubercular laryngitis (Da C). [Compare 
Cough, Dysphagia, Syphilis.] 



Laryngitis, Tuberculous. 



Cocaine, as pastilles or by insufflation, to relieve pain and dysphagia, especially 
when much ulceration or perichondritis present; in the later stages its use prolongs life. 
Resorcinol, a strong solution locally, very beneficial in tuberculous and other ulcera- 



LAKYNGOTOm LEPROSY. 



7 '5 



tions of the larynx (Tymowski). Zinc Sulphate, in solution mixed with a i or -• |kt 
cent, solution of Cocaine, in the earh catarrhal stage (Neumann). Silver Nitrate, 
m powder or solution locally (R). Bismuth Subnitrate, by insufflation is hi 
efficient (Tr). Iodoform, in large insufflations has surprising anodyne efl 
extensive tubercular ulceration exists (Neumann). Iodol, and Boric Veid, equal parts, 
by insufflation, in less severe cases (Id). Sulphaminol by insufflation, gives 
results. Ichthyol locally, relieves the pain (Berens). Guaiacol is a good application 
in 20 per cent, solution, increased to 8o, or even full strength (Coulter); Guaiacol 
Menthol io, Olive Oil 65, is often useful (S. Solis-Cohen). Orthoform 1 pai 
thesin 1, Suprarenal substance 2, and Iodoform 2, is the best combination for insuiila 
tion, especially where there is painful ulceration (Id). Menthol, is of great value, 
relieves pain and is claimed to destroy the local deposits; a solution of 1 in 10 of pure 
olive oil brushed freely over the part daily, a solution of 1 in 5 being used after the lust 
week. Lactic Acid, is reported by many authorities as highly successful, even curative; 
a solution of 30 per cent., gradually increased to 75 per cent., brushed over the affected 
surface after swabbing with Cocaine, or a few drops injected into the larynx by a larvn- 
gcal syringe: is excellent, lasting good results having been obtained thereby (Whitl'a). 
Scraping the ulcerated spots before applying lactic acid, done by me in 200 cases with 
28 cures (Ehring). Tracheotomy, where deep and extensive ulcerations exist beyond 
the reach of local treatment. Diet, thick liquids are more easily swallowed than thin 
ones, and if the patient lies on a couch or bed with his head hanging down over the side 
while swallowing, this is rendered easier (Wolfenden); feeding should be done by the 
soft rubber tube w T hen much dysphagia exists which does not yield to cocaine. Dys- 
phagia, as a constant symptom of chronic laryngitis is indicative of the tubercular 
form (Da C). 

Laryngotomy. 

Laryngotomy is more quickly and easily performed on the adult than tracheotomy, 
being farther from the lungs and less dangerous. It is usually directed to be performed 
by cutting longitudinally through the skin, then horizontally through the crico-thyroid 
membrane, which may be felt as a soft depression, an inch below the pomum Adami. 
In urgent cases, however, Professor Wood recommends a narrow-bladed knife to be 
passed horizontally through both skin and membrane at once, and then to enlarge the 
opening laterally to the required extent. The advantage of having a horizontal incision 
in the skin is the greater openness of the wound when the patient throws up his head 
under a sense of dyspnea (D). In Laryngo-Tracheotomy, the deep incision is carried 
downward from the crico-thyroid membrane, through the cricoid cartilage and one or 
two upper rings of the trachea (CI). 

Leprosy. 
Anacardium Orientale, Oil of Cashew, has been much lauded; investigation 
established that much of its success was due to hygienic measures and use of fresh 
meat as food (P). Arsenic, with 5 or 6 times the quantity of black pepper, in esteem 
in India (Wa). Sarsaparilla, as tonic and alterative is valuable (P). Gurjun Bal- 
sam, Wood Oil, as ointment and emulsion, has been used with success in alleviating the 
disease, by Dr. Dougall, Port Blair, Andaman Islands; the ulcers of 24 lepers healed 
thereby. Ferri Arsenas, gr. A daily, is used with success (Wa). Mercury, the Oint. 
of the Red Iodide, diluted 1 to 10, or gr. j of the salt to 5v of unguentum, gives very- 
good results (Wa). -Europhen, 5 per cent, in oil, cured a case some years ago on the 
Island of Madeira (Goldschmidt). Chaulmoogra Oil, is credited with a few cures 
and many cases improved; the oil is mixed with Psoralea corylifolia as a liniment, 
and is also used internally (Wa). Hoang Nan, is considered of utility by a number of 
writers on leprosy, and is given in combination with Alum 1, Realgar 2 or 1, and the 
drug 2 parts, the whole being made into 3-grain pills, one pill daily being given at first 
and gradually increased (Pf). Argenti Nitras, is said to act as a tonic and alterative, 
and to control leprosy for a limited period (Pf). Ichthyol, used internally in increas- 
ing doses, with vigorous rubbing of the arms and legs twice daily with a 10 per cent. 



716 LEUCOCYTHEMIA — LEUKEMIA — LEUCORRREA. 

ointment of Pyrogallic Acid in Lanolin, and the cheeks and trunk with Chrysarobin, 
10 per cent, in Lanolin, also applying to the forehead and chin a plaster of Chrysaro- 
bin, Salicylic Acid and Creosote, changed every day. This treatment, continued for 
a month, and followed by a course of warm baths before being resumed, has cured 
several cases (Unna). Sodium Salicylate, in doses of gr. xv four times a day, gradu- 
ally increased for six months or a year, if commenced early in the disease, sometimes 
effects a cure (Danielssen). Thyroidin, caused marvelous improvement in a case 
of nerve leprosy during 3 years of its use (Mn). Goto Treatment, consists in bathing 
daily in hot water in which are placed bags containing hichiyon bark, taifunshi, sulphur 
and yoku yaku; internally are given seiketsuren pills, tincture of the chloride of iron, 
quinine, strychnine, potassium iodide, gentian, columbo, carbonate of soda and potash, 
and Epsom salts (Alvarez); but proof is lacking that cure has been obtained in any 
case (Emerson). Toxins and Antitoxins, are being tried in various parts of the 
world, but are not trustworthy, as the bacillus has never been cultivated and animals 
are quite refractory thereto (Goldschmidt). Antivenene, has been used successfully, 
and has cured after other treatment had failed completely (Dyer). Diet, unsound 
fish is a frequent cause of the disease (Hutchinson); nutritious food, frequent baths 
and great cleanliness, will do much to prevent its manifestations (R). 

Leucocythemia — Leukemia. 

Arsenic, in as full doses as can be borne, may be of service, though hitherto in- 
effectual (Gowers); produced rapid improvement in a severe case, conjoined with 
Oxygen inhalations, 5 minims of Liquor Arsenicalis being given thrice daily, increased 
by 2 minims every 4 or 5 days until the dose reached 45 minims (Taylor) ; is of the 
greatest value and great improvement has resulted from its use in many cases (Muir). 
Oxygen, 30 litres by inhalation daily with the conjoined use of Arsenic, has been suc- 
cessful in the early stages in some cases, but in many it has failed (Muir) ; 4 litres daily 
for 2 months cured one case, the spleen being of normal size after the treatment (Koster). 
Alkaline Hypophosphites, are used with more or less benefit (Wa). Digitalis, in 
young subjects (B). Nitrohydrochloric Baths, should not be neglected, with tonics 
and nutrients (A). Iron, is of little value (B); large doses may do good in the early 
stage, with careful diet, and Ergot to contract the spleen (Da C). Phosphorus, gr. ^ 
increased to gr. ■%-$, has proved successful in several cases (Wa) : good results have been 
reported in one or two cases, but the general experience is that it is of no value (Muir). 
Quinine, in large doses, is considered of value by some, but it is distinctly inferior to 
Arsenic (Id). Thymus Extract, has been used with benefit. Bone-marrow is 
worth a fair trial. Galvanization of the spleen, is curative in uncomplicated cases 
(B); causes improvement of the blood, increasing the number of its red corpuscles 
(Gowers). Roentgen Rays cured a case of spleno-medullary leukemia, the only case 
known by me to have recovered (Senn). Cold Water by douche to the abdomen twice 
daily contracts the spleen (Mosler). Splenectomy has been performed in a number 
of cases, almost invariably with fatal result; is absolutely unjustifiable and is also useless 
(Muir). [Compare Anemia, Lymphadenoma.] 

Leucorrhea. 

Phenol in 5 per cent, solution, as an injection in vaginal leucorrhea (R). Creo- 
sote may be substituted for phenol when the discharge is fetid (W). Hydrastis, 
the fluidextract undiluted, applied topically, quickly improves in uterine and vaginal 
leucorrhea (B). Pulsatilla, 5 -drop doses ter die for a few weeks; also a teasp. of the 
tinct. in a pint of cold or tepid water, as vaginal enema daily, when pain in the loins, 
depression of spirits, loss of appetite (P). Silver Nitrate, in solution locally, also 
tampon saturated with 5j each of Alum and Bismuth, when leucorrhea due to granular 
vaginitis (Parvin). Balsams of Peru and Tolu, internally (P). Glycerin, is largely 
employed for vaginal leucorrhea, and for erosions and ulcerations of the cervix uteri 
(B); the best vehicle for other agents (E). Glycozone, applied on small rolls of lint 
or absorbent cotton, after thorough washing of the vagina with solution of Hydrogen 



I [( ill \ I'l ANUS. 



VI 



Dioxide, i to .( of water, and repeated twice daily (Edson). Borax, 5j to < )j of water, 
as vaginal wash for the leucorrhea of pregnancy (Parvin). Cimicifuga, is said to be 
useful (P). Copaiba, has been used with success (P). Cocculus Indicus when sero 
purulent discharge, pain in lumbar region (P). Bismuth Subnitrate in mixture with 
mucilage, gr. xx to the 7). may be used as an injection (W); or as a vagina] suppository 
Resorcinol in 1 to 15 per cent, solutions locally (W), Copper Sulphate, in so I u 
lion, as injection (R). Tannic Acid, in chronic rases serviceable as injection, . 
oviij of claret wine (B); if os ulcerated, a suppository of tannin and cacao-butter to 
mouth of uterus (R). Iodo-Tannin, is an excellent application, 5j of iodine to 8j 
of tannic acid, a sufficient quantity to be packed dry around the cervix (B). Iodine, 
the tincture diluted, as an alterative and stimulant application (W). Alum and 
Borax, make a useful injection in vaginal leucorrhea (RV Belladonna, with Tannin 
as bolus when neuralgia or ulceration of the os; when disease due to over-secretion of 
mucous glands about the os and much pain present inject Sodii Bicarbonat., oj; Tinc- 
tura? Belladonna?, oij; Aquas, Oj (R). Potassium or Sodium Bicarbonate, oj in 
Oj aqua? as injection, especially when discharge alkaline and copious (R). Pareira, 
Uva Ursi, are successfully used (P). Sumbul, recommended in atonic form (P). 
Myrrh, with Iron or Aloes, beneficial (P). Ergot, said to be useful in some cases (R). 
Potassium Permanganate, has no special advantage; is used in solution, gr. ij to 
the 3 (B). Potassium Chlorate, 3j to Oj of water as injection in simple cases (Par- 
vin). Iron, the Iodide, internally and externally has proven serviceable; the Mistura 
Ferri Composita, when anemia and general debility (Wa); the styptic preparations 
locally (R); the Ammonium Sulphate in doses of gr. v thrice daily, often gives marked 
benefit in atonic leucorrhea (W). Phosphates, for the cachexia (B); Calcium Phos- 
phate, gr. j-ij several times daily, of great value in checking profuse discharge (Wa). 
Injections, water at 6o° F. to prevent recurrence (R); hot water injections are the 
best tonic for the pelvic vessels to relieve venous congestion; use with elevated hips 
(E). [Compare Endometritis, Uterine Ulceration, Vaginitis.] 



R. Aluminis, 5j- 

Zinci Sulph., 5ss. 

Sodii Boratis, gr. iv. 

Aq . Rosa? 5 viij . 



R. Liq. Plumbi Subacet, 5jss. 

Phenolis, oss. 

M. Sig. — One-fourth to be added to a 



M. Sig. — Injection. (B.) ! pint of water and used as an injection. 



Lichen Planus. 

Arsenic, is the only remedy which exercises anything like a specific effect, and it 
not infrequently fails (Brooke). Antipyrine, internally for the itching, is efficient. 
Aconite, sometimes useful (R). Mercury, Calomel and Mercuric Nitrate Oint. 
mixed, also Tar Oint. may be added, in patches of obstinate lichen (R). Silver Nitrate, 
the Nitrous Ether solution painted over the patch every day or two (R). Quinine, 
with Belladonna and Ergot, as in urticaria (Brocq); large doses in an effervescing 
mixture (Crocker). Potassium Chlorate, gr. xv before meals, also dilute Nitric 
Acid, ttux after meals, thrice daily, has given very good results (Bulkley). Lead-water 
as lotion, thickened with zinc and starch powder or calamine, with the addition of a 
few drops of Phenol or Liquor Picis Carbonis, has a sedative effect in acute cases 
(Brooke). Mercury, as in Unna's ointment, composed of Hydrarg. Chlor. Corr. gr. 
iij-v-xx, Phenol gr. xx, Ung. Zinci Ox. oj; the smallest quantity of the mercurial for 
extensive cases, the larger for local caustic effects in stubborn patches. If used early 
and efficiently this ointment alone will remove the threatening general symptoms of lichen 
neuroticus (Unna). Excision may be required to remove the horny accumulations of 
lichen comeus (Brooke). Cautery for the same purpose, even superficially applied it 
sometimes removes the itching permanently (Van Dort). Formerly used to denote 
many spreading papular eruptions, the term Lichen is now restricted to one specific 
form of disease, that described by Erasmus Wilson as Lichen Planus, of which Hebra's 
Lichen Ruber is a rare and aberrant acute manifestation (Brooke). [Compare Eczema, 
Strophulus, Tinea Sycosis.] 



7 i8 



LITHEMIA — LOCOMOTOR ATAXIA. 



Lithemia. 

Salicylates powerfully promote the excretion of uric acid and may be used with 
the utmost confidence in all troubles due thereto (Haig); they aid in keeping down the 
diathesis (W); the Strontium salt is the most valuable, especially in chronic gouty condi- 
tions and in lithemia with intestinal indigestion (W). Piperazin is one of the best 
eliminants, and relieves the pruritus of the uric diathesis; has not maintained its original 
reputation (W). Lithium Salts, especially the Citrate, gr. xx thrice daily, is very 
efficient (Da C) ; the Carbonate invaluable (Wa); the Bromide, in solution of Potas- 
sium Citrate given after stomach digestion is completed, one of the very best agents 
(Aulde); Lithium clears the blood of uric acid but drives it into the tissues, and dimin- 
ishes its excretion (Haig). Alkalies are useful, especially the Potassium salts; alkaline 
mineral waters have a deserved reputation (B). Sodium Phosphate is a good solvent 
of uric acid and promotes its excretion if given with alkalies or when there is a good 
supply of alkalies in the blood and tissues (Haig). Uro tropin energetically eliminates 
uric acid (Bardet). Citarin liberates formaldehyde in the blood and is indicated in 
all forms of the uric diathesis (Ardo). Lysidin is more solvent than piperazin on uric 
acid. Cascara Sagrada promotes the excretion of uric acid. Chimaphila is believed 
to check the secretion of uric acid (P). Colchicum, the wine in doses of ngxv twice 
or thrice daily is very useful (Wa); the combination of Colchicine with Oil of Gaul- 
theria in capsules is said to be a useful remedy. Thialion is a proprietary preparation 
much advertised for lithemic conditions. Coffee, a tincture of green coffee is anti-lithic, 
and is useful in lithemia and gout, though the beverage of the roasted bean is injurious. 
Potassium Permanganate converts uric acid into urea and thus prevents the forma- 
tion of uric calculi (B). Buchu with an alkali, has proved beneficial (P). Pichi is 
of great value in lithemia with cystitis (Wyman). Arsenic, in small doses, is useful 
(Da C). Nitric Acid, 10 minim doses of the dilute acid in half-glass of water thrice 
daily, with an occasional dose of Pil. Rhei Compos, at bedtime, is the most efficient 
treatment for patients who will not diet themselves (Hughes). Purgatives, especially 
alkaline mineral waters, to clear the portal system (Da C). Drugs increasing the 
excretion of uric acid are Alkalies, Salicylic Acid and its compounds, Sodium Phosphate 
Piperazin, Quinine, and Belladonna (Haig). Exercise is very important, seden tan- 
habits are injurious; alcohol in any form is poison to a lithemic (Da C). Diet, bread- 
stuffs and cereal foods form the best diet (Haig); occasionally abstain from animal 
food, also from tea, coffee, meat soups, sugar in excess; drink water freely. [Compare 
Calculi, Dyspepsia, Gout.] 



1$. Lithii Bromidi, 3ss-j. 

Liq. Potassii Citrat., 5iv. 

Syrupi Simplicis, §ij. 

M. Sig. — A teasp. in a wineglassful or 
more of water, 2 hours after each meal. 
Reduce the dose after a week. 



1^. Potassii Nitratis, 3j- 

Fluidextr. Pichi, 5 j • 

Elixir Simpl., oiij- 

M. Sig. — A teasp. every 2 hours. 



1$. Tinct. Belladonnas Fol ttj; xviij. 

Vini Colchici Rad oij. 

Liq. Potass. Citrat. ,.q. s. ad §iv. 
M. Sig. — A dessertsp. well diluted, every 
3 hours. 

1$. Vini Colchici Rad oij - 

Fluidextr. Phytolacca, 5j- 

Potassii Acetatis, oiij • 

Aquae, q. s. ad 5 vj . 

M. Sig. — A tablesp. four times daily. 



Locomotor Ataxia. 

Antipyrine or Acetphenetidin for lancinating pains; the former relieves them 
remarkably; the use of Morphine for the pains should be avoided as long as possible 
(Osier). Acetanilide, is admirable for relief of the pains (B). Belladonna and 
Ergot are highly efficient (Brown-Sequard). Silver Nitrate, when motor disturbances 
are very marked; improved r case in 20 (R); gives the best results in doses of gr. \ to 
gr. \ thrice daily, withholding it after a few weeks to prevent argyria (Da C); the only 
remedy which has done good in progressive locomotor ataxia; gr. ^-i two or three 



I I Mi; VGO 



:"> 



times daily, with Sodium Hypophosphite, both to be discontinued when blue line appears 
on gums (Althaus). Silver Oxide, may be used instead of the nitrate, in ball grain 
s (Da C). Aurum, is especially curative in all forms of sclerosis; the Bromide 
of Gold and Arsenic has been of special service in this form 1 \: A. Wood). Potassium 
Iodide, Corrosive Sublimate, or Gold and Sodium Chloride, all in full doses, often 
retard the progress of the disease (Da C). Iodipin has given good results (Schuster). 
Mercury, the Benzoate in daily doses of gr. }■- \ hypodermically, diminished ih 
in six cases, and otherwise caused a slight improvement (Lemoine). Hyoscine is 
serviceable in the crises (Winnett). Hyoscyamine in gradually increased doses am, |j 
orates the symptoms (B). Physostigma has proved beneficial (R). Sodium Cin- 
namate hypodermically, used in several cases with good results (15). Pilocarpine, 
produces general improvement if given in the incipiency, gr. j to 3j of water, of whi< h 
nt;xxx thrice daily (B). Strychnine, gr. ,-;',-, in 5j of Syr. Hypophosphitum, thi 
daily, when the system is saturated with silver (Da C). Morphine, sooner or later 
becomes necessary for the lancinating pains; in one case, personally known to the author, 
which had been treated ineffectually by every known method, including suspension by 
Charcot himself, and was rapidly progressive, the abandonment of the hypodermic 
svringe for Morphine by mouth, gr. xv daily in divided doses, seemed to result in com- 
plete cessation of progress, the disease remaining stationary for several years. Orchitic 
Extract has seemed to be of service in some cases. Spermine has been used with 
reported benefit. Cerebrinin has been employed with satisfaction (Paul). Suspen- 
sion daily, by head, has seemed to give relief to pain and improve condition: is known 
as Charcot's treatment, but originated with Matchoukowsky of Odessa, and was carried 
out systematically by Hessing of Pesth, before Charcot took it up: is now abandoned. 
Electricity, the galvanic current relieves pain; faradic stops wasting of muscles (B); 
in the stage of irritation the constant current (ascending) through spinal column (R). 
Water, one of the most efficient agents; friction with a cloth dipped in water of 60-65 
F., a cold compress to head; 4-8 minute bath of 70-75 ° gradually lowered to 6o°, then 
shower-bath and frictions (R). Rest, as complete as possible, must be insisted on; 
with good, nutritious diet, milk being very desirable (Da C). 

Lumbago. 

Cimicifuga, is said to be more effectual than any other remedy (R); has sometimes 
wonderful success; no indications can be given for it; oss— ij of fluidextract (B); is cura- 
tive (P). Rhus Toxicodendron, in subacute muscular or tendinous rheumatism, worse 
at night; completely relieves some cases (Pf). Veratrum Viride, the tincture useful 
(R). Aconite, in minim-doses of tincture every 2 hours, with Linim. Aconiti locally 
(Wa). Iodides, if referable to syphilis, mercury, copper, tin, or lead poisoning (B). 
Salicylates in cases due to uric acid; are of value in subacute or muscular rheumatism 
Wi. Saloquinine is efficient, a few doses relieve (Coile). Mesotan, 5j or more in 
a plaster is very effective. Ichthyol in 10 to 50 per cent, solution externally, is superior 
to any other remedy (Schweninger); frequently gives prompt and surprising results 
(Eulenberg). Ammonium Chloride, is very efficient in myalgic lumbago, gr. xx 
thrice daily for 2 days or until signs of congestion of the nasal mucous membrane appear, 
then to be replaced by Quinine, gr. v, thrice daily for a week (Waugh). Antipyrine, 
gr. vij, hypodermically, completely banished it in a very bad case at the Hotel Dieu, 
Paris. Morphine, hypodermically, to relieve pain (R); gr. £ with Atropine gr. „',,, 
hypodermically, will frequently cure lumbago in two or three hours (Da C). Capsicum, 
a strong infusion applied on lint, and covered with oiled silk, very efficient in recent 
lumbago (R); a Capsicum plaster is a very efficient application. Potassium Nitrate, 
in ten-grain doses hourly or every two hours, when urine scanty and high-colored (R). 
Belladonna, as plaster, very valuable for persistent lumbago remaining in a small 
spot (R). Turpentine, in doses of 20 to 30 minims, carefully lest strangury and nephri- 
tis, is of value when the bowels are regular and the urine is clear and abundant (Wa). 
Formic Acid gtt. v of a 2 per cent, solution hypodermically, preceded by gtt. viij of a 
1 per cent, solution of cocaine, injected in several places, gives immediate relief and is 
promptly curative (Couch). Ether Spray, externally as freezing mixture (R). Guar- 



720 LUNG DISEASES. 

ana, in 20 to 40 grain doses, removed severe chronic lumbago (Rawson). Chloro- 
form Liniment, affords relief (Wa). Canada Balsam, gr. v-xx, is useful, or Bur- 
gundy Pitch, as plaster (P). Acupuncture, occasionally gives instant relief (B); 
not when high fever (R). Aquapuncture, has been employed with extraordinary 
success (B). Heat, by hot douche to seat of pain (B); or by very hot poultices for 
three hours, then the skin covered with flannel and oiled silk; or a hot flat-iron (R). 
Galvanism, the constant current (B); is highly useful; faradization almost as successful 
as acupuncture (R). Phototherapy, the ultra-violet rays are specific for relief of 
pain (Rosenberg). Cupping, dry cups often give relief and are a valuable adjunct 
to internal treatment. Strapping from the thigh upward with overlapping strips of 
adhesive plaster, is of great value, especially when it is necessary for the patient to be 
up and about. Diet depends on the underlying condition, and should usually be anti- 
lithemic. Rest in bed is important in severe cases. Massage is often employed with 
benefit. [Compare Lithemia, Myalgia, Rheumatism.] 

]$. Collodii, ; R<. Ammonii Chloridi oj- 

Tinct. Iodi., Fluidcxtr. Cimicifugae, 

Spt. Ammoniae, aa part. aeq. Syr. Simplicis, aa. 5j- 

Sig. — Paint over the part with a camel's- Aq. Laurocerasi, . . .q. s. ad gvj. 

hair brush. (Burggraeve.) M. Sig. — A dessertsp. every four hours. 



Lung Diseases. 

Aconite, is indicated in most acute congestions (P); is especially indicated for 
inflammatory states of the respiratory organs (R); Belladonna, in doses of nj»j of the 
tincture frequently, is of great benefit in pulmonary edema, to retard exudation of serum 
and to counteract failure of the heart (Smith). Terebene, is very valuable in many 
morbid conditions of the lungs. Terpin Hydrate is equally efficient and more easily 
administered. Thiocol was given with excellent results in pulmonary abscess following 
pneumonia (Braun). Ergot is useful in pulmonary congestions (W). Ammonium 
Acetate, serviceable not only in bronchitis, but in the whole range of acute pulmonary 
complaints occurring in children (Dessau). [See under Bronchitis, for formula;. J 
Veratrum Viride renders important service in acute parenchymatous congestions (B); 
gr. £ of resin in pill when temperature and pulse are high ; it tends to induce prostration 
and collapse (A). Blisters, flying blisters to chest, and perhaps along the pneumo- 
gastric in hypostatic congestion (R). Copaiba, exercises a powerful influence over the 
pulmonary mucous membrane, and is beneficial in lung diseases generally, when attended 
with excessive secretion (Wa). Pilocarpus is serviceable for the attacks of breathless 
ness attendant on lung affections, but must be watched lest collapse ensue (Berkart). 
Liq. Potas. Hydrox., doses of ircx-xv added to an ordinary expectorant mixture, is often 
attended with good results in congestions of bronchi and lungs, chronic bronchitis, 
plastic bronchitis (Walshe). Cimicifuga, is a useful sedative in many irritative affec- 
tions of the lungs and bronchial tubes, relieving cough, improving appetite, and ameli- 
orating the general condition (Wood). Croton Oil, as liniment, is a higlhy useful 
counter-irritant in many chronic lung diseases, and even in the bronchitis of infancy 
(Park). Cubeb, in small and oft-repeated doses, is efficient in chronic bronchitis and 
other lung affections of old persons, checking the excessive secretion and gently stimu- 
lating the system (Wa). [Compare Bronchitis, Emphysema, Hemoptysis, Phthisis, 
Pleuritis, Pleurodynia, Pneumonia.] 



Lungs, Gangrene of. 

Creosote, by inhalation, to obviate the fetor (R). Phenol, in spray as inhalations, 
used with marked benefit (Wa). Mineral Acids, especially Nitro-hydrochloric, with 
Quinine, the main reliances in chronic pulmonary gangrene (A). Stimulants, as 
malt liquors, with general tonic treatment, are necessary (A). Ammonium Carbon- 
ate, one of the most reliable remedies; is best given in decoction of Cinchona (Wa). 



i rrrs. 

Myrtol in doses of mij-ij several limes daily, is an efficient disinfectant ami alterative. 
Eucalyptus, the Oil with Alcohol, equal parts of of which ,~>i as inhalation 

steam atomization, is useful (Wa). Turpentine, the spirit on boiling water inhaled 

for fifteen minutes every two hours, successfully employed (Skoda). [Compare I'niii 

Pneumonia.] 

Lupus. 

Iodine is useful in lupus, whether syphilitic or scrofulous, the tincture or a glycerin 
solution locally (Hebra); the tincture or liniment applied to the edges and around" them 
(R); it may also be employed internally. Thymol Iodide has given excellent results 
as a dressing (Eichoff). Mercury, in small doses, is one of the constitutional remedies 
which should receive a fair trial (Whitla); as ointment in lupus erythematosus, and in 
form of Calomel ointment in scrofulous and tubercular lupus of children (R); internally 
Calomel in doses of i to 2 grains increased to 4 grains, will quickly check it (Wa); the 
Emplastrum Hydrargyri is very efficient in lupus erythematosus and allied affections 
1 K.ohn). Salicylic Acid, is the most typical member of the group of agents which have 
selective action on the new growth and destroy it with the least amount of injury to 
healthy tissue (Whitla); as dressing, Salicylic Acid 5, Creosote 5, Glycerinum Saponatum 
00, after destruction of the growth, has given good results where no scraping nor any 
other operation was performed (Hebra). Lactic Acid, seeks out the diseased tissue, as 
a dog does game, surely finds it and effectually destroys it (Hortmann) ; the concentrated 
acid should be used, either alone or as a paste made with Kaolin. Lead, the Liquor 
1'lumbi, with 1 or 2 of glycerin, in the milder forms, applied warm after the removal of 
the crusts (R). Jequirity, is a good application to destroy the diseased tissue by setting 
up the jequirity inflammation (Shoemaker). Sodium Ethylate, on absorbent cotton, 
is the best of the caustics, followed by Bismuth Oleo-palmitate as a soothing and astrin- 
gent application (Id). Phenol, as a mild escharotic (B); the pure phenol applied 
to the elevated border, a portion at a time, every 2 or 3 days (Licorish). Iodoform 
gr. ij to the 3 of Collodion, applied to the whole patch after the border has been treated 
fully by Phenol; the thick coat thus formed should remain until it drops off, when 
most cases will be found cured (Id). Arsenic, in chronic cases not of syphilitic origin; 
Fowler's solution long continued exerts a curative influence, also Arsenic Trioxide locally 
(B); the best remedy in lupus of the head and face (Wa); the Oleate in ulcerating 
forms, constantly applied, will destroy cell infiltration in a mild and comparatively pain- 
less manner; it is also well employed in the tubercular variety (Id). Phosphorus, 
as an internal remedy, may be used as a substitute for arsenic (B). Aurum Arsenate, 
internally, is said to be serviceable. Aurum salts, locally and internally, have proved 
curative; the Chloride has been used as a caustic (P). Zinc Sulphate, dried, freely 
dusted over the surface as a caustic, followed by a poultice to remove the slough (B). 
Silver Nitrate, a weak solution gradually strengthened, may be used in superficial 
forms (R). Chromic Trioxide, in solution, 100 grains to 5j of distilled water, is an 
efficient escharotic (B). Formalin locally, caused marked improvement in lupus of 
4 to 5 years' standing (Scatchard). Guaiacol and Glycerin, equal parts, applied twice 
daily to the lesions (Leplat). Thiosinamin in 15 to 20 per cent, alcoholic solution hypo- 
dermically (Hebra). Thyroid Extract, has been used as a stimulant of cutaneous 
functional activity with most satisfactory results. Tuberculin, in this disease has 
excited great interest, but the best authorities deny that its use has produced a single 
absolute cure; yet combined with surgical methods it will give good results (Whida). 
Scraping off the diseased tissue with Volkmann's spoon under anesthesia, is the most 
radical and satisfactory of the mechanical procedures (Id); the Paquelin cautery is 
better than the spoon for removing the morbid tissue (Unna). Electrolysis, has given 
good results in Jackson's hands, who reports that the electrolytic action of the current 
seems to expend itself only on the diseased tissue. Cauterization, with the actual 
cautery at white heat, after scraping out as much as possible of the diseased tissue, so 
as to destroy the lupus cell. Phototherapy, the violet and ultra-violet rays of sunlight 
or of electric light from lamps of 80 ampere power (Finsen); cured 149 cases at the 
London Hospital, and 600 cases were thus treated at Copenhagen with astonishing 
47 



722 



LYMPHADENOMA — LYMPHANGITIS — MALARIA. 



success. Roentgen Rays have proved curative in lupus erythematosus (Woods); 
cured a case of lupus vulgaris of 15 years' standing (Smith); are rapidly curative in the 
sebaceous form of lupus erythematosus (Harris). 



B- Iodi, 

Potassii Iodidi, aa 5ss. 

Glycerini, 3j- 

M. Sig. — Locally in lupus. 

{McCall Anderson.) 



B- Ung. Arseni Oleat., 3ij- 

Ung. Simplicis, 3j. 

M. ft. unguentum. Sig. — Use constantly 
over the affected surface. If pain sets in 
Opium may be added. {Shoemaker.) 



B- Hydrargyri Bromidi, 5jss. 

Adipis, 3v. 

M. ft. unguentum. Sig. — To cover the 
part affected, using Cod-liver Oil freely, and 
the following solution internally. In tuber- 
cular lupus of the face. {Hardy.) 



B- Potassii Iodidi, gr. lxxv. 

Sodii Chloridi, gss. 

Aq. Destil., Sviijss. 

M. Sig. — Teasp. before meals, night and 
morning. {Hardy.) 



Lymphadenoma — Hodgkin's Disease. 

Arsenic is by far the most successful remedy, both in acute and chronic cases, 
several having been recorded in which the glandular swellings have disappeared and 
the patients have recovered under its influence (Murray); large doses, njjxv-xx of 
Fowler's solution, arrived at by gradual increase, should be maintained until some 
physiological effect is produced (Ty); injected into the lymphoid masses has given 
good results, especially when not well borne by the stomach (Id). Phosphorus, has 
had good effects in a few cases, and should be used if arsenic is not well borne (Gowers). 
Iodine and Potassium Iodide, have been used but with little benefit; the latter may be 
distinctly harmful (Murray). Quinine, Iron and Cod-liver Oil, as tonics; every 
means must be employed to support the patient's strength (O). Organic Extracts, 
of spleen, thymus and other glands, are being tried but with no very decisive results as 
yet (Murray). Bone-marrow is perhaps worthy of trial, §j of fresh ox marrow thrice 
daily for an adult (Id). Local Treatment, by applications to or injections into the 
diseased glands, has reduced their size but has no influence on the progress of the disease 
(Id); is of doubtful benefit (O). Extirpation of the diseased glands, in suitable cases, 
especially where the enlargement is confined to one group, when the spleen is not gready 
enlarged and when there is neither fever nor marked anemia, may arrest the disease and 
is the proper treatment (Murray) ; if the number of red corpuscles is below 60 per cent, 
removal should not be attempted (Gowers). [Compare Anemia, Leucocythemia.] 

Lymphangitis. 

Belladonna, the extract softened with glycerin and freely applied, is of great ser- 
vice; when pain is severe a poultice may be applied over the extract for a few hours 
only (Wa). Lead, Liq. Plumbi Subacet. Dilutus, as an external application, con- 
stantly applied, to soothe and restrain the inflammation (Wa). Iodine, in strong 
tincture, applied around the glands, to prevent suppuration (Roberts). Quinine, or 
Salicin, with alcoholic stimulants freely, in septic cases (Id). [Compare Bubo.] 



Malaria, Chronic. 
Arsenic plays an important role in chronic malarial disease (B) ; diminishes splenic 
engorgement, and combined with Iron is rapidly curative of many affections due to 
malaria (Boudin) ; is a powerful prophylactic against malaria, and in chronic malarial 
poisoning, with frequent return of fever and neuralgia, its continued use is of great 
benefit (Fayrer); is of especial value in nervous affections due to malaria, but large 
doses are required (Wa). Arrhenal is of especial value (Gautier). Quinine is less 
efficient in chronic malaria than when the infection is recent, but in periodical affections 
depending on the malarial cachexia it is of specific value, large doses being required (B); 



MANIA. j 2 -, 

indiscriminate use of quinine as a prophylactic in malarial countries is attended with 
a danger, seriously weakening the action of the heart and so inuring the subjei i to 
its action that it has no longer any value of importance as a remedy (Koch), Salicy- 
lates, of Quinine and Cinchonidine are especially effective in chroni< malarial di 
(B). Saloquinine is tasteless, devoid of unpleasant effects, and vei at. Iron, 

the Sulphate has decided antiperiodic power, and is particularly successful in anemic 
subjects and in those with enlargement of the spleen i\\a); it improves the 
chronic malaria, and should generally be combined with Arsenic ( B). Iron and Man- 
ganese Iodide, the syrup in doses of njxx-xxx, is a successful remedy for chronic 
malaria (B). Manganese Sulphate, gives excellent results in jaundice of malarial 
origin (B). Cornus, Calumba, and other bitters are highly efficient, especially the 
first named, in chronic malarial poisoning and in convalescence after malarial fever 
(B). Phenol and Iodine in combination, are of great value in chronic malarial 
infection; both are highly antiperiodic, and the latter is the best substitute for Quinine 
and the most active reducer of splenic enlargement (Gimwell). Eucalyptus, is of high 
utility to reconstruct damages in the organs of assimilation (B). Nuclein, has been used 
with benefit (Vaughn). Baths, the vapor-bath and Turkish baths are efficient aids to 
medicinal treatment in breaking up chronic cases, and may of themselves cure such by 
inducing profuse perspiration (Da C). [Compare Hemoglobinuric Fever, INTER- 
MITTENT Fever, Remittent Fever.] 

1$. Cinchonidinae Salicylate 5ij- j R. Quinine Sulph., gr. xl. 

Arseni Trioxidi, gr. j . Ferri Sulph. Exsic, gr. xx. 

Ferri Sulph. Exsiccat., gr. xx. Arseni Trioxidi, gr. j. 

M. ft. pulv. no. xx. Sig. — One powder I M. ft. pil. no. xx. Sig. — One pill thrice 

in wafer thrice daily. ' daily. 



Mania. 
Stramonium, of value; allays irritation and induces tranquil sleep; in wild and 
furious but intermittent delirium, also in nymphomania (P); many facts seem to confirm 
its reported value (Tr). Daturine, gr. T^o-i/,! hypodermically in acute mania, but is 
less useful than Atropine or Hyoscyamine (Wa). Duboisine, gr. s \ hypodermically in 
acute mania (Gubler); is more sedative and hypnotic than the other alkaloids of the 
group and acts well in doses of gr. y^ at first, gradually increased to gr. /, y . Bella- 
donna is useful, especially in monomania with fixed hallucinations, though a large 
dose causes a temporary insanity (Tr); one of the very best remedies in all hyperemic 
conditions of the brain (P). Hyoscyamus, in violent intermittent forms, to procure 
sleep and calm violent delirium (R) ; delirium with hallucinations but not congestion; in 
milder and less inflammatory forms, also in hypochondriacal monomania (P). Hyos- 
cine, finds its greatest and most useful application in the treatment of maniacal violence 
and noisiness, and is a drug for emergencies of this kind (Weatherly). Veratrum 
Viride, successfully combats the excitement in acute mania (B). Camphor, has 
been used successfully; its action is uncertain (P). Opium with Tartar Emetic is 
satisfactory for many cases; also Morphine hypodermically to induce sleep (R); its nar- 
cotic effect is of doubtful utility, better in insanity with depression (P); will not produce 
narcotism in many such cases, even in 2-grain doses. Apomorphine, gr. >V-£ hypo- 
dermically, as a sedative and hypnotic (Rabow). Chloral stands in the first rank as 
a calmative and hypnotic (Palmer); has induced mental improvement in mania (B). 
Trional in doses of gr. xxx every 2 to 4 hours, is a reliable remedy for maniacal excite- 
ment (Palmer). Bromides are used in puerperal mania, that of pregnancy, nympho- 
mania and other forms (R); the combined use of Potassium Bromide and Tinct. of 
Cannabis Indica, equal parts, 5j of each thrice daily for weeks and months, has proved 
very efficient in acute and periodical mania, senile mania, and other forms (Clouston). 
Paraldehyde, as a hypnotic, in doses of oss-j, is often decidedly useful (R); larger 
doses are necessary, an average one is oiss. Conii'ne, most suitable to acute mania, 
quiets muscular action; doses of njss-iij, or hypodermically, beginning with gr. 1 1 ,,; 
with Morphine conjointly injected, is very successful (R). Digitalis, 5ss-3j of tinct. 



724 MASTITIS — MASTODYNIA. 

valuable in acute and chronic mania, especially when complicated with general paresis 
and epilepsy (Maudsley); caution! watch the pulse for any marked intermittence (B); 
a very valuable palliative in acute mania (Van der Kolk). Ergot, large doses, 3ss-j 
of fluidextract, to reduce excitement, shorten attacks, widen intervals between them, 
and prevent exhaustion, hence is very useful in recurrent and epileptic forms, and in 
chronic mania with lucid intervals (Crichton Browne). Iron, as a restorative, is fre- 
quently used in chronic mania with benefit, the tincture of the Chloride in 5-10 minim 
doses (B). Gelsemium, is useful in mania with great motor excitement and wake- 
fulness; large doses required, ttj»xv-xx of tincture. Croton Oil, as a purgative, w\~h 
every hour, as revulsive in mania from cerebral congestion (R). Cimicifuga, is often 
efficiently used in cases of mania occurring during the puerperal or pregnant condition 
(R). Chloroform, may be necessary to control very violent cases temporarily; its 
inhalation need not be carried to complete anesthesia. Galvanism, of the head and 
cervical sympathetic, has produced distinct improvement (B). Cold Douche, in 
maniacal delirium, the patient being in a warm bath during the application of the douche 
to the head (R). Removal from home, from sympathetic friends, and from surround- 
ings connected with the origin of the malady, is a prime necessity to a cure. [Compare 
Delirium, Insanity, Puerperal Mania.] 



Mastitis. 

Belladonna, Atropine locally [see Lactation], or combined with Morphine and 
Chloral, when much pain (B); especially as liniment to check secretion of milk when 
inflammation is imminent (R); or when breasts are distended by milk (P); when in- 
flammation has set in, continuous application of Belladonna for 24 hours often arrests 
it; also useful when abscess has formed; fomentations in addition, but skin must be 
dried well before the Belladonna is rubbed in (R); ir$y-x of tinct. internally at the same 
time (P). Camphor, a saturated solution in glycerin locally, in mammary congestion 
threatening abscess (Wa). Phytolacca, has power to arrest inflammation of the 
mammae and to prevent suppuration; the fluidextract in 10-minim doses internally, 
and the solid extract to the inflamed breast (B). Conium, the extract in small doses 
several times a day, of striking benefit in mastitis and impending abscess of breast (Wa). 
Calcium Sulphide, internally in mammary abscess; occasionally increases pain (R). 
Hyoscyamus, as plaster, to relieve painful distention from milk (P). Stramonium, 
fresh leaves as cataplasm to discuss indurated milk (P). Iodine, tinct. and ointment 
to remove indurations of breasts after inflammation (B). Mercury and Morphine, 
the Oleate locally in mammary abscess (R). Tobacco leaves, as poultice in abscess 
(R). Digitalis, the infusion locally as fomentation in severe inflammation of the 
breasts, causes it to yield speedily (Fairbank). Ichthyol with an equal part of water, 
gently rubbed in, is very efficient (Schmitz); a 30 per cent, mixture with mucilage 
applied early will prevent suppuration (Akerblom); in ointment to fissured breasts 
diminishes the pain of nursing (Behren). Ammonium Chloride, 3j in Spt. Rosmarini 
Oj, as lotion on linen cloths, constantly applied, especially in induration after the abscess 
has suppurated (Wa). Tartar Emetic, in small and frequent doses, given early, is 
beneficial (Wa). Oil frictions in first stage of inflammation of breasts, from circum- 
ference towards the nipple (L). Rest, by supporting mammae with strips of plaster, 
and bandaging the arm to the side, to prevent motion (T). Alcohol, over proof, 
applied by sponging until part is cold; renew if high heat returns. Heat, applied by a 
basin lined with flannel saturated with hot water, to relieve pain and prevent suppura- 
tion. [Compare Abscess, Lactation.] 

Mastodynia. 

Conium, has specific anodyne action on the mammae and generative organs. Cimi- 
cifuga, relieves infra-mammary pains of uterine origin in spinsters. Olive Oil, 2 
parts, to 1 of Tinctura Opii, may be used by gentle friction to painful breasts after par- 
turition (Parvin). Non-interference is best in simple cases of enlargement and 



MEAS1 ES MM VNCH01 I \. 



7-5 



tenderness, which will spontaneously subside ii let alone; in severe cases support by 
strips or bandage, if breasl pendulous; Belladonna ointment or liniments; amputation 
of the breast Has been necessary I l' 1 



Measles. 
Aconite, for febrile symptoms, and especially to arresl the catarrhal pneumonia 
; a valuable remedy (P); the host drug when fever is very hig ip doses of the 

tincture every 2 hours (Da C). Pilocarpus, with a hot bath, as a diaphoretic in 1 
of delayed eruption (Da C). Asclepias, an infusion or decoction freelj as a diapho 
to promote the eruption (W). Veratrum Viride, has been employed (R). Pulsa- 
tilla, for the catarrhal ophthalmia, nasal and intestinal catarrh; 5j ij of tincture to 
5iv water as wash (P). Ammonium Carbonate, dissolved in a solution of the 
Acetate, is much vaunted; when feeble circulation, cyanosis, delirium, gr. v-x to ■ 
oj Liq. Ammonii Acctatis (B); gr. iij-vj orvij, every hour or two, in Cinnamon-water 
or milk; one of the reliable remedies (W). Camphor, the water with Liq. Amnion. 
Acetatis, excellent when cough and catarrh the most urgent symptoms (A), Ipecac- 
uanha, for cough and catarrh, gr. j-ij every 4 or 6 hours (A). Antimony, preferred 
to Ipecac by some (A). Quinine, in small doses, gr. j-iij, for the adynamia, or large 
doses, gr. xv, for hyperpyrexia and catarrhal pneumonia (B). Phenol, has been 
employed in several hundred cases with decided advantage; most useful at early stage 
(\Ya). Cod-liver Oil and Iron, to scrofulous children, a long course of such medica- 
tion after convalescence (Da C). Purgatives, must be given with caution (R); the 
milder purging salts, as Magnesium Sulphate, to be preferred (A). Mustard, as 
bath on sudden retrocession of rash (R); often increases the fever without benefiting 
the pneumonia or other complications (A). Water, cold affusion at commencement; 
packing, especially when retrocedent (R); hot foot-baths for convulsions (A); tepid 
bath with cold douche to head, if cerebral symptoms are severe (Da C). Ichthyol in 
25 per cent, ointment with lard, over the entire body twice daily, gives excellent results 
in abating the disease (Strisover). Inunction with Cacao-butter is very grateful to 
the patient and reduces the temperature (B); a firm fat rubbed over the hands and feet 
to relieve the heat and tightness of the skin (R). Diet, a low diet chiefly of fluids, 
giving no animal food. Hygiene, dark room, complete disuse of eyes, strict cleanliness 
(A). [For Sequelae see Bronchitis, Cough, Ophthalmia, Otorrhea, Pneumonia.] 

R. Phenolis, 

Acidi Acetici, aa. 3j- ojss. 

Tinct. Opii Deodorati, 

Spt. Chloroformi aa 3j- 

Aquas, q. s. ad §viij. 

M. Sig. — A tablespoonful every 4 hours, 
until fever abates. (Keith.) 



R. Tinct. Tolutana;, 5ij. 

Syr. Senegae, oss. 

Acidi Acetici, ojss. 

Syr. Pruni Virg q. s. ad §iv. 

M. Sig. — A teaspoonful as required for 
cough after convalescence. 



Melancholia. 
Aurum, gives excellent results, gr. ^ to ^ of the Chloride thrice daily, especially 
when cerebral anemia coexists (B); the Bromide of Gold and Arsenic has rendered 
good service in many cases, njx hypodermically thrice daily: Gold is highly recom- 
mended in suicidal melancholia. Bromides, sometimes afford relief which no other 
agent will; no indications (B); Potassium Bromide for townspeople, especially women 
with unendurable despondency (R). Arsenic, gives great comfort in the melancholia 
of aged persons, is best when combined with small doses of opium, thus — Liq. Potas. 
Arsenit. njij, Tinct. Opii, njfiij-v ter die (B). Opium, in stimulant doses of tincture, 
gives good effects (B); especially when paroxysms of acute anguish and despair, or 
when suicidal impulse (Wa); Morphine hypodermically is of great benefit in some 
persons who have a peculiar idiosyncrasy therefor (R). Camphor has been highly 
recommended (R). Musk and Castoreum are employed in melancholia with benefit 
(R). Cannabis Indica, sometimes relieves (B). Phosphorus, depression from over- 



726 MENINGITIS. 

work (R). Chloral, as hypnotic, has been followed by marked amelioration and cure 
(Wa). Valerian, in hysterical or suicidal melancholia, is often beneficial (Wa). 
Caffeine has been useful (B). Iron, as restorative, the tincture of the Chloride (B). 
Cocaine, a useful tonic and especially beneficial in nervous affections accompanied 
by depression (Br). Cimicifuga, in puerperal or uterine despondency, of singular 
value (P). Ignatia, has soothing effect in great mental depression (P). Orchitic 
Extract, has been used with benefit. Water-cure, shower-bath for 15-20 seconds, 
or warm -bath, 95 ° F. for 30 minutes; the shower or cold douche may be usefully em- 
ployed in cases where reaction takes place after it (W). [Compare Hypochondriasis, 
Hysteria, Insanity.] 

Meningitis, Cerebral. 

Aconite, is as serviceable in this as in the other acute inflammations; during the 
stage of excitation, the tincture, gtt. ij with gtt. v of the tincture of Opium, every 2 hours, 
gives admirable results (B). Belladonna, in all hyperemic conditions of brain and 
spinal cord one of the very best remedies, especially during the period of excitement (P). 
Hyoscyamus, valuable in subacute form (P); for nervous irritability during con- 
valescence (A). Gelsemium, extremely useful; n$y of fluidextract every 2 hours (B). 
Mercury, as ointment gives good results in children (A); Calomel in small, frequent 
doses, so as to bring the system under it quickly, a most valuable remedy apart from 
its purgative effects (W); the Unguentum Hydrargyri rubbed for 30 minutes into the 
skin on the front of the abdomen, groins and arm -pits, repeated after 12 hours if no 
evidences of improvement or salivation; such unmistakable benefits follow the free 
use of mercury that to withhold this remedy in desperate or apparently hope.less cases 
is unjustifiable (Whitla). Potassium Iodide in large doses where vomiting and gastric 
derangement are absent, and in the later stages of syphilitic meningitis may be very 
valuable (Id); has cured (Niemeyer). Ergot, the fluidextract in 3ss doses with an 
equal quantity of Potassium Bromide, every four hours, to diminish the vascular excite- 
ment (B). Potassium Bromide, in the convulsions following simple meningitis (R). 
Opium, in small doses; by clinical evidence proved to be the best remedy, especially 
for acute stage before exudation, or during the stage of excitation (B) : when collapse, 
it may sustain the vital powers; with Tartar Emetic has proved most beneficial, but 
should be used with caution, as it may do great harm (Wa). Bryonia, exceedingly 
valuable for serous inflammations in stage of effusion (P). Pulsatilla, valuable in 
the acute form (B). Purgatives, as soon as possible, unless exhaustion; Calomel 
and Jalap the most active and searching (A) ; Croton Oil as a derivative and revulsive, 
also locally to the shaven scalp is productive of the best results (Wa). Venesection, 
or arteriotomy (temporal artery) gives good results (B); when high cerebral excitement 
and vascular action (A). Blisters, on nape of neck if coma, after active symptoms 
are subdued (A)* useless, and cause needless suffering (O). Water, cold water for 
hyperpyrexia (C); pounded ice in bag or bladder, as a cap to the head (R). There 
are no remedies which in any way control the course of acute meningitis (O). [Com- 
pare Meningitis, tuberculous.] 



Meningitis, Cerebro-Spinal. 

Opium, in small doses is the most effective remedy; its utility ends when effusion 
occurs and stupor and coma ensue (R) ; large doses (Valleix) ; gr. j every hour in very 
severe cases (S); has been used in France and Germany with much success (Tr); is 
the best remedy in doses of gr. j every hour for 4 days, even such doses will not narcotize 
the patient in this disease (Da C). Bromides to guard the Opium and enable the 
latter to be pushed, doses of gr. xx every 4 hours (Id). Antipyrine was very efficient in 
the epidemic among the Boer prisoners (Freeman). Aconite, is useful combined with 
Opium (B) ; affects the cranio-spinal axis from 3d nerve to phrenics, the region where 
this disease is most manifest (Harley). Gelsemium, extremely valuable, njiv of fluid 
extract every 2 hours, to maintain constant physiological effect (B); is efficient for the 



MENINGITIS. 727 

delirium. Belladonna, in all hyperemic conditions of brain and spinal cord, espei ially 
daring stage of excitemenl (P). Iron, the tincture of the Chloride, in ainini 

doses, ever) two hours, suggested by the similarity of the disease to eryrip aade 

many successful euros without leaving any sequelae (Klapp). Ergot is one . 
remedies (B). Digitalis is valuable in the early stage (Rummel). Collargol 
inunction in the suppurative form (MargueO. Hydrocyanic Acid, dilute, "t'j-ij with 
gr. iij-vof Sodium Bicarbonate, every 3 or 4 hours for severe vomiting 1 1 lelafield). Qui- 
nine, in large doses at the commencement (B); has been exhaustively tried in this 
disease and tailed (Da C). Potassium Iodide for the sequelae, a long course of Iodides 
during convalescence is the best treatment (Da C). Turpentine by enema as a deriva- 
tive (B). Counterirritation by the actual cautery freely applied to the back, relieves 
the pain (A); a valuable method in the chronic form (W)'. Cold to the spine, the most 
satisfactory treatment (Radcliffe); to the head and upper spine for 5 minutes only at a 
time, for the headache and tetanic symptoms (Da C). Heat to the body, except the 
head and neck (Id); hot-water bottles or hot sand-bag to the trunk and extremities 
to keep up the body warmth; bath of io2°-io6° F. for a short time only (A). Vene- 
section, or arteriotomy (the temporal artery) is probably of service (B); leeches to 
:he temples and back of the neck if the patient is vigorous, to relieve the terrible head- 
ache (Da C). Lumbar Puncture and hot baths, have cured many cases of the sup- 
purative form (Netter). Diet, nutritious and suitable food at short intervals, day and 
night (A); tonics with fresh air and good diet during convalescence (A). Ventila- 
tion, of dwellings, the best sanitary precaution when the disease is epidemic (Simon). 



1> . Morphinse Sulph., gr. ss. 

Ac. Sulphurici Aromat.,. . . . 5j- 

Tinct. Cinchona? Co., ad Svj. 

M. Sig. — Tablesp. every 2 hours, for a 
boy 12 years old. {Meigs &° Pepper.) 



R. Potass. Iodidi, 5iv. 

Tinct. Gentian. Comp., 
Syr. Sarsaparilla? Co., . . . .aa oij- 
M. Sig. — Teasp. thrice daily, to promote 
absorption during convalescence. 



Meningitis, Spinal. 

Aconite, is very useful (B); with an Ergot and Opium impression to reduce the 
amount of blood in the vessels of the cord (Da C). Potassium Iodide, in the chronic 
form, with the Bichloride of Mercury when a specific history present (Hammond). 
Belladonna, strongly to be relied on, even when brought on by external violence (P). 
Bryonia, in serous inflammations when effusion, is extremely valuable (P). Purging, 
by Magnesium Sulphate, combined with Tinct. Hyoscyami (A). Quinine, when 
paralysis occurs, in 3-grain doses thrice daily, with J-grain doses of Ext. Belladonna;, 
or 20-30-grain doses of Potassium Iodide, and flying blisters along the spine (Da C). 
Opium, in some form, must be used for pain (Bastian). Mercury, gr. T V of the Bichlor- 
ide, with increasing doses of Potassium Iodide, to promote absorption of inflammatory 
products, if the inflammation subsides (Bastian); a mercurial impression often benefits 
the paralysis (Da C). Mercury is the only drug which has any influence on the acute 
process; it is best given by inunction (Risien Russell). Cold, by ice to spine is deemed 
necessary, and no doubt alleviates the pain, though heat would be a more rational appli- 
cation for the inflammation (Bastian). [Compare the preceding article.] 



Meningitis, Tuberculous. 
Potassium Iodide, is the routine remedy, to be administered in ordinary typical 
cases, full and frequently repeated doses are necessary, gr. j every 2 hours for a child 
of 2 years (Whitla). Iodine, lotions to scalp, or inunction of Iodine ointment together 
with Ferrous Iodide and Cod-liver Oil internally, offer the best chance of success. 
although most remedies often fail (Wa). Potassium Bromide, combined with the 
Iodide in double the dose of the latter, is advantageous (Whitla). Tartar Emetic, 
the oint. as counter-irritant to scalp in tubercular meningitis (R); in large doses inter- 
nally was formerly employed (Wa). Croton Oil, is said to have removed the excess 
of fluid from the ventricles (R); as a derivative and revulsive, also locally to the shaven 



728 MENORRHAGIA. 

scalp, is productive of the best results (Wa). Mercury, the Bichloride internally has 
proved a successful remedy (Wa); mercurial inunction should be used heroically as 
long as there is any reason to doubt the diagnosis, in the hope that the case may be one 
of simple meningitis (Whitla). Magnesium Carbonate, 5j-ij saturated with Lemon- 
juice, every 2 or 3 hours, a useful purgative in hydrocephalus (Wa). Turpentine, 
in doses of n^v-x with njjxx-xl of Castor Oil, or terebinthinate enemata, in incipient 
hydrocephalus (Wa) Purgatives, in small doses, every 4 or 6 hours after having 
overcome the constipation, to maintain action for some days; a single dose of Calomel, 
followed up by Magnesium Sulphate at short intervals; their value can hardly be over- 
rated (Wa). Leeches, on crown of "head rather than on temples, when much febrile 
action; inadmissible if patient is much debilitated ; sometimes serviceable (Wa). Cases 
of recovery have been reported by reliable authorities, but they are extremely rare, and 
there is always a reasonable doubt as to the correctness of the diagnosis. I have never 
seen a case recover which I regarded as tuberculous (O). [Compare Hydrocephalus.] 

Menorrhagia. 

Opium, has specific action in reducing the uterine circulation and should be pushed, 
even to inducing habit, in severe cases (Lutaud). Cotarnine is a powerful vaso-con- 
strictor and is almost specific in uterine hemorrhage (Boldt); is efficient in uncomplicated 
cases (Gartig) ; the Hydrochloride gr. j every 2 or 3 hours, or gr. ss 4 times daily for a 
few days before the expected period in habitual cases. Hydrastinine arrests uterine 
hemorrhage and is successfully used in menorrhagia (W); gr. j of the Hydrochloride 
hypodermically for immediate effect, by the mouth for prolonged action. Ergot, large 
spongy uterus; Bromides better (B); Ergotin, gr. j or ij in glycerin and water, undoubt- 
edly efficacious as hypodermic injection (P); in all forms (R); minim doses of the fluid 
extract are very beneficial (Smith). Bromides, usually arrest promptly (B); that of 
Potassium most useful in young women if loss occurs at period only; commence the 
Bromide a week before and discontinue when discharge ceases till a week before the 
next term; if loss occurs every two or three weeks give Bromides continuously in 10- 
grain doses, but more when organic changes in womb (R, Wa). Potassium Chlorate 
or Bromide, in doses of gr. xv thrice daily, combined with Ergot, has an almost infalli- 
ble influence over uterine hemorrhage, unless caused by cancer, polypi, adherent placenta, 
or other similar affections (Tait) . Cannabis Indica, often successful (R) ; gtt. v-x of 
tinct., thrice daily, productive of extraordinary success (Wa); has a stimulant action 
on the uterine muscular fibre, and may be given in combination with Ergot (B). Gos- 
sypium, a favorite uterine hemostatic in many hospitals, 30-minim doses of the fluid 
extract every four hours (Parvin). Quinine, has been recommended (R); after Ergot 
it is the best agent, in 6-grain doses every 3 hours (Parvin). Saloquinine is very effi- 
cient in profuse menorrhagia. Digitalis, very useful, especially when from heart 
disease, in plethoric subjects (R); 5j-jss of infusion will arrest menorrhagia when 
unconnected with disease (P, R). Aloes, with Iron in debilitated and relaxed sub- 
jects (B). Gallic Acid is very efficient (R). Calcium Chloride gr. vij every 2 hours 
increases the coagulability of the blood and is an efficient hemostatic (Gross). Cal- 
cium Phosphate in anemia due to excessive menstruation (R) ; in the menorrhagia of 
anemic subjects (Schonian). Ipecacuanha, in full emetic doses (Wa); is excellent 
(B); Ergot is better (P). Savin, enlarged, relaxed, and passively congested uterus 
(B); in 5-10 drop doses of tinct. in water every half-hour to three hours, has proved 
useful (P); when menorrhagia due to want of tone in uterus (R). Erigeron, the Oil 
in doses of ttjx is efficient (Wa); is especially valuable (W). Rue when there is a low 
vascular tonus (B). Iron in cases due to anemia (B). Hamamelis is of high repute 
(Pf). Cimicifuga in passive form, the blood being coagulated and dark colored 
(P); for the accompanying headache (R). Ammonium Chloride for the headache 
(R). Magnesium Sulphate, very small doses with a little dilute Sulphuric Acid and 
syrup, is exceedingly useful (Wa). Cinnamon, the Oil, in drachm doses (R). Mam- 
mary Extract, gave signal satisfaction as an internal remedy in two cases of menorrhagia 
with dysmenorrhea and enlarged uterus (Bell); is of benefit (Shober). Thyroid Ex- 
tract will prove of service. (W). Water, hot water bag to lower dorsal and lumbar 



Ml NSTRI \i DISORD] RS Mil RORRB M.I \. 






vertebra (R); cold sit/ bath, feet in warm water, especially valuable; oo -6s° !•'., for 
5-15 minutes, patient then quickly dried and put to bed. [Compare M 1 1 RORRB \<-i \ 1 

U. Fluidextr. Ipecac 3ij. ty. 1 piil.l.) gr-Jdj. 

Fluidextr. Ergotse T>iv. , Rr . v j, 

Fluidextr. Digitalis 7>ij. dh , in nil. no. xij. 

M. Sig. — A half teasp. to a teas] Sig.— One pill every hour, Id profuse 

required until emesis occurs. (B.) menstruation of atonii type. 

Menstrual Disorders. 

Aconite, gtt. j of tinct. every half-hour or hourly promptly restores the discharge 
when suddenly suppressed from chill (P, B, R, Wa); as emmenagogue (Tr). Pulsa- 
tilla, often of the greatest value when menses scanty or delayed, or suppressed l>v 
flight or chill (P, B). Ignatia, in the suppression of hysteria (P). Savin, a powerful 
uterine tonic; as emmenagogue certain, powerful, safe (P). Ferrum, in anemic sub- 
jects (B). Aloes, as emmenagogue [see Amenorrhea]. Cocculus Indicus, for 
irregular menstruation with colicky pains and scanty discharge; should be given for a 
few days prior to and during period (P); nRij-iij of a saturated tincture thrice daily. 
Opium, in suppression from violent mental emotions, a valuable remedy (Wa); in 
many menstrual disorders it proves invaluable, but must be cautiously administered 
lest the habit be formed. Saloquinine in doses of gr. xxx, is very efficient for menstrual 
colic. Cimicifuga, relieves heat and pains in the head, flushings of the face, pains in 
back and limbs, when occurring as the result of menstrual perversion (Wa). [Compare 
Amenorrhea, Dysmenorrhea, Menorrhagia, Climacteric Disorders.] 



Metritis. 

Opium, by suppositories or enema is more effectual than if administered internally 
(Wa). Aconite, is invaluable in early stage of simple inflammatory fevers (P). Ich- 
thyol in 5 per cent, mixture with glycerin or vaginal tampons, is of great value in chronic 
parametritis, subacute and chronic perimetritis, and other uterine affections of inflam- 
matory origin (Freund). Picratol in saturated glycerin solution on tampons, to relieve 
congestion and pain (Yale). Heat, to the feet, and by large poultice to the abdomen; 
also hot water vaginal injection literally for hours if possible, repeated at short intervals; 
the only means of aborting an attack of cellulitis (E), which is the condition generally 
present in cases which are usually supposed to be acute metritis (Playfair). Turpen- 
tine, as hot' epithems; few measures are more generally serviceable (Wa). Linseed 
Poultices, produce great relief to pain and favorably affect the course of the disease 
(Duncan). Leeches, to the hypogastric region, may be required in patients of full 
habit. [Compare Endometritis, Puerperal Fever.] 

Metrorrhagia. 
Opium, has specific action on the uterine circulation and should be given freely in 
intractable cases of metrorrhagia from uterine fibroids or cancer, in which the estab- 
lishment of the opium -habit is often advisable (Lutaud). Cotarnine is a powerful 
uterine hemostatic and is efficient in all forms of uterine hemorrhage, in doses of gr. j 
of the Hydrochlorate every 2 or 3 hours (Boldt). Hydrastinine is a powerful uterine 
vaso-constrictor, and is efficient (see under Menorrhagia). Ergot in full doses every 
hour is the most valuable remedy (R). Iodipin hypodermically, proved curative in 
a severe and long-standing case of uterine hemorrhage (Keith). Atropine hypoder- 
mically, in profuse metrorrhagia after abortion or of obscure origin; may require as 
many as four injections to cause cessation of the flow (Squibb). Salipyrin, in doses 
of gr. xv thrice daily, employed in fifty cases of metrorrhagia from various causes, 
with best results in cases following labor or abortion (Orthmann). Ipecacuanha, 
possesses considerable energy in arresting flooding (P); in full emetic doses, grr. xx in 
evening, followed by an acidulated draught in the morning (Wa). Hamamelis, when 



73° 



MILIARIA — MUSC.E VOLITANTES. 



persistent oozing (R). Cannabis Indica, often arrests metrorrhagia especially when 
at climacteric; tincture gtt. v-xx ter die (P); has had extraordinary' success in number 
and rapidity of cures (Wa). Sulphuric Acid, sometimes very effective, especially when 
due to fibroid or polypus; Ac. Sulphurici Dil., gtt. v-xx, well diluted (B); long and ex- 
tensively prescribed (Wa). Cinnamon, is used with good effect (P); has specific action 
on the uterus (T). Digitalis, in plethoric subjects; the infusion best, a tablesp. bis 
die (P); the effect is prompt and decided (Wa). Magnesium Sulphate, often suc- 
ceeds (B). Senegin, in 2-grain doses, is successfully employed (P). Calcium Chlor- 
ide in doses of gr. vij every 2 hours, increases the coagulability of the blood and is effi- 
ciently hemostatic (Gross). Savin in doses of gtt. v-x of the tincture in cold water 
every half hour (P). Iron, the styptic preparations as injections into the uterus (B). 
Ice applied to the abdomen or within the uterus (B) ; Ice in every way the first thing to try 
(Wa). Rest, absolutely necessary. Dry Cupping, over the sacrum, is found useful 
(R). [Compare Menorrhagia, Uterine Tumors.] 

R<. Fluidextr. Ergotae, 5 ss. 1$. Cotarninae Hydrochl., gr. xv. 

Fluidextr. Senec. Aur., Ergotini (Bonjean), gr. xxx. 

Fluidextr. Viburn. Prunif., .aa 5 j- Ext. Gossypii, gr. xxx. 

Ol. Myristicae, nj xx. M. fiant capsulae no. x. Sig. — One cap- 
Syr. Simplicis, q. s. ad 3 vj. sule every 2 or 3 hours. 

M. Sig. — A dessertsp. every \ hour until 
relieved, then reduce the dose. Keep the 
head low, and apply cold over the hypogas- 
trium. 



R;. Cotarninae Hydrochl., gr. x. 

Fluidextr. Ergotae, 3iv. 

Elix. Simplicis, q. s-. ad 5ij. 

M. Sig. — 3ij every 2 hours. 



Miliaria — Prickly Heat. 

Phenol, a 4 or 5 per cent, solution in water, adding a little glycerin, is much the 
best local application for the itching and prickly sensations. Baths, warm or contain- 
ing Sulphides (R); sponge baths with alkaline lotions, diluted lead -water, fluid ex- 
tract of Grindelia well diluted, or a solution of Copper Sulphate gr. x to the 5, with 
dusting powders of Lycopodium, Zinc Oxide or Starch, singly or combined (Hughes); 
fine rice powder makes an excellent application. Tannoform with Boric Acid and 
Talcum, equal parts of each, makes an excellent dusting powder. Diet in severe cases 
should be simple, nutritious but not stimulating, alcohol is most deleterious (Pringle); 
it is most important to avoid all causes of perspiration, as the copious consumption of 
fluids, excessive exercise, close rooms and warm clothing (Mn). Prickly heat is a form 
of miliaria, not of lichen, and is due to the excessive sweating incident to the heat of 
tropical climates (Id). Inunction of the body after the morning bath, with vaselin or 
some fatty material, is a valuable prophylactic in persons who are subject to the affection 
(Pringle). 

Miliary Fever. 

Aconite, for the hyperpyrexia (R, P). Cooling Drinks, purgatives and anti- 
phlogistics, in mild cases; malignant ones sometimes occur, and are dangerous (A). 
Lime-water applied by sponging, is very useful; or a lotion of Zinc Oxide suspended 
in Lime-water, gr. xl to oj, painted on the affected parts of the skin, and permitted to 
dry thereon (E. Wilson). 



Muscae Volitantes. 
Potassium Iodide, very effectual in curing muscae depending upon hepatic derange- 
ment (Wa). Valerian, often found curative (Wa). Muscae Volitantes are due to 
shadows cast on the retina by fibrillae floating in the vitreous body, and are most visible 
to myopic persons; they do not merit attention unless very abundant, or steadily increas- 
ing (C). Rest of the eye necessary. Neutral -tint glasses may be worn to render the 
muscae less visible, if troublesome. 



OTALGIA M \ 1 i i ns MYOPIA MYXEDEMA. 731 

Myalgia. 
Arnica, the best agent for contused muscular fibre; also for shake, concussion, 
shock; nRv-x every 2 or 3 hours in water (P); a few drops of tincture internally, n 
stiffness, after packing with cold, wet sheet (R). Cimicifuga, often succeeds wonder- 
fully, as often fails; no indications for its use (B); general bruised sensation (R). Am- 
monium Chloride, in 10- to 20-grain doses, the most efficient remedy (Anstit ■); is 
effective (R). Formic Acid is a wonderful remedy for muscular fatigue; should be 
combined with sodium bicarbonate to save the stomach from distress (Clement). Vera- 
trine, the ointment externally may control (B). Belladonna, as liniment, is often 
successful (R). Gelsemium, frequently cures, but large doses are necessary, irtiv-xx 
of the fluid extract every 3 hours (B). Coca, to relieve the sense of fatigue (P). Opium, 
by frictions or poultices (R). Iodine, ointment for pain and tender muscles of the 
chest, when skin may be pinched without pain (R). Xanthoxylum, externally and 
internally, has a deserved reputation (B). Chloroform Liniment, with friction, 
often affords great relief (Wa). Firing, sometimes very beneficial (B). Packing, with 
dripping wet sheet (R). Counter-irritation, by firing, aquapuncturc, acupuncture (B). 
Electricity, the constant current (B). Baths, Turkish, in aching muscles, from 
over-exertion (R). Poultices, very hot, followed by applications of lint and oilskin 
(R). Rest, is the remedy, of course (Wa); rest and support to weak muscles are 
important until they regain tone; especially in painful muscular affections following 
prolonged or excessive exertion, or in the soreness or stiffness which occurs during con- 
valescence from any long illness, or accompanying general debility, and generally better 
after repose, but increased with fatigue. [Compare Lumbago, Pleurodynia, Rheu- 
matism, MUSCULAR.] 

Myelitis. 

Belladonna, is decidedly effective, especially when disease is brought on by external 
violence (P). Ergot, most successful: large doses are necessary (B). Electricity, 
in chronic, not in recent form (B). Silver Nitrate in chronic inflammations of the 
cord, is still employed but is of doubtful value (W). Phosphorus is often of 
value in myelitic paraplegia from excessive venery (\V). Silver Phosphate is of value 
in myelitis with disturbance of the bladder and rectum (Wa). Sodium Phosphate 
hypodermically, was employed with great benefit in a case of syringo-myelitis. Elec- 
tricity, galvanic currents should be strictly forbidden until the effects of the inflam- 
mation are to be dealt with (W). Water-cure, Ice-bag to spine, feet in hot water; 
or better, hot douche to spine (B). Cold, externally, by ice-bags along the spine, with 
cupping or leeching if much localized pain or tenderness; spoon feeding and a sparing 
amount of stimulants, also copious warm enemata to relieve the bowels and act as 
derivatives. Little, if anything, is to be done with drugs. Posture should be prone, 
or on side; absolute rest'(Bastian). [Compare Meningitis spinal, Paralysis.] 

Myopia. 
Atropine, by daily instillation, for the purpose of sacrificing either the convergence 
or the accommodation, in cases where failure of the internal recti occurs, the disability 
assuming the form of muscular asthenopia (C). Glasses, properly adjusted, should 
be worn from the commencement. Extraction of the Lens, produces the happiest 
results in extreme myopia, especially when progressive, since by removal of the crystal- 
line lens the refraction of a very myopic eye is brought back nearly to emmetropia 
(Valude). 

Myxedema. 

Thyroid Extract, or the thyroid gland itself, fed to the patient daily, is now the 
recognized treatment, and produces the best results. Tonics, as Iron, Arsenic and 
the Hypophosphites, with diaphoretic drugs, as Pilocarpus, and daily baths, formed 



732 NAILS — NASAL AFFECTIONS — NAUSEA. 






the early treatment of this affection (Ord). Exposure to Cold, aggravates all the symp- 
toms and causes great weakness and depression, even though the patient is not con- 
scious of any discomfort from the impact of cold air, by reason of the thickened and 
insensible condition of the skin. Even while reaping so great a benefit from the use 
of the thyroid, we are still bound to shield our patients from exposure to cold (Ord). 

Nails, Ingrowing. 

Liq. Pot. Hydrox., a solution, 5ij to oj, on cotton-wool, applied to margin of nail 
at ulcerated surface, to soften the nail in ingrowing toenail (B). Glycerin, or Silver 
Nitrate, on a fold of lint, to the ulcerated surface (C). Picric Acid in saturated solu- 
tion freely, after removing the offending corner of nail, is very efficient (Milward). 
Lead Carbonate, a piece softened between the fingers, and applied as plaster beneath 
the fungous cushion, cures in a few days (Tr). Paring the nail, after softening in 
warm water, and cutting a V-shaped incision in centre of nail; the ingrowing portion 
should not be cut. 

Nasal Affections. 

Ammonia, by inhalation, in pain and inflammations of nose apd frontal bones (R). 
Potassium Iodide, large doses, gr. xxx-lxxv daily, valuable in syphilitic affections of 
the nose (Wa). Glycerite of Tannin, to excoriations of inside of nose, after measles, 
scarlatina, etc., also for impetiginous eruptions of inside; epilation sometimes needful; 
also in discharge of greenish, black, stinking mucus (R). Glycerite of Starch, or Zinc 
Ointment, applied often, a good supplementary application (R). Hydrastis, in 
chronic catarrhal conditions and nasal ulcers, used internally and externally with 
great benefit (P). Pulsatilla, may be employed both internally and externally in nasal 
inflammations (P), and in acute inflammation of nose (B). Cod-liver Oil for chronic 
discharge (R). Adrenal Extract, locally, has many valuable uses in congestions of 
the nasal passages, also as a styptic after operations. Mercurol is the least irritant of 
the efficient antiseptics for use in the nasal passages (Lake). Argyrol in 5 to 20 per 
cent, solutions locally, for catarrhal affections of the nose (Holmes). Zinc Chloride, 
gr. ij to the o, or the Phenolsulphonate, gr. v to the o, as solutions locally by cotton - 
wrapped probe to diminish sensibility of the nasal mucous membrane (Sajous). Co- 
caine, has many applications in treatment of nasal affections; a 4 per cent, solution 
by mop or spray will empty the engorged venous sinuses, and is very useful in acute 
catarrh and hay fever, also for posterior and anterior rhinoscopy (R). [Compare Acn'E, 
Catarrh, Epistaxis, Hay Fever, Influenza, Ozena, Polypus, Sneezing.] 

Nausea. 
Phenol, or Creosote, is very useful in the reflex nausea. Hydrocyanic Acid, 
nji— iv of the dilute acid in oj of water, is useful (Beale). Ammonia, irjiij-iv of 
Aqua Ammonias in a winegl. of water when the feeling of nausea is most troublesome, 
may cure the ailment (Id). Hydrargyrum, a small dose of Blue Pill or Calomel will 
sometimes cure very obstinate nausea, although many other remedies have failed (Id). 
Cocaine, a 2 per cent, solution sprayed high into the nasal passages, so as to reach the 
terminal filaments of the olfactory branches, is specific against nausea, its influence 
lasting several hours (Ingraham). Chloroform, njij-v on sugar, will relieve some 
kinds of nausea (B). Chloretone gr. iij every J hour for 2 or 3 doses, is very efficient 
in the sickness accompanying menstruation (Hutton). Ipecacuanha, has no rival in 
sickness of pregnancy, scarcely less useful in that of chronic alcoholism; very small doses, 
gr. 7 V of powder or mj of wine (P). Pulsatilla, in dyspeptic nausea, with coated 
tongue, flatulence, sick headache (P). Cocculus Indicus, in cephalic nausea, violent but 
ineffectual efforts at vomiting (P) . Calumba, in nausea of languid stomach with flatulence, 
has considerable reputation (P). Cinnamon or Cloves, will check nausea (P). Nutmeg, 
the simple powder in wine (P). Pimenta, Pepper, Peppermint, relieve nausea (P). 
Tartaric Acid, as effervescing draught, with a few drops of Tinct. Opii, Tinct. Calum- 



NECROSIS NERVOT S EFFECT IONS. 






be, or Dilute Hydrocyanic Vid added, when from morbid gastric irritation (Wa) 
Bismuth Subnitrate, or the Liquor Bismuthi, when the sail in substance disagrees, 
is ■ remedy of established value in nausea and vomiting arising from gastric disc 
may be combined with Hydrocyanic Acid (Wa). Counter-irritation, by a mustard 
poultice applied over the region of the stomach and liver for 20 minutes even 
days (Beale). Heat, hot water on spongio-piline, worn for an hour or two, will [re 
quently he found efficacious (Id). Cold, by a compress or ice-bag, over the stomach, 
is often very useful. [Compare DYSPEPSIA, HEADACHE B1JJOUS-SICK, Si I 

INC.] 

Necrosis. 

Sarsaparilla, a very useful medicine in diseases of the hones (P). Rest, in a Salter's 
swing, with poultices, water-dressings or stimulating lotions, to aid the work of repair 
iCl, Hilton). Tonics, nutritious food, baths, good hygiene, all are necessary adjuncts 
to local treatment (Andrews). Acid Solutions, of no use as solvents, may b 
ployed with benefit for detergent and alterative effects to expedite the sloughing ami 
restorative processes (Gross). Operation to remove sequestrum is generally necessary; 
or resection of the devitalized bone, the latter in young subjects greatly exhausted, 
where delay would endanger life (Gross). Potassa cum Calce introduced into fistula;, 
to convert them into large openings, permitting the removal of diseased bone (Kirk- 
patrick). [Compare Bone Diseases, Caries, Scrofulosis, Syphilis.] 

Nervous Affections. 

Nux Vomica, in one-drop doses of the tincture every 5 minutes, is promptly efficient 
in relieving many affections of reflex neurotic origin, as cough, dyspnea, syncope, palpita- 
tion, flatulent dyspepsia, eructations, especially when occurring in hysterical subjects 
(Macfarlan). Arsenic, of especial value in nervous affections resulting from malaria, 
in which large doses are required; li.tjx of Liq. Arsenicalis, increased to njjxxx thrice daily 
(Wa). Asafcetida, is a remedy of much value in nervous affections connected with 
uterine derangement, also in dyspeptic hypochondriasis and other nervous affections; 
may be combined with bitter tonics and mild aperients (Wa). Potassium Bromide, 
takes precedence in epilepsy, epileptiform convulsions, hysterical convulsions and 
spasms, tetanus; is of great value in chorea, insanity, acute mania, insomnia, delirium 
tremens, some forms of neuralgia, and the numerous symptoms of vaso-motor distur- 
bance, such as numbness, coldness, deadness, pricking sensations, indefinable but dis- 
tressing sensations in abdomen, hypogastrium or epigastrium; feelings similar to rigors, 
with anxiety, palpitation or fluttering of the heart — all due to interference with the local 
circulation (Reynolds). Valerian and Valerates, are thought to exercise some 
special influence over nervous affections, especially Zinc Valerate, in half-grain to 
grain doses in pill, or the Ammoniated Tincture of Valerian, from which every good 
that can be expected from the valerates will be more certainly obtained (W). Sum- 
bul, acts as a nervous stimulant, and is especially efficacious in neurotic migraine, also 
in hysteria and the obscure paralytic affections associated therewith (Wa). Caffeine, 
is of signal value in neuralgia, hemicrania and other nervous affections (Shafter); grain - 
doses in solution hypodermically afford great relief in dorso-intercostal neuralgia attend- 
ing shingles, and insomnia (Anstie). Cocaine is a powerful nerve stimulant, destroy- 
ing the sense of fatigue, and often evincing marked analgesic power in neuralgia?; is 
effective in melancholia and hypochondriasis, also locally in nerve pain over a limited 
area; it acts as an excitant upon the central nervous system (R). Opium, is a remedy 
of marked value in insanity, melancholia, mania, and all nervous affections accom- 
panied by pain (W); gives general repose to both body and mind, is of decided value in 
diabetes, and produces marked improvement in melancholia and despondency (R). 
Lupulin, is peculiarly useful in nervous affections when Opium cannot be tolerated, 
?specially in chronic hysteria attended with morbid vigilance, 10-grain doses every 6 
hours afford great relief, without causing any unpleasant symptoms (Eberle). San- 
tonin, in convulsions, epileptiform seizures, and affections regarded as choreic, the 



734 



NERVOUSNESS — NEURALGIA. 



result of reflex irritation from worms (Wa). Phosphorus, of occasional utility in 
affections of the nervous system induced by mental exertion or over-excitement; the 
danger from its use is its liability to produce fatty degeneration of the internal organs 
(Wa). Sodium Phosphate, hypodermically, employed with great benefit in a case of 
syringo-myelitis, also in one of unilateral astasia-abasia: is considered by Luton to be 
posessed of reconstructive power equal to that of the animal extracts. Orchitic Ex- 
tract, has been used with benefit in several affections of the nervous system. Physos- 
tigma, given for six months or longer, in small doses, gr. yV of the extract every 3 hours, 
is useful in many nervous affections, as locomotor ataxia, writer's cramp, and paraplegia 
due to myelitis (Murrell). Silver Phosphate, is of special value in sclerosis of the 
nervous substance and in myelitis (Wa). Shower Baths, cold, are often beneficial 
in nervous affections unconnected with disease of the brain. [Compare Diabetes, 
Headache nervous, Hemicrania, Hemiplegia, Hysteria, Insomnia, Locomotor 
ataxia, Mania, Melancholia, Myelitis, Nervousness, Neuralgia, Neurasthe- 
nia, Neuritis, Paralysis, Paralysis agitans, Spinal paralysis.] 

Nervousness. 

Opium, calms the nervous system and gives general repose to both body and mind 
(R); small doses, identity of drug to be carefully concealed lest the opium -habit be 
formed. Antipyrine, is efficient for nervous irritation. Ignatia, in small doses better 
than Morphine for mental excitement and nervous erethism (P) ; for the nervous exal- 
tation of cinchonism (Pf). Strychnine, affords relief in functional irritability of the 
nervous system, manifested by restlessness and wandering neuralgic pains (B); espe- 
cially useful as a tonic in nervousness from over-use of tobacco (H). Potassium 
Bromide, especially for women who are despondent, irritable, and sleepless, from 
overwork, grief, and worry; often connected with migraine (R); gr. ss-j of any Bromide 
every \ hour, is very efficient for the nervous disturbances of children (Smith). Bromi- 
pin gives good results in nervous insomnia and various other conditions due to nervous 
excitement (Frieser). Valerian is extremely useful as a sedative to reflex excitability, 
calms nervousness, does much good in fevers where restlessness, fidgets, anxiety (P). 
Aconite, gtt. j of tinct. at bedtime, repeated if needful, for restlessness and "fidgets" 
of men as well as women (R). Caffeine, for restlessness due to great lowering of 
nervous power (P). Chamomile, lowers reflex excitability (P); minim doses of the 
tincture every 15 minutes an excellent sedative for children (Smith). Resorcinol, pro- 
duces quiet sleep in general nervous excitability. Conium, where a great deal of 
motor agitation, especially in the typhoid-like condition with insomnia, exaggerated 
nervousness and delirium, often resulting from mental overwork, acts charmingly in 
securing sleep, by removing the motor agitation; ttjjx of a fluidextract of the unripe 
fruit, every \ hour, carefully watched (Madigan). Musk, serviceable in nervous affec- 
tions when due to uterine derangement (Wa). Sumbul, often invaluable in restlessness 
of pregnancy; inxxx-xl of tinct. with a little Chloric Ether as a draught (P). Camphor, 
a powerful subduer of reflex excitability (P). Chloral, where restlessness, debility (R). 
Chloroform, the Spirit internally (R). Hop, the hop-pillow is deserving of trial. 
Lupulin is peculiarly useful when Opium cannot be tolerated (Wa). Water, warm 
sponging to induce sleep and calm restlessness in convalescence; also, cold sponging 
(R). [Compare Insomnia, Irritability.] 



1$. Strychninae Sulphatis, gr. j. 

Quininae Sulphatis, 3j- 

Tinct. Ferri Chloridi, 3 v. 

Ac. Phosphor. Dil., 

Syrupi Limonis, aa 3 ij • 

M. Sig. — A teasp. in water thrice daily. 



R. Potassii Bromidi, 5 j • 

Fluidextr. Guaranae, 3jss. 

Syr. Tolutani, 3uj- 

Aquae, q. s. ad Bvj. 

M. Sig. — Teasp. to a dessertsp. three or 

four times daily. To relieve nervousness. 



Neuralgia. 
Antipyrine, is prescribed in all forms of neuralgia (M) ; is highly efficient in neuralgia 
of the 5th nerve associated with neuritis (B). Acetanilide, is used with success in 
facial and intercostal neuralgias (M); is highly useful against pain due to inflammation 



Ml K U G] \. 



73S 



of nerves (B). Acetphenetidin, is especiall) useful in the fugacious and variable neural 
gias so common in the hysterical and neurotaxic (M): of the three drugs named Acel 
phenetidin is the safest and most efficient in doses of 8 co grains. Salipyrin baa 
been employed with excellent results; a dose of gr. viij being often sufficient. Pheno- 
coll, is used successfully, especially for the neuralgic pains of epidemic influenza (grippe). 
Salol, is very efficient in some forms. Salicylates, in large doses, i] il, 

douloureux of 12 years' standing (Dercum). Saloquinine in supraorbital 
geminal forms, gr. xxx given 4 hours before the time of expected attack to prevent 
recurrence (Tauszk). Aspirin is an excellent remedy (Gorges). Opium, internally, 
or Morphine hypodermically, in the vicinity of the alffi cted nerve, the best treatment; 
caution! morphine-habit (B); gr. ,',; to \ often relieves and frequently cures after a 
few repetitions (P); no remedy promises more speedy and permanent relief than M01 
phine by subcutaneous injection in sciatica, lumbago, tic douloureux and other neui 
affections (Wa). Heroin is efficient in various neuralgic affections as a palliative anal- 
gesic. Aconite, when arterial excitement (B); in congestive neuralgias, and acrodynic 
of extremities; has important role (P); as ointment or liniment, especially when fifth 
nerve affected; also in neuralgic headache (R); a remedy of great value (Wa); a per- 
fect physiological remedy against neuralgia, especially those forms which are based on 
congestive or subinflammatory affections; but its action is often slow, so that Morphine 
must be given with it as a palliative. Aconitine, with Veratrine as an ointment locally, 
a good application (Da C); internally the best agent of all in essential neuralgia; should 
be combined with Quinine in intermittent forms and those which resist quinine alone. 
Veratrine as ointment in facial neuralgia and sciatica (R); is frequently of much 
benefit (P). Atropine hypodermically in the vicinity of the nerve (B); of especial 
utility in tic and sciatica, also in peri-uterine and dysmenorrheal forms (B); in spinal 
and intercostal, also as liniment or ointment in facial neuralgia (R). Belladonna gr. 
ij of the extract every hour until giddy, then a less dose continued for several days (Tr). 
Quinine, large doses, gr. v-xx in sherry, just before the attack in periodical neuralgia, 
whether malarial or not; useful also, in small, frequently repeated doses, in other types, 
especially of supra -orbital nerve (P); has selective action upon supra -orbital form 
(Spender). Arsenic, cures by its influence on bodily nutrition; directly so in neuralgia 
of malarial origin, though inferior to Quinine (B); in various neuralgias, also in angina 
pectoris (R); the Bromide of Gold and Arsenic rendered good service in an obstinate 
case of trifacial neuralgia diagnosed as due to syphilis, after other treatment besides anti- 
syphilitic had failed (E. A. Wood). 

Nux Vomica, is most useful in visceral neuralgias, as gastralgia, hepatalgia, etc., 
the tincture with carminatives in the former affection; or Strychnine, gr. -,-, 1 ,,, to 
twice or thrice daily: in all forms of neuralgia this remedy should be used in small 
doses (P). Ignatia, in hysterical and intercostal neuralgia with nervous erethism, is 
valuable (P). Phosphorus, gr. T \ every few hours, has made very effective cures (B); 
gr- tots to T 5 every 3 hours; very useful in all forms, especially when uncomplicated (R); 
always a good remedy, except for cases due to cold or inflammation, and those not de- 
pending on depraved nutrition (H). Ammoniated Copper, in neuralgia of the 5th, 
used with remarkable success; $-grain doses pushed (Fereol). Physostigmine, very 
efficient in neuralgia of the eyeball, a solution of gr. ij to the o by instillation. Canna- 
bis Indica, }-£ gr. doses of extract 2 or 3 times a day; especially for neuralgic headache 
(P); found useful (R). Cod-liver Oil, when low nutrition, faulty assimilation (W). 
Iron, when from anemia; tincture of the Chloride irjxxx-xl ter die, also chalybeate 
waters (B); only moderate doses required (R); in chlorotic subjects, of whom nearly 
all will have neuralgia (Tr). Iodides, for neuralgia of fifth, dependent on syphiloma 
of the nervous system, pain, nocturnal chiefly (B). Bromides, benefit some kinds, 
especially ovarian (B); Potassium Bromide occasionally relieves (R). Bromipin is 
often effective and has decided advantages over the ordinary bromides (Losio). Am- 
monium Chloride, half-drachm doses in facial and other neuralgiae, is much used 
R); a very efficient and diffusible stimulant, gr. xx-oj at first, repeated every hour 
luring the attack (H). Chloroform, as anesthetic to relieve pain, is occasionally 
jseful locally, also as spray for uterine neuralgia (R); ttjv-xv of pure Chloroform by 
ieep injection into vicinity of affected nerve, a very efficient method of dealing with 



736 NEURALGIA. 

long-standing cases (B); used in one case it caused symptoms so severe as to imperil 
the life of the patient (W). Croton-chloral is very effective in trigeminal neuralgia 
(Liebreich); has failed to sustain itself and is but little used (W). Chloral-camphor 
painted over the painful surface (R); has been commended (W). Caffeine hypo- 
dermically is analgesic (Mays); has been found useful in cervico-brachial neuralgia 
(P). Cocaine, as a hypodermic injection, a 4 or 5 per cent, solution is very effective 
if administered in the vicinity of the aching nerve (R); also by instillation in neuralgia 
of the eyeball , and whenever it can be applied to the mucous surface in the vicinity of 
the pain. Guaiacol, a few drops rubbed in gently, gives immediate relief in ciliary 
neuralgia (Brodnax). Phenol, pure by subcutaneous injection, used in 600 cases, 
many obstinate ones were effectually controlled and cured (Baccelli). Ichthyol hypo- 
dermicaily is analgesic and valuable in neuralgic pains due to inflammatory exudations 
(Damiens); externally and internally in intercostal form (Schmitz); most successful in 
chronic neuralgia of bones, muscles and joints accompanied by difficulty in moving 
(Nussbaum). Amyl Nitrite, inhaled in dysmenorrheal neuralgia (B); and when of 
5th nerve (R). Nitro-glycerin, has often afforded great relief (Wa). 

Sumbul, for certain types, of more value than any other remedy; facial, sciatic, or 
ovarian neuralgias, in women of nervous constitution, often yield to it at once (P). 
Cimicifuga, in neuralgia of the 5th from cold, and in ovarian (B). Gelsemium, 
successful in neuralgia of 5th (B); especially dental branches (R); of value in trigem- 
inal, ovarian (W); in suitable cases small doses answer as well if not better than 
large ones (Pf) ; njjiij of the tincture every \ hour often succeed miraculously with no ill 
results in neuralgiae about the head and face (Smith) ; no better remedy in tic douloureux, 
but must be given in large doses, ttjx-xv of a strong tincture or fluid extract (H). Zinc 
Valerate, extremely beneficial in neuralgia from reflex irritation of female pelvic 
organs (B). Valerian, serviceable in facial neuralgia of hysterical type (P). Bibiru 
Bark, in intermittent forms (P). Pyrethnim, the root is chewed with benefit in 
facial neuralgia (P). Capsicum, a strong infusion on lint covered with gutta-percha 
(R). Coccus Cacti, has been very successful in 20-30 minim doses of a 1 to 8 tincture 
twice daily, the larger doses in the paroxysms (W). Peppermint, the Oil, painted 
over the part in facial neuralgia (R); especially the Chinese oil, which contains a large 
excess of Menthol, a very useful application in superficial neuralgiae (W). Turpen- 
tine, has cured tic douloureux and sciatica (B) ; often of wonderful service (P). Potas- 
sium Chlorate, for facial neuralgia (B). Alcohol, containing much volatile ether; 
care must be taken in prescribing it (R). Piscidia, almost specific in many forms, 
useless in many cases (W). Tonga, is efficient in facial neuralgia, tijx-xx even,' two 
hours (H). Osmic Acid, a one per cent, aqueous solution with glycerin to prevent 
change, of which 5 to 10 drops hypodermically, has made striking cures of inveterate 
neuralgias, with no ill effects resulting (Shapiro); if employed at all it should be injected 
directly into the exposed trunk of the affected nerve (Wright). Formic Acid gtt. v 
of a 1 per cent, solution, by deep injection alongside the nerve, preceded by gtt. viij of 
a 1 per cent, solution of Cocaine, is remarkably efficient (Couch). Chamomile, in 
neuralgia of the 5th nerve (R). Staphisagria, internally and externally often curative 
in obstinate facial and cervical neuralgia (P). Ergot, much employed in visceral 
forms, especiallv gastralgia (P); is said to be useful (R). Digitalis, is strongly recom- 
mended in sciatica, also locally in earache (P). Carbonic Acid Gas, injected into 
vagina for neuralgia of uterus. Aquapuncture, strangely relieves pain in a super- 
ficial nerve, so much so, that some hold the curative effects of morphine injections to 
be due to the water alone (B). Counter-irritation, Mustard poultices in neuralgic 
pains (P); blisters to a posterior branch of the spinal nerve-trunk from which the pain- 
ful nerve issues (Anstie). Wet Pack, is of great benefit, especially in sciatica. Intense 
Cold, produced by a spray of Methyl Chloride, or concentrated Carbonic Acid gas, 
directed along the nerve from special apparatus, immediately relieves the pain, and 
usually cures (Jacoby). Compressed Air, by insufflation into the middle ear, in cases 
of persistent and paroxysmal temporo-occipital neuralgia, due to chronic follicular 
pharvngitis and inflammation of middle ear; if these insufflations result in diminution 
of the pain, treatment should be directed to the naso-pharynx and Eustachian tubes 
(Masucci). Galvanism of the affected nerve, one of the most important curative 



Ni'.UKASI lll\l \. 



737 



measures; a continuous current of 4 to 8 cells down the nerve generally uswen Iks, 
though some cases are helped more by a rapidly interrupted faradic current: Ele< tri( itv 
isof no value in cases dependent upon organic lesions, and in any individual 1 aae is purely 
experimental (W). Diet animal fats necessary, as cod-liver oil, butter, cream, i 
large quantity as can be digested. Rest often needed, with protection from cold and 
damp, also flannel clothing, bathing and shampooing. [Compare Gastkalom Him, 

CRANIA, HEPATALGIA, OTALGIA, OVARALGIA, SOATICA, TlC DOULOURETO | 



For Internal Use. 
R-. Tinet. Aconiti, 

Tinct. Colchici Sem., 
Tinct. Cimicifugae, 

Tinct. Belladonnas Fol.,. . .aa part. aeq. 
M. Sig. — 6 drops every hour until re- 
lieved. (Metcalj.) 

R. Cupri Ammonio-sulphat., . . gr. j-iv. 

Syr. Aurantii Flor., O j- 

Aquae Destil., §iij. 

M. Sig. — One-third as a dose, thrice 

daily. (Prof. Fireol.) 

R*. Aconitinas Crystal., gr. y$. 

Quininae Hydrobrom., gr. xx. 

M. ft. massa, et div. in pil. no. xij. 

Sig. — One every 4 or 5 hours. (Potter.) 



For Local Use. 
I>. Aconitin.-e (Duquesnel), . . . gr. v. 

Veratrinx, g r . xv . 

Glycerini, ^jj. 

Cerati, 5vi. 

M. Sig. — To be rubbed over the part, 
carefully avoiding any abraded surface. 

(Da Costa.) 



R<. Mentholis, gr. x lv. 

Cocainas Hydrochlor., gr. xv. 

Chlorali Hydrati, gr. x. 

Petrolati, * v . 

M. ft. ung. Sig. — For local use. 

(Potter.) 

R. Veratrinae, gr. xl. 

Adipis, vel Unguenti, gj. 

M. Sig. — Local use. (Da Costa.) 



Neurasthenia. 

Ammonia, the Aromatic Spirit has proved very serviceable; oss-j in water thrice 
daily (Wa). Hypophosphites of Limtf or Sodium, or Iron, are actively tonic in cases 
of nervous depression and torpor, with occasional shooting pains (Wa); the Syrup of 
the Hypophosphites with Strychnine is of service as a general tonic, in connection with 
other remedies. Arsenic, is often very serviceable; Fowler's or Pearson's solution, 
in doses of ntuij-v, in water, after each meal. Aurum, the Bromide of Gold and 
Arsenic (Barclay), gave excellent results in 3 out of 4 cases of marked neurasthenia, 
in doses of itjtv of the solution 4 times daily (Love). Strychnine Acetate, a remedy 
of great promise, when combined with a rigid system of diet and mental discipline 
(Marshall Hall). Zinc Oxide, often excellent as a tonic and sedative, in nervous 
irritability and depression from anxiety or over-study (Wa). Phosphorus, of occa- 
sional utility in nervous breakdown from over-study (Wa). Caffeine, gr. j or more in 
a cup of coffee, to relieve brain weariness and nervous exhaustion (Wa). Cocaine, 
in i-grain doses proves serviceable in nervous exhaustion (R) : danger of cocaine-habit 
if identity known to the patient. Coca, as a stimulant has been used with benefit, 
but only for a short time, and acts deleteriously unless given in small doses (W). Kola- 
nut is used in France, contains Caffeine, is subject to the same remarks as Coca, above. 
Ichthyol in doses of gr. v-x, when vaso-motor instability is a prominent symptom 
(Rankin). Musk is a valuable remedy, it stimulates the nervous centres when ex- 
hausted, without producing any very pronounced symptoms (W). Orchitic Extract, 
has been used with benefit. Nuclein, is useful in many cases (Vaughn). Cerebrinin, 
has been used with advantage (Paul). Artificial Serum, in cases of lowered arterial 
tension (lessening of first sound, tachycardia embryocardia), an injecdon hypodermically 
of ir^xv of the solution formulated below, 2 to 4 times a day. Electricity is often of 
signal service, chiefly for its suggestive influence on the patient's mind (Rankin). Diet 
should be chosen from the most readily assimilable food, calling for a minimum amount 
of digestive work. As a rule, neurasthenics eat too much and drink too little; plenty 
of water, at least a liter and a half per day, is the best drink; it maintains the arterial 
tension, irrigates the tissues and assists the excredon of debris. Milk should be pro- 
48 



738 



NEURITIS — NEVUS. 



hibited, also vegetable soups, peptones and extracts of meat. The albuminoid element 
of the food should not exceed one-fifth of the total (Vigoreaux). Counter irritation, 
the actual cautery along the spine has rendered excellent sendee in several cases of 
neurasthenia accompanied by neuralgia of the superficial branches of the spinal nerves; 
its action is doubtless often a mental one, and it renders the carrying out of the rest- 
cure more thorough than when attempted without something to enforce quiet. Rest- 
cure, with forced alimentation and systematic massage to keep up the muscles while 
holding the nervous system as inactive as possible, will do more than medicine in these 
cases. Many such will recover under the discipline and quiet of a hospital or sanitarium 
alone; while others are greatly benefited by removal from home influences and cares, 
and from association with certain persons who irritate them. [Compare Adynamia, 
Exhaustion, Gout, Hysteria, Spinal Irritation.] 



3 



Artificial Serum. 

Sodii Phosphatis Pur., 3iij- 

Sodii Sulphatis Pur., gr. lxxx. 

Sodii Chloridi Pur., gr. xxx. 

Phenolis, Cryst., gr. v. 

Aq. Destil. Bullient., ad 5iv. 

Dose, njxv hypodermically. 



R. Strychninae Acetatis, gr. j . 

Ac. Acetici Diluti, ttjjxx. 

Alcoholis, 3ij ■ 

Aquae Destil., 3vj. 

Sig. — Ten drops thrice daily. {Hall) 



Tonic and Stimulant. 

1$. Tinct. Kolas, Sjss. 

Ac. Citrici, gr. xx. 

Sodii Arseniat., gr. j. 

Tinct. Cocae, q. s. ad %\\. 

Dose, 3j at each meal. 






%■ 



M. 



Ac. Phosphorici Dil., 3 j. 

ElixirCalisayae(U.S.Disp.), 3vj. 

Elix. Ammonii Valeratis, 5ij- 

Glycerini § iij . 

Vini Xerici, q. s. ad Oj. 

Sig. — §j thrice daily. 



Neuritis. 

Strychnine, internally, is of value, and may be given in increasing doses (O); 
hypodermically, in multiple peripheral neuritis, € is of great advantage; no case remem- 
bered in which it failed to cause improvement (Walker). Acetanilide, is so effective 
that it seems to have specific action (B) . Antipyrine and Salicylates, are recommended 
in the acute cases with fever (O). Aspirin is an excellent remedy in polyneuritis. 
Arsenic may be employed (O); the Bromide of Gold and Arsenic cured a case of 
neuritis with partial hemiplegia lasting five years, with inability to walk and considerable 
pain along the spine and in right arm and leg (Barclay). Potassium Iodide and 
Mercury, if there is a history of syphilis (O). Massage is probably the most reliable 
means at our command in the later stages, when the atrophy is marked and the pains 
have lessened. Contractures may be gradually overcome by passive movements and 
extension. The interrupted current is useful when the acute stage has passed (O). 
Phototherapy, the ultra-violet rays relieve pain in acute and chronic cases, and effect 
recovery in the acute ones (Rosenberg). [Compare Alcoholism, Beriberi, Neural- 
gia, Spinal Irritation.] 

Nevus. 

Ferrum Chloride, injected, is effectual; but dangerous when applied thus to nevi 
about the head (Wa). Creosote, pencilled over twice a day, may remove nevi (Wa). 
Chromic Trioxide, as escharotic, or local application, gr. c ad oj aquae. (B). Elec- 
trolysis, or galvano-cautery, to remove nevi (B); 40 cases so treated; the process is 
certain and safe, leaving a faint cicatrix and no after-pain (Knott); in my hands has 
answered well during ten years' use in these cases (Marshall). Nitric Acid, strong, as 
escharotic for small superficial nevi, followed by Oleum Olivse (B). Zinc Chloride, 
Iodide and Nitrate, locally, especially the first named (R). Setons, threads passed 
across the growth in various directions, to produce suppuration; when pus appears 
the threads should be removed. Sodium Ethylate, prepared by adding the metal 
Sodium, piece by piece, to absolute alcohol in a wide-mouthed bottle; the crystalline 
substance found deposited after effervescence ceases is an excellent caustic for nevi; 



NIGHTMARE NYurnou.wi \. 



739 



painted over them it rapidly causes an eschar, and usually rives bul little pain (Richard 
son). Mercury, the Acid Nitrate, an excellent caustic for removing moles from the 
face (Thomas). 

Nightmare. 
Potassium Bromide, in nightmare of adults, and children's attacks of night- 
screaming often associated with squinting: the digestive organs mav also require atten- 
tion (R). Camphor-water, a teaspoonful or two the most suitable medicine ill. 
Sleep, in abundance, may prevent nightmare (II). Diet, light; avoid late meals and 
indigestible food. 

Nipples, Sore, Fissured. 
Benzoin, an admirable local application (P); the tincture locally for slight erosions 
(Parvin). Benzoic Acid as cutaneous stimulant in chapped nipples (W). Picric 
Acid in i per cent, solution locally, for cracked nipples (Maddock). Silver Nitrate, 
touched lightly, is effectual (Wa). Sulphurous Acid, solution neat or diluted, con- 
stantly applied, or with equal quantity of glycerin as lotion (R). Collodion, sometimes 
used (R); useful for protection (P); better applications are Arnica cerate, the glycerite 
of Starch, or 2 parts of eau-de-Cologne to 1 of glycerin (R). Lime-water, is a useful 
application for cracked nipples. Alcohol, Brandy and water as a lotion before delivery 
and after each suckling to prevent cracking (R). Borax, saturated solution, beneficial 
(\Y). Iron, the solution of the Subsulphate diluted with 3 parts of glycerin, and applied 
with a camel's-hair brush, an effective application for fissured nipples (B). Tannin, 
the Glycerite, one of the best applications to fissured nipples (B). Lead Nitrate, in 
glycerin, or ointment oj to oj, for fissured nipples (B). Zinc Shield, constantly 
worn (R). Balsam of Peru or Tolu, valuable as an application, with Oil of Almond, 
gum arabic, and rose-water (P). Rhatany, as wash or cerate, has had great success 
in fissure (Tr); 1 part of extract to 15 of cacao-butter (Wa). Nipple-shield, to give 
the nipple rest while the child sucks, gives great comfort. [Compare Lactation, 
Mastitis.] 



1$. Balsam. Peruvian., 5ij. 

Olei Amygdalae, 5 jss. 

Mucil. Acaciae oij- 

Aquae Rosas, q. s. 

M. Sig. — Apply to the nipples after each 

nursing. (Phillips.) 



R. Liq. Plumbi Subacet. Dil.,.. §ss. 

Ext. Opii, oj- 

Aquae Rosae, Siijss. 

M. Sig. — Lotion to be used after a bread- 
and-milk poultice, for inflamed nipples. 

(F. Barker.) 



Nodes. 

Mercury, the Oleate of Mercury and Morphine externally, is very valuable (R). 
Potassium Iodide, as ointment in conjunction with internal use, in syphilitic nodes 
of children; also in non -syphilitic periosteal thickenings (R): in syphilitic nodes it 
holds the first place, especially when pains are worse at night and increased by heat of 
bed (Wa). Stramonium leaves, locally, relieve (Wa). [Compare Exostosis, Peri- 
ostitis.] 

Nymphomania. 
Hyoscine is useful in all cases of sexual excitement, through its influence on the 
spinal centres (W). Potassium Bromide, when from plethora; not useful when 
relaxation, or from cerebral lesion (B); large doses required, at least gr. xx ter die (R); 
an abundance of evidence testifies to its value (W). Tobacco, to nausea, effectually 
cures, but is horribly depressing (B). Camphor, in considerable doses said to control 
inordinate sexual desire (R); at present not much relied on (Wa). Lupulin, seems 
worthy of fair trial (Wa). Sulphur, or dilute Sulphuric Acid internally, when arising 
from hemorrhoidal congestion, not an infrequent cause (Wa). Orchitic Extract, has 
given satisfaction. Cerebrinin, has been used with benefit (Paul). 



740 OBESITY — ODONTALGIA. 



Obesity. 

Iodoform is highly efficient, but causes wasting and anemia, the latter by injuring 
the red blood corpuscles (B). Iodol, in 2-grain doses thrice daily, is equally effective 
(B). Alkalies, as solutions of Oxides or Bicarbonates (R); alkaline mineral waters, 
with exercise and dietary (B); serviceable (Wa); Liq. Pot. Hydrox. oss in milk, thrice 
daily, of established value (Wa); generally fails (R). Ammonium Bromide, sets up 
gastric catarrh (B); but lessens corpulency (Wa). Sulphurous Waters, especially 
Blue Lick, 5iv before each meal (B). Potassium Permanganate, for attendant 
dyspepsia and flatulence; also useful for the obesity; gr. J-j ter die, in distilled water 
(B). Vinegar, only successful at expense of serious injury to the body (R). Fucus 
Vesiculosus, has power to reduce adipose tissue; an extract is sold under the title 
Antijat as a proprietary medicine (W). Phytolacca, has been long known as a reducer 
of adipose tissue; a resinoid preparation, named Phytoline, is on the market as an 
"anti-fat," the dose of which is itjyc, six times daily, before and after each meal. Thy- 
roid Extract, has been employed in several cases with uniformly good results; in one 
reported case small doses of this extract with Quinine, Theobromine, and a course of 
mineral water, produced a loss of from 2 to 6f pounds weekly. 

Banting Dietary is alone sufficient to improve the condition ; its chief feature is 
the exclusion of the two elements, starch and sugar, from the food; therefore bread 
(except toast, or the crust of a common loaf), potatoes, sweet roots, butter, sugar, cream, 
beer, porter, and champagne, should be avoided. In one year, on this diet, Mr. Banting 
reduced his weight 46 pounds, and his girth about 12 inches; at the same time, his 
numerous corporeal infirmities were greatly mitigated or altogether removed; but it 
cannot be recommended indiscriminately. This was the method of Hippocrates, avoid- 
ing all fats, starches, and sugars; in fact, all roots or vegetables which grow underground 
(B). Meat Diet, very successful in 42 cases, the diet being confined to rump-steak, 
hot water and codfish, for 14 days, absolutely excluding everything else (Smith). The 
Schweninger or Oertel method is similar, using chiefly albuminous food, excluding 
fat and carbohydrates, limiting the fluids drank, especially at meals, and enforcing 
exercise. Peanuts, a're an excellent article of food for the corpulent (Furbringer). 
Exercise, daily, in the open air, is necessary, and if carried on systematically is the 
most efficient and least injurious method of reducing an excess of adipose tissue. [Com- 
pare Abdominal Plethora.] 

Odontalgia. 

Sodium Bicarbonate in solution on plugs of cotton in painful cavities, or applied 
to the gums, to appease agonizing toothache (Duckworth). Sodium Salicylate, 
gr. xv every 4 hours, is highly efficient for toothache started by taking cold, also for the 
periostitis in which the tooth becomes loosened and projects so as to be exquisitely 
tender when eating (Coley); may be given with the utmost confidence in toothache due 
to periostitis in gouty subjects (Haig). Methyl Salicylate locally to the face over the 
painful tooth and its roots, promptly relieves and removes such irritation, in many cases 
obviating the necessity for using salicylates internally (Id). Aconite, as ointment or 
liniment for facial neuralgia due to diseased teeth, will succeed quickly if at all (R, Wa). 
Arsenic, as escharotic to destroy pulp; when used for pain may be mixed with Opium; 
it sometimes at first aggravates pain (R, W); a very minute quantity is efficient to de- 
vitalize the nerves and is practically painless. Cocaine in 4 per cent, solution on cotton 
applied to a cavity causes instant relief. Chloral-camphor has been recommended 
(W) ; equal parts of Chloral and Camphor rubbed together and placed in the painful 
cavity (R). Creosote mixed with Tannic Acid or Opium or Chloroform, and placed 
in the cavity of a decayed tooth, will often give relief (R). Guaiacol, a few drops 
rubbed into the gum gently, gives immediate relief (Brodnax). Oil of Cloves applied 
on cotton in the cavity (P); will frequently stop toothache (W). Tannic Acid in 
ethereal solution, is a good application to a carious tooth (B). Phenol, pure, with an 
equal part of Collodion, as jelly for the temporary filling of a decayed tooth (R). Opium 



ONYCHIA AND PARONYCHIA OPHTHALMIA. 



741 



in 



mixed with Tannic Acid or Creosote, and inserted into the cavity (R). Coniine 
alcoholic solution inserted into ca\ ity (R). Staphisagria, tlie alcoholic solution dropped 
into the cavity (P). Alum, a solution in Nitric Ether, 5ij to gvij, is said to lie an 
effectual application (W); Alum and salt powdered and placed in the cavity, excellent 
when nerve exposed. Xanthoxylum, a domestic remedy (B). Capsicum, a strong 
infusion on lint (R). Gelsemium, useful in some forms (R), Zinc Chloride, to 
destroy exposed painful pulp I R). Ginger, Mezereon, Pyrethrum, are useful masti- 
Catories in toothache (P). [Compare Gi MS, Ti 1111] 



R. Camphorae, 

Chlorali Hydra ti, 

Phenolis, 

Glycerini, aa part. asq. 

M. Sig. — To be applied on cotton after 
cleaning the cavity. (Brodnax.) 



R. Creosoti ni>xv. 

Ol. Carvophvlli, ". 

Ol. Menth. Piperil 3j. 

Camphome Sijss. 

Alcoholis q. s. ad 50- 

M. Sig. — Toothache Drops. 



Onychia and Paronychia. 
Silver Nitrate, a strong solution in Nitrous Ether, painted over the adjacent tissue, 
will abort if applied early (B); frequently causes resolution of the inflammation (Wa). 
Lead Nitrate, dusted over night and morning (R); relieves pain and hastens healing 
process (B). Turpentine, applied on a piece of lint or other absorbent material, stops 
the pain at once, and seems to abort the felon. Mercury, as ointment, for 10 minutes 
in every hour; poultices in interim (R). Arsenic, gr. ij ad 5j Adipis, as ointment, 
almost specific in onychia maligna (Wa). Tartar Emetic, will shorten course and 
render it milder (R). Iodoform, oint. or powder dusted on (B); or 1 part to 9 of 
Ether applied by a dropper, in syphilitic onychia (Fox). Iodine, a strong alcoholic 
solution locally will often subdue the disorder (Wa). Chloral, a solution locally, as 
antiseptic and to promote healing (B). Sodium Chloride, common salt roasted until 
the chlorine is driven off, equal parts of this, Castile Soap and Venice Turpentine, as 
a poultice, is a very efficient application. Phenol pure, to benumb surface during 
incision (R); which should be carried down to the bone, especially in tendinous whitlow 
(D). Cocaine, hypodermically, will accomplish the local anesthesia more thoroughly, 
if delivered deeply into the tissue. Ichthyol in 50 per cent, ointment rubbed in, has 
arrested several cases in the beginning (Gadde). Picric Acid in saturated solution 
on cotton to the bottom of the cavity, is very effective in perionychia affecting the root 
of the nail (Mihvard). Glycerin as the official Cataplasm of Kaolin, an excellent 
application for a felon. Heat, by poultices, is a very beneficial application. In Open- 
ing a felon avoid the lines of the arteries on the sides of the fingers, and that of the flexor 
tendons, which is the median line on the palmar surface; the incision should be made 
midway between these fines. If the sheath of the tendon be opened the tendon may 
slough, and the finger be rendered useless (Ashhurst). Removal of the nail may be 
necessary in obstinate cases of onychia, the raw matrix being dressed with powdered 
Lead Nitrate. [Compare Nails, ingrowing.] 



Ophthalmia. 
Silver Nitrate, a strong solution, gr. xx to the o, in granular lids; cautiously when 
corneal ulcers exist (B); in solution, gr. v to 5j aquae destillatae, locally once a day in 
purulent ophthalmia of the new-born, washed off with a weak solution of common salt 
(Noyes); in solution, gr. iij to the o, to abort the discharge in catarrhal ophthalmia 
(Fox). Argyrol, in 10 to 20 per cent, solution, a few drops locally, is the most efficient 
remedy to prevent and cure ophthalmia of the new -bom child (Darier). Protargol in 
2 per cent, solution, is very efficient in ophthalmia neonatorum (Van Hoesen). Nargol 
in 5 to 10 per cent, solution, for acute contagious ophthalmia (Hartridge). Alum, 
gr. viij to oj aqua;, applied every J to £ hour in purulent ophthalmia of children; suc- 
cess depends on the frequency of the application (R) ; a crayon formed of a crystal of 
alum, a mild and occasionally useful application (C). Mercury, Calomel dusted over 



742 OPIUM HABIT. 

membrane in phlyctenular ophthalmia; or after detaching scales rub in Brown Citrine 
Ointment every night, for eczema of margin of lids (B). Pulsatilla, as a lotion to 
conjunctiva 8 or 10 times in 24 hours, also internally (P). Arsenic, invaluable in in- 
veterate cases of strumous ophthalmia, especially when complicated with cutaneous 
eruptions (Wa). Copper Sulphate, gr. j to oj aquas camphorae as collyrium in puru- 
lent ophthalmia of infants; in substance to inner part of lids in granular conjunctivitis 
(Wa). Tannin, powdered or in solution, gr. j-x to the 5, produces remarkable results 
(B). Zinc Chloride, gr. j ad 5j aquae, as collyrium in gonorrheal ophthalmia is 
used with marked benefit; also a stronger solution, gr. ij-iv to the 5, effectually arrests 
the muco-purulent discharge remaining after subsidence of purulent ophthalmia, and 
has succeeded admirably in diphtheritic conjunctivitis and pustular ophthalmia (Wa); 
in solution, gr. ij to the o, is the best remedy for purulent ophthalmia in infants or 
adults (Hutchinson). Zinc Sulphate in solution, gr. j-iv to the 5, as collyrium, in 
ophthalmia of infants or adults (Wa). Sodium Salicylate in large doses, is of great 
value in sympathetic ophthalmia (Gifford). Iodine, is employed locally in scrofulous 
ophthalmia for its alterative stimulation (W). Iodoform, in gonorrheal ophthalmia, 
and purulent conjunctivitis, of very great value locally, but should be pulverized very 
finely (Grossmann) ; does not bear out the claims made for it (Keyser). Lead Acetate, 
gr. j ad oj aquae destillatae, applied by camel's-hair pencil to surfaces of everted lids, 
washed away before the lid is replaced; or the Tannate of Lead i£ to 3 parts fine Oil 
and 1 of fresh Lard, a very small piece as ointment to lid (C). Carbonic Acid Gas, 
said to relieve the pain and photophobia of strumous ophthalmia, when locally used 
(R). Physostigmine, locally, to reduce pupil and shut out the light (P). Boro- 
glyceride, in many catarrhal affections, especially ophthalmia neonatorum, is a most 
efficacious application, the solutions used being of 10, 25 and 50 per cent, strength 
(Fox). Spigelia, useful in rheumatic ophthalmia (P). Antimony, as Tartar Emetic, 
gr- T¥ to ^V) three or four times a day in strumous ophthalmia, with sharp purgation at 
commencement (R). Belladonna or Atropine locally, of great service in strumous 
ophthalmia to relieve pain; constitutional treatment also required (Wa); Atropine, 
gr. ij of the neutral sulphate to the o of aqua destillata, twice or thrice daily, as soothing 
application (C). Staphisagria, especially in tarsal ophthalmia (P). Colchicum, 
when gouty diathesis (P). Cod-liver Oil, in strumous subjects, tends to remove the 
manifestations of the disease (R). Cold Wet Compresses, or iced, are held to be 
essential in the early stage of acute purulent and gonorrheal ophthalmia (C). [Com- 
pare Blepharitis, Conjunctivitis, Eye Diseases, Keratitis.] 

Opium Habit. 

Sodium Bromide, in large and increasing doses, with Codeine and Trional, form 
a combination of unrivalled efficacy, if properly used in proper cases, and combined 
with minor aids make a method far in advance of any yet presented, to secure the mini- 
mum freedom from pain (Mattison): a combination of Bromides does not depress 
vitality or produce the injurious effects of the bromides as commonly administered 
(Mann); by acute bromidism it is possible to obliterate quickly and permanently the 
desire for morphine without the usual suffering, but requires careful nursing (Macleod). 
Bromides may do great harm, if recklessly administered, paralyzing the muscular sys- 
tem and causing prolonged delirium. Cocaine, or the fluidextract of Coca, has been, 
by many careful observers pronounced of great benefit, restoring appetite, inducing 
sleep, promoting digestion, while soothing the brain and inducing a feeling of content- 
ment and calm (R): should never be entrusted to the patient, lest he jump out of the 
frying-pan into the fire. In the treatment of the combined morphine and cocaine habit, 
the latter drug may be withdrawn entirely at once without any suffering, and the former 
may be reduced one-half at the same time. Codeine, in doses of a grain or more, is very 
useful in combating the nervous agitation which succeeds to the final withdrawal of the 
opium. Heroin is useful, but should not be used hypodermically, as it is then apparently 
more toxic than morphine (Studelmann). Dionin is highly efficient as a substitute 
and does not seem to form a habit. Atropine, used with great benefit in one severe 
case, repressing the copious exudation from the air-passages, bowels and skin, and 



iM'll M 1IA1U I'. 



743 



moderating the distressing symptoms due to the withdrawal of the morphine (W. Koch) 
Duboisine, injected daily succeeded in destroying the craving lor morphine in 
long standing (Birnabee); is an excellenl calmative and hypnotic at the crisi Hyos- 
cyamine, Merck's amorphous, useful as a hypnotic, and is perfectly safe in patients 
of good general condition, in whom the disuse of opium produces unusual insomnia 
and motor activity (M). Hyoscine, is of great value and properly used is the most 
efficient agent to prevent suffering (Pettey); is the safest and most easily controlled 
agent, effectually relieving the suffering at time of withdrawal (Lott); is a very danger 
ous remedy and causes a profound toxic condition (Cro thers). Physostigmine has 
given satisfaction at the crisis. Cannabis Indica in full doses, for restlessness after 
withdrawal of the opiate, 5-doses of Squibb's tluidextraet. repeated every hour or two, 
as required (M); or increasing doses of Hering's solid extract, beginning with one or 
two grains. Chloral, as a hypnotic, fails in the first few days of abstinence; later in 
full doses, 45 grains at once, rather than three 15-grain doses, alone or with a Bromide, 
it can be relied on (M). Trional, in dose of 30 to 40 grains as a hypnotic, is of special 
value in these cases. Paraldehyde, in dose of 5jss-ij, as a hypnotic, is efficient, hut its 
sleep is of briefer duration than that produced by Trional or Sulphonal. Gelsemium, 
subdues the restlessness and motor excitement; proved of great value in one case where 
30 grains of morphine were used daily; ttjjj' of tincture every £ hour (Pennoyer). Co- 
nium, in 10-drop doses of a good fluid extract, to check motor activity and relieve the 
wandering pains. Sparteine, in doses of gr. J to J hypodermically, at moment of 
systolic cardiac depression which answers to the period of craving, and corresponds to 
the truncated curve of the sphygmographic trace, characteristic of the period when 
the stimulant effect of morphine has passed (Jennings). Nitroglycerin acts in the 
same manner, but its effect is more rapid and ephemeral (Id). Camphor is sedative 
to the nervous system, stimulant to the heart and vaso-motor system, restores the vascular 
tone let down by withdrawal of morphine, and is of great benefit (Erlenmeyer). 
Sodium Salicylate used in many cases with advantage, preventing the opium re-bound, 
and enabling withdrawal to be made with slight discomfort (Haig). Ergot hypodermi- 
cally to tone up the relaxed, dilated vessels, and equalize the circulation (Livingston); 
for the headache. Strychnine, is invaluable, especially when the cure is nearly com- 
pleted (Barr). Aurum, the Bromide of Gold and Arsenic, itux hypodermically, as a 
tonic, thrice daily, to complete the cure. Capsicum, is serviceable as a stimulant to 
the stomach and a cerebral sedative; removes the sinking sensation at the epigastrium, 
and tones up the intestines. Catechu, the tincture in 5 doses, for the diarrhea. Lupu- 
lin, with Phosphoric Acid, helps to sustain the patient, lessens the force of his suffering, 
and shortens its duration (Fleming). Zinc and Iron, as blood tonics, administered 
for a month at least, are valuable restoratives, and are best given on alternate days 
(Fleming). Piscidia Erythrina, has been proposed as a substitute, and highly recom- 
mended, but is worthless, as are also Avena Sativa and many other falsely termed sub- 
stitutes (M); there is no specific for the opium habit (Da C). Zinc Oxide, for the 
vomiting and diarrhea, beginning with gr. j once daily and increasing to tolerance 
(Da C). Argemone Mexicana ojss-ij of the fluidextract 4 times daily, the doses 
being gradually diminished during 4 weeks, is a valuable substitute (Fromme). Gal- 
vanism, is very efficient for the neuralgic pains in various parts; a strong faradic current 
sometimes acting better (M). Baths, if hot, 105 to 112° F., are of great value to 
relieve disquiet; warm baths are worthless (M). Lavage of the stomach with a solution 
of Sodium Bicarbonate, or the drinking of such a solution to neutralize the hyperacidity 
of the stomach, which is the cause of most of the distress (Erlenmeyer). Purgation 
freely, before reducing or stopping the drug, to remove effete material and clear the 
portal system, is very effective in lessening the duration and degree of suffering and 
preventing severe symptoms (Pettey). Antitoxic Serum of rabbits immunized by 
morphine, has been successfully used in acute opium poisoning and may prove effective 
in cases of addiction (Hirschla'ff). Withdrawal of the drug suddenly and completely, 
is the method of Levinstein and other Germans, and is preferred when we can have 
absolute control and surveillance of the patient (Da C); entails horrible suffering, and 
is utterly inexcusable (M): a more gradual reduction is the method usually employed, 
taking off one-third the first day, one-fourth the second day, and then gradually reducing 



744 



ORCHITIS — OTALGIA. 



the amount until the sixth or seventh day, when it may be withdrawn entirely. No 
agent is of any value unless strengthened by moral courage and perseverance on the 
part of the patient (Squibb). Useless to try to cure a patient while he is pursuing his 
ordinary avocations; failure will result unless there are complete seclusion and entire 
giving up to the treatment (Mann). It is very important to keep the patient in total 
ignorance of the rate of reduction. 



1$. Ammonii Bromidi, 

Sodii Bromidi, aa Bss. 

Potassii Bromidi, §j. 

Liq. Potass. Arsenit 5j- 

Syr. Tolutan., oj- 

Aquae Mentha Piper., 5 jss. 

Syr. Hypophos. Comp. oiij- 

M. Sig. — 3j to 3ij in water thrice daily. 

Has of total Bromides, gr. 21 y in each 3- 

(Mann.) 

R;. Hydrarg. Chlor. Mitis, 

Ext. Cascarae, aa gr. x. 

Ipecacuanhas, (pulv.) gr. ij. 

Strychninae Sulph., gr. |— gr.ss. 

M. et div. in capsulas no. iv. 
Sig. — One capsule every 2 hours before 
reducing the drug. (Pettey.) 



R<. Tinct. Capsici, 

Potassii Bromidi, aa. 3 iv. 

Spt. Ammoniae Aromat., Biij. 

Aquae Camphorae,. .q. s. ad oyj. 
M. Sig. — A dessertsp. several times daily, 
in the depression of alcoholism and the opium- 
habit. Instead of the bromide, Fowler's so- 
lution, tijjI, may be added; or Tinct. Nucis 
Vomicae 3ij, or Tinct. Aurantii Amari 3 v. 

(Ringer.) 

R<. Codeinae, gr. xvj. 

Alcoholis, q. s. ad solv. 

Cocainae Hydrochlor., gr. xvj. 

Elixir Simplicis, q. s. ad 5ij. 

M. Sig. — oj in water, occasionally, 
when great restlessness. Formula never to 
be given to the patient. (Potter.) 






Orchitis. 

Pulsatilla, njj or less of the tincture every hour, relieves the pain rapidly, though 
not the edema (St). Belladonna, int., and as oint.; extract j ad iij Adipis, when inflam- 
mation has subsided (Wa). Sodium Salicylate, in gonorrheal orchitis, subdues the 
pain in a few hours. Iodine, tinct. locally to remove swelling after the acute stage has 
passed (B). Iodoform, 1 part in 10 of vaselin, as ointment to reduce enlargement, 
a very efficient application. Mercury, the Oleate locally (B); Calomel gr. iij with Ipe- 
cac gr. x, at once, followed by a saline next morning, and smaller doses of Calomel and 
Ipecac every 6 hours, with Morphine gr. \ hypodermically into cellular tissue of scrotum 
(McElroy). Ammonium Chloride, makes a good evaporating lotion in solution 
with alcohol and water (R). Silver Nitrate, a strong solution to the scrotum, with 
gentle pressure (Wa). Tartar Emetic, in acute orchitis (R). Digitalis, locally, is 
found most useful (P). Guaiacol, pure, as a local application for the pain; or 1 part 
in 10 of vaselin locally, and Salol internally (Bocchi). Alcohol, with equal quantity 
of water, as evaporating lotion (B). Ice, benefits the inflammation and relieves pain 
(B). [Compare Epididymitis.] 



R-. Ammonii Chloridi, gr. xl. 

Alcoholis, Aquae, aa oij- 

M. Sig. — Lotion, to be applied on thin 
cloths to the part. 



R. Hydrarg. Ammoniat., 3j- 

Cerati Simplicis, j- 

M. ft. unguent. Sig. — Apply locally, with 
gentle friction. 



Otalgia. 

Aconite and Opium, equal parts of the tinctures, a few drops well down the external 
meatus, will usually subdue the pain. Blistering Fluid, or Croton Oil Liniment 
behind the ear, often relieves earache (R). Phenol, in solution 1 to 40, ten drops 
by instillation into the ear (Gould). Morphine in solution, gr. iv to the o, with gr. j — Ij 
of Atropine, is an excellent application (B). Atropine, gr. ■£$ in 5xx of water, a teasp. 
every three hours for a child in the acute otitis media of children from coryza, very 
successfully used to abort the otitis and relieve the earache (Miot) ; a solution locally is 
especially applicable in the earache of children from whatever cause, gr. j to the 5, of 
which gtt. iv dropped into ear to remain for 10 or 15 minutes. Pulsatilla, internally 



OTITIS OTORRHEA. -.,c; 

and externally, is often used with advantage (P). Cocaine, cent solution 

lyed over the tympanic membrane through the external meatus, and forced into the 
stachian tubes by inhaling the spray and then expanding the tul.es by Valsalva's 
method; this repeated every three minutes is a very sure method of curing Otalgia 
Dry Heat by the hot-water bag or bottle, or a hot stone wrapped in flannel, or a bag 
of hot salt, or any other convenient method. Olive Oil, often used warm as a local 
application, but it is of no service and may Ao harm by undergoing decomposition and 
becoming favorable soil for the growth of aspergillus or other vegetable fungi. (Com 
pare Onus.] 

K. Chlorali Hydrati, Si g , , hl . ear (after warming) 

Camphors, enough to till it; cover with cotton wet with 

rhenolis aa gr. xx. rm water, and a cloth wrung out of hot 

Olei Ricini, 3 j. water. (Brodiuix.) 

Otitis. 
Pulsatilla, in inflammation of external auditory canal; in otitis, as lotion warmed 
and applied by syringe, three or four times a day (P). Aconite, quickly relieves the 
pain (R); should be used internally and locally. Phenol in a 20 per cent, solution 
instilled into ear in moderate otitis, relieves the pain at once and checks progress; a 
solution in glycerin is best (Rohrer). Atropine, in the acute otitis media of children, 
is very efficient (Miot). Resorcinol in 1 to 15 per cent, solutions locally (W). Naphthol 
in weak solution 1 to 200, locally (W). Borax 'and Phenol, as in Dobell's solu- 
tion, by spray to naso-pharynx once or twice daily, to soften secretions and permit their 
outflow (Gould). Boric Acid or Thymol Iodide, dusted over after removing 
secretions and drying i^Smitlu. Petrolatum Liquidum with a few drops of Eucalyptol, 
or a grain or two of Menthol, by moderate spraying to the naso-pharynx (Gould). 
Incision of the membrana tympani, not a simple puncture, is the logical measure for 
evacuation of pus from the tympanic cavity (Smith). Blisters behind the ears, either 
kept discharging or repeated, are often very useful (Wa). Leeches, behind the ear, 
afterwards a small blister upon the same place, when the leech-bites have healed (H). 
Warm Douche frequently to the ear, to secure cleanliness, then dry the part thoroughly 
(Roosa). Inflation and aspiration of the middle ear, also syringing and douching 
the naso-pharynx, must be avoided in acute catarrhal otitis media, lest pathogenic germs 
be forced into the middle ear (Gould). [Compare Otalgia, Otorrhea.] 

Otorrhea. 

Salol and Camphor, equal parts, heated together, have given good results in sup- 
puration of the middle ear; the application causes neither pain nor inflammation (Pegon). 
Bismuth Subgallate, on cotton tampon, introduced after thorough syringing with a 
3 per cent, solution of Boric Acid, and careful drying with absorbent cotton, the best 
means of combating an acute or chronic otorrhea, outside surgical measures (Chaniav- 
sky). Boric Acid, finely pulverized, as astringent and disinfectant application; may 
be mixed with pulv. Alum, and just enough powdered Lycopodium to keep it dry; 
this packed carefully through speculum, after washing with a weak and tepid alkaline 
solution. Phenol in 1 to 40 solution, as wash by syringe, once or twice daily is 
enough in the worst cases (Gould). Creosote locally in fetid otorrhea, instead of 
phenol (W). Hydrastis, itjrx-xx of the fluidextract to the 5 of solution, is a 
valuable local application (W). Potassium Permanganate in dilute solution, gr. 
j-v to the 5, as a disinfectant and germicidal wash (W). Formalin solutions, 1 to 
1,000 or 1 to 2,000 as wash, in place of phenol (Gould). Mercury, the brown citrine 
ointment in chronic cases (B). Mercurol in 1 per cent, solution by syringe in 
middle ear diseases, acts well on the purulent discharge without irritating (Burnet). 
Acetanilide by insufflation daily, after cleansing the canal, is highly efficient in chronic 
purulent otitis' media of children (Melzi). Lead solutions, as astringents, are much 
employed (B). Silver Nitrate solution locally, gr. iv to the 3 (B); gr. x to the 5 



746 OVARALGIA — OVARITIS. 

(Roosa). Argyrol in 50 per cent, solution, freely in the tympanic cavity, is effective 
and painless. Protargol in 2 per cent, solution, is very efficient in chronic otorrhea 
(Van Hoesen). Picratol, njjv of a 1 per cent, solution every 2 hours locally, is very 
efficient (Yale). Copper Sulphate, solution of gr. j to the 3 locally (Roosa). Tannin, 
the Glycerite, locally, is successful (B); especially in children (Wa). Zinc Sulphate, 
locally, in solutions of gr. ij-viij to the 5 (B); gr. j-x to the 5 (Roosa). Cadmium, 
gr. ij to oj rose-water (B). Liquor Sodae Chlorinatae, njxv-xxx ad oj aquae when 
discharge fetid; is highly useful as injection (Wa). Quinine, with Sulphuric Acid, 
advisable in otorrhea after scarlatina (Wa). Absorbent Cotton, on holder, may be 
used every few hours by the patient to keep pus removed from the canal. Syringing 
with warm salt water, once daily, as absolute cleanliness is essential in the treatment. 
Politzer Bag, inflation is a useful adjunct in keeping secretions out of tympanum and 
breaking up adhesions (Roosa). Ossiculectomy may be required in obstinate cases, 
to favor drainage and better local treatment of the middle ear by antiseptics (Gould). 
[Compare Otitis.] 

Ovaralgia. 

Codeine, has especial value against ovarian pain (Freund), whether of inflammatory 
or neuralgic origin, in doses of gr. f at least. Opium, often the cause; if use stopped 
entirely improvement may ensue (E) ; one of the best remedies in ovarian pain of non- 
inflammatory character (Graily Hewitt). Atropine, subcutaneously, the best remedy 
for pain in the pelvic viscera (Wa). Camphor, with Cannabis Indica, of great service 
in relieving ovarian pain, especially when spasmodic in character (Wa). Conium, or, 
better still, its alkaloid, used as a vaginal pessary, in all cases of ovarian pain, whether 
neuralgic or inflammatory, is quite a specific (Meadows). Ether, the compound spirit, 
in doses of ttjjxxx-xI as a palliative (Anstie). Salix Nigra, the "pussy willow," in doses 
of njxxx of the fluidextract thrice daily, of decided benefit in ovarian hyperesthesia of 
highly nervous women. Gelsemium has much evidence in favor of its value (W); 
deserves a trial, its power is great but not certain (Wa). Ammonium Chloride 
formerly used in ovarian neuralgia, but has not given satisfaction (W). Aurum, the 
Gold and Sodium Chloride is believed to have specific power in ovarian neuralgia and 
irritation (W). Hot Water, as vaginal injections night and morning; sunlight baths, 
fresh air (E). Leeches over the groin, or inside the thigh, when ovarian pain persistent, 
or tenderness and aching (Wa). Surgical, Battey's operation as a last resort (E). 
[Compare Dysmenorrhea, Ovaritis.] 



Ovaritis. 

Tartar Emetic, as ointment for counter-irritation over seat of disease, in subacute 
ovaritis; at the same time a pill of Opium, Hemp and Camphor (Hewitt). Opium, 
in suppository or enema, more effectual than internally (Tilt). Mercurial Ointment, 
combined with Camphor and Belladonna, over the seat of the disease by friction (West). 
Hydrated Chloral as glycerite, 2 to 5 per cent., or vaginal tampon to reduce local sensi- 
bility before proceeding to Ichthyol treatment (Freund). Ichthyol in 5 per cent, 
glycerin mixture on vaginal tampons, is valuable in chronic ovaritis (Freund). Picratol 
gr. ij-iij in vaginal suppository, or as a saturated glycerin solution on tampons to relieve 
congestion and pain (Yale). Ergot with Potassium Bromide and rest, valuable in 
chronic ovaritis (Tait). Aurum salts are beneficial in dropsy of the ovaries (Martini); 
are believed to have specific power in ovarian irritation (W). Ovarian Extract in 
conditions due to partial or entire arrest of the ovarian functions from disease. Parotid 
Extract, used as an internal remedy in six cases of enlarged and tender ovary with 
menorrbagia, etc., with signal success (Bell). Turpentine, hot turpentine epithems ap- 
plied over the seat of the disease (Wa). Ice, in bag, over seat of pain, when intolerable, 
and patient too much reduced to bear leeches; is often of benefit (Wa). Poultices 
of Linseed meal, as light as possible, often produce great benefit in ovarian inflammation. 
Blisters, in subacute ovaritis are often of great service, placed over the region or to the 



OXALT Ki \ 021 \ \ PAIN. 



747 



cervix uteri (Wa). Enemata, of warm water, simple or medicated, in subacute ovaritis, 
IN warmly recommended; they should be retained as long as possible (Wa). 



R. Ext. Opii gr. iij. 

Ext. Cannabis Ind., 

Camphors, aa gr. vj . 

M. ft. pil. no. vj. Sig. — One pill twice 
daily. (Grail y Hewitt.) 



1$. Ung. Hydrargyri ~ )V j. 

Camphors gr. xl. 

Ext. Belladonna Fol ,-)ij. 

M. ft. unguent. Sig To be rubbed In 
twice daily. (Wtsl.) 



Oxaluri'a. 

Nitric Acid has been used with advantage but is much inferior to nitro-hvdrorhloric 
acid (W). Nitro-hydrochloric Acid in a few days produces a surprising revolution 
(W); also in sciatica and other forms of neuralgic rheumatism accompanied with oxa 
luria, full doses, itRyj-x, of this acid, with an occasional brisk purgative, and cold douche 
followed by friction (Wa). Zinc Sulphate, often very serviceable in irritability of 
the nervous system, associated with dyspepsia and oxaluria (Bird). Alkalies when 
uric acid is associated with oxalic acid in the urine in excess (Tirard). Bromides in 
full doses at bedtime for insomnia, and ordinary tonics during waking hours when the 
depression is extreme (Id). Exercise in the open air is important (Id). Diet should 
be free from articles rich in oxalic acid or oxalates (Id). [Compare Dyspepsia.1 



Ozena. 

Aurum Salts are very serviceable in syphilitic ozena (B). Mercury, the Ointment 
of the Nitrate in syphilitic form; the White or Red Precipitate with 58 times its weight 
of sugar, snuffed after clearing the nose, in non-syphilitic forms (R). Potassium 
Permanganate, solution oj to Oj as an injection or spray (B); affords an elegant 
disinfectant and germicidal wash (W). Iodine, a dilute solution of the tincture as an 
alterative and stimulant application (W); with Phenol as inhalation (B). Phenol 
in 1 per cent, solution inhaled from an atomizer (B). Bromine 5j to the B 
of Alcohol, vaporized by the heat of the hand, as an inhalation (B). Ichthyol in 2 to 
5 per cent, aqueous solution as injection, after removing crusts by irrigation with tepid 
water, followed by swabbing with a 25 to 30 per cent, solution (Ertler); locally and inter- 
nally acts more quickly and certainly than cod-liver oil in the scrofulous ozena of chil- 
dren (Hoffmann). Hydrastis, the fluidextract locally (B); in solution 5j to Sviij 
locally, also the tincture ttjjv internally thrice daily (P). Silver Nitrate, a solution, 
gr. v-xx to the 5, applied behind the veil of the palate (B). Alum in solution, 5j to 
the pint, for irrigation (R). Glycerite of Tannin, by irrigation (R). Salicylic 
Acid, in very weak solution, 1 to 500, as cleansing, astringent, and disinfectant wash, 
used by retro-pharyngeal syringe, and followed by applications of Calomel, in powder, 
to the ulcerated portions of the mucous membrane (Massei). Hydrogen Dioxide, 
the solution as spray, is a most excellent application. Salol, has done good service, 
as insufflation. Strontium Iodide, has been used in scrofulous ozena, with varied 
results. Cubeb, the Oleo-resin, gtt. xv-xx on sugar after each meal, to restrain the 
secretion and perhaps modify its character (Cohen) Calcium Chloride, gr. xxx-lx 
with oj Decocti Krameriae; of which 5ij-iij, diluted with an equal quantity of water, 
should be injected twice daily after cleansing with salt and water (Cohen). [Compare 
Catarrh, chronic nasal.] 



Pain. 
Opium, is the most efficient of all analgesics and is universally used to relieve pain 
from any cause except acute inflammation of the brain (W) ; opiates soon lose their power 
in any particular dose, and require increasing dosage to sustain their analgesic influence, 
hence in chronic cases all other means should be exhausted before resorting to them (R). 
Morphine, is the most analgesic alkaloid of opium; hypodermically in the vicinity of 



748 pain. 

the nerve is efficient when not so by the stomach (B); the morphine-habit must be kept 
in mind; a single injection thereof is sometimes curative in sciatica and other neuralgia; 
the conjoined administration of Morphine and Antipyrine is much more efficient in 
pain than the use of either agent alone. Codeine, has a special influence over abdominal 
pain and that of the ovaries, and is not liable to give rise to a drug habit. Dionin in 
4 to 7 per cent, solution locally, is the best analgesic for the eye. Belladonna, is the 
best remedy for every kind of pain in the pelvic viscera (Anstie). Atropine, hypo- 
dermically in local pain, neuralgia, sciatica, glaucoma; when it succeeds, has more 
lasting effect than morphine (R); for sciatica, tic douloureux (B); has little value unless 
the pain be due to spasm or some cause situated so that the remedy can be brought into 
direct contact with sensory nerve-endings (W). Duboisine may be used instead of 
Atropine (B). Cocaine, as a local anesthetic to mucous surfaces, or hypodermically 
for minor operations involving a small area, as circumcision, eye operations, has no 
equal; a 4 per cent, solution is generally employed (R); also as a general anesthetic by 
spinal subarachnoid injection. Eucaine is fully as efficient as cocaine and much less 
toxic (Schleich) ; in medicinal doses is harmless and does not affect the heart (Reichert). 
Antipyrine, is a most efficient analgesic in doses of 10 to 15 grains, being especially 
adapted to neuralgia, migraine and the pains of gouty and rheumatic origin, but is of 
no value in pain due to a local inflammation; it may be used hypodermically. Acetan- 
ilide, is highly efficient in doses of 4 to 7 grains for the pains of locomotor ataxia and 
those of rheumatic origin; also locally as a dry dressing for painful wounds, ulcers, 
etc.; it is the active ingredient in a host of recent proprietary remedies against pain. 
Acetphenetidin, efficient in 10 grain doses, for neuralgia, hemicrania. Phenocoll 
Hydrochloride, in doses of 12 to 15 grains, is a good analgesic in the neuralgic pains 
of influenza, and in gouty and rheumatic pain. Lactophenin, is analgesic and non- 
toxic; a feeling of comfort follows its use (Clevenger). Chloroform by inhalation 
as a general anesthetic; internally for the pain of colic, even that of lead colic, and 
externally as liniment with other substances for chronic neuralgic or rheumatic pains 
(W); the vapor to the raw surface of cancers, to the photophobic eye, etc. (R). Ether 
as spray for local anesthesia, by inhalation for general anesthesia (R); anesthetics 
should be employed only when pain is exceedingly severe and transient (W). Hydra ted 
Chloral is analgesic only in large and dangerous doses (W); sometimes relieves 
neuralgia, chronic rheumatic pains, colic, gastralgia, etc. (R). Aconite was formerly 
much used for neuralgic pain (W): Aconitine locally is one of the most certain and 
powerful palliatives in neuralgic, rheumatic and gouty pains (Wa); especially in tri- 
geminal neuralgia (B). Veratrine as ointment locally for neuralgia, is readily absorbed 
through the skin and is more dangerous than useful (W). Guaiacol, locally or by 
hypodermic injection, 1 part in 10 of olive oil, or mixed with equal part of glycerin for 
painting on the surface, is an efficient local anesthetic, and is used successfully in orchitis, 
in neuralgic pains of tuberculous subjects, also in sciatica and rheumatism (Moissy); 
a few drops rubbed in gently give immediate relief in many superficial pains, also in 
labor-pains (Brodnax). Phenol pure, is a local anesthetic (R); but has been sup- 
planted by cocaine (W). Creosote locally is efficient for the pain of an exposed dental 
nerve. Ichthyol locally is analgesic against inflammatory pain; hypodermically is 
analgesic, less so than morphine and less dangerous (Damiens). Amyl Nitrite, also 
Nitroglycerin and other Nitrites, are effective usually against cardiac pain (Leech); 
especially when arterial spasm exists as in angina pectoris (Br). Cannabis Indica 
is inferior to opium, but may be tried when the latter is contraindicated for any reason 
(W). Salicylates are efficient in rheumatic and gouty pain, also in rheumatic neuritis 
(W). Mesotan locally for superficial rheumatic pain (Ruhemann). Iodoform in 
suppository for painful disease of the rectum or bladder (R). Iodides, are magical 
in syphilitic nocturnal pains of the head (B); Ammonium Iodide, gr. iij ad 5j 01. 
Olivae, with friction; causes the disappearance of nocturnal syphilitic pains (W). Cimi- 
cifuga, relieves many kinds of pain, as neuralgia of 5th, rheumatic headache, ovarian 
neuralgia, dysmenorrhea; inferior to Ergot in labor-pains or after-pains; 3j doses of 
the tincture (B). Conium, in cancer, rheumatism, neuralgia, ovarian pain (R); also 
for the fulgurant pains of locomotor ataxia, chronic alcoholism, sciatica, phthisis, doses 
of irj>x of a fluid extr. of the unripe fruit every \ hour, well watched (Madigan). Iron, 



'PARALYSIS \\i> paresis. 



749 



with Belladonna, for the wandering pains of anemia, in which morphine is dangerous 
and bromides are useless (Waugh). Oil of Peppermint locally is sum. ti 
effective in relieving pain (W); has been long used in China for neuralgia and suba< ute 
rheumatism. Menthol freely rubbed on for superficial neuralgic pain of peripheral 
origin (\\). Rhatany relieves the pain of ulcers, burns, ami blisters (Tr). Aqua- 
puncture relieves pain in a superficial nerve (B). Electricity, the galvanic currenl 
for neuralgia, it is powerless against pain of phlegmonous inflammations (W); galvanism 
of the affected nerve gives certain relief; the positive pole on point of emergence, nega- 
tive over superior ganglion of cervical sympathetic (B). Heat, if pain is without fever 
or inflammation (B); warm injections soothe the pain of cystitis, prostatitis and ab- 
dominal pains generally (B). Hot Water, as bath, relieves pain most wonderfully; 
Napoleon, at St. Helena, suffering from cancer of the stomach, appreciated highly the 
pain-relieving power of the hot bath; often staying half and even whole days therein. 
Cold, when pain is inflammatory in origin (B). Phototherapy, the ultra-violet rays 
are very effective in relieving acute muscular pain, especially if obtained with iron- 
carbon electrodes (Rosenberg). [Compare After-pains, Anesthesia, Boils, Chest- 
pains, Colic, Gastralgia, Headache, Hepatalgia, Inflammation, Lumbago, 
Myalgia, Neuralgia, Neuritis, Odontalgia, Otalgia, Ovaralgia, Rheuma- 
tism.! 



R<. Antipyrinae, gr. xv. 

Cocaina: Hydrochlor gr. ss. 

Aquae Destil., Ttjjxv. 

M. Sig. — One-half as hypodermic injec- 
tion, or the whole when rapid action desired. 

(Ste.) 



1% . Liquoris Morphinae Magen- 

die 5j- 

Aquae, q. s. ad 5 i j . 

M. Sig. — A teasp. to dessertsp. every 
six or eight hours, for pain. Each drachm 
contains J grain of Morphine Sulphate. 

(Potter.) 



Paralysis and Paresis. 
Nux Vomica, in hysterical paralysis and in that from lead-poisoning; only in 
chronic cases (P); in paraplegia due to softening and wasting of the cord (Brown- 
Sequard). Ignatia, in paralysis of the lower extremities (P). Strychnine, hypoder- 
mically into the affected muscles, for hemiplegia, paraplegia, local, mercurial, paludal, 
rheumatismal, facial, infantile and diphtheritic paralyses; in that of the spinal muscles, 
of the bladder and all local forms (B); in hysterical paralyses (P); in all forms except 
cerebral and spinal paralyses (Barwell); internally in doses of gr. -„'„ to r ' 2 (R). Phos- 
phorus, with Cod-liver Oil in the paralysis of white softening of the brain (B) ; in hysteri- 
cal paralysis (R); in myelitic paraplegia from excessive venery; the only drug which 
really affects the nerve-centres (W). Belladonna, when depending on chronic inflam- 
mation of the cord (R); externally as ointment along spine, with Ergot internally 
I Brown-Sequard). Physostigmine, into the eye in ocular paralyses (B); Physostigma 
in general paralysis of the insane, also in progressive muscular atrophy without much 
mental disorder, long-standing hemiplegia, paraplegia, locomotor ataxia (R). Ergot, 
in paralysis of bladder from over-distention (B); paralytic dysuria, sensation of but 
partial emptying of bladder (P); said to be useful in paraplegia (R); in paraplegia 
complicated with menstrual irregularity and forms of paralysis arising from spinal 
congestion (Wa); has cured cases of constipation of the paralytic when all the most 
powerful cathartics failed (Curran). Mercury Benzoate in daily doses of gr. § to h 
hypodermically, markedly ameliorated the symptoms in six cases of general paralysis 
(Lemoine). Cocculus Indicus, valuable in hemiplegia, paraplegia, and paralytic 
stiffness (P). Picrotoxin has greatly benefited several forms, especially paralysis 
of the sphincters, hemiplegia from cold, and glosso-labio-laryngeal paralysis. Cannabis 
Indica, for retention of urine in spinal paralysis (R). Rhus Toxicodendron, is cer- 
tainly efficacious in paralysis depending on rheumatism (P). Ammonium Iodide 
and Carbonate, to aid in absorption of thrombi, thus promoting cerebral nutrition in 
cases of incipient hemiplegia, due to endarteritis deformans reducing the lumen of the 
vessels in the brain (B). [See formula below.] Arnica, in paralysis of the bladder 
and many forms (P). Colocynth, in cerebral paralyses, sometimes seems to act favor- 



750 PARALYSIS AGITAN'S — PAROTITIS. 

ably upon principles of revulsion or counter-irritation (P). Mustard, as an emetic to 
stimulate failing heart in certain forms of paralysis (P). Senega, in rheumatic paraly- 
sis, is a powerful help (P). Nutmeg, the Oil as external stimulant (P). Oil of Bay, 
has been given; is obsolete (P). Capsicum as a general stimulant, in doses of gr. j-ij 
every 4 hours (P). Orchitic Extract has been considered beneficial in general paraly- 
sis. Counter-irritation by blistering fluid, in peripheral paralysis of the 7th nerve 
(R). Cod-liver Oil, when low nutrition and faulty assimilation (Anstie). Galvanism, 
in hemiplegia and many forms (B). Electricity, faradization of the muscles affected; 
localized electricity probably of more importance in confirmed spinal paralysis than 
medicinal treatment. Galvanism should not be used on the muscles in an acute palsy 
connected with active irritation of the nerve-centres until the centric disturbance has 
subsided (W). Massage, in infantile paralysis, given with Calcium Lactophosphate 
and Cod-liver Oil, and Strychnine injected into the muscles (B). [Compare Hemi- 
plegia, Locomotor Ataxia, Paralysis Agitans, Tongue.] 

R. Strychninae Sulph gr. iij. I R. Ammonii Iodidi 3j- 

Aquas Destillatae (fervid.), ox. Ammonii Carbonatis 3ij. 

M. Sig. — For hypodermic administra- Liq. Ammonii Acetatis, ...jjvj. 

tion: it£x = gr. 5 V of Strychnine Sulphate. M. Sig. — A tablesp. thrice daily. (B.) 

Paralysis Agitans. 

Hyoscyamus, full doses of the tincture will palliate the trembling (B). Hyos- 
cine temporarily but effectually controls the tremor, if used continually will lose 
its power (W). Duboisine acts similarly in most cases. Conium has seemed to 
benefit in some instances (Harley). Gelsemium, in full doses, to quiet the nervous 
irritation (Lavers); a combination of Conium, Hyoscyamus and Gelsemium [see under 
Tremor]. Potassium Iodide, to promote absorption (Lavers). Cocaine, influences 
paralysis agitans more favorably than any other remedy, large doses and frequent 
administration are unnecessary (B). Cannabis Indica, in large doses, lowers reflex 
activity. Picrotoxin, has greatly benefited some cases. Opium, Arsenic and Hyos- 
cyamine may be tried, but the disease is incurable, and nothing can be done except 
to attend to the physical comfort of the patient; there is no treatment which can be 
recommended as satisfactory in any respect (O). Sodium Borate, gr. xv-xlv daily, 
in 3 or 4 doses, produced most striking improvement in a case of paralysis agitans which 
developed after a fall upon the shoulder (Sacaze). Phosphorus, in small doses, with 
Cod-liver Oil, is very useful (R). Hypophosphites, the Syrup ought to be of service, 
if taken steadily for a long time. Cod-liver Oil, long continued, is more constantly 
useful than any other medicine (Anstie). Orchitic Extract, has been used with 
apparent benefit. Sulphur Baths, are certainly of great value in this disease (Lavers). 
Electricity, the constant current, anode over the spine, cathode drawn along the 
course of the nerves from where they leave the vertebral column to the periphery (Id). 
Cupping the skin of the spinal region with dry cups, to dilate the vessels of the cord 
improving its nutrition, also to improve the elasticity of the deep muscles and ligaments 
(Taylor). Exercises of the muscles are beneficial, whenever by exertion of the will- 
power a temporary intermission of the tremors and control of the muscles are still possible 
(Friedlander) ; a series of directed movements, passive and active, to restore tissue 
elasticity and overcome contractures, gives much relief in many severe cases if faith- 
fully performed (Taylor). Electric Baths caused recovery or lasting improvement in 
44 out of 56 cases so treated (Schnee). [Compare Chorea, Tremor.] 

Parotitis. 
Aconite, in febrile conditions (R). Mercury, $ grain of Gray Powder, 3 or 4 times 
a day, is very useful, relieving pain and swelling (R). Ichthyol, in 20 per cent, oint- 
ment with Lanolin, causes rapid removal of the pain and swelling (Stauffner). Guaia- 
col in 5 per cent, ointment spread over the gland, gives relief from pain on the first 
application, and cures after two or three (Grande). Poultice of Flaxseed meal, is a 



PEDICTJ] 1 PEMPHIGT S PERICARDITIS. 751 

pod local application for the gland. Leeching, often gives speedy relief, when pain 
t and resists hot fomentations (Wa). Care to avoid chilling, important In- 
cision, when suppuration occurs. Stimulants and Tonics internally are very neces- 
sary in symptomatic parotitis, occurring as a complication or sequel of other diseases, 
with adynamic symptoms. 

Pediculi. 

Mercury, as Citrine Ointment or a wash of Corrosive Sublimate solution, for lice 
on all parts of the. body; the Oleate destroys lice immediately, and also kills the ova (R); 
for crab-lice the ordinary Blue Oint. is very disagreeable, and often toxic in its effect 
on the patient; a better preparation is Calomel in 5 per cent, oint., or the Bichloride, 
a 1 per cent, solution in alcohol, of which a teasp. to a pint of water, as a bath to parti 
twice daily. Cocculus Indicus, destroys pediculi (P); the tincture undiluted as a wash. 
Staphisagria, as Oil or an ointment of the powdered drug (R); " lice-bane" (P); the 
tincture a very efficient application, and much more cleanly than an oil or an ointment. 
Acetum, Vinegar removes the nits, as it softens the adhesive chitin by which the ova 
are glued to the hairs. Benzol, is a very efficient, convenient and cleanly application 
for destroying pediculi capitis or pubis, if fire or light be carefully avoided: a single 
application is usually sufficient. Ether, washed over the parts, effectually destroys 
crab-lice. Tobacco, a decoction of the leaf is an efficient application, but requires 
care, especially if the surface is abraded (Wa). Essential Oils, will kill pediculi, as 
Rosemary, Anise (P); or powdered Pyrethrum (R). Cleanliness, cannot be dispensed 
with, and in many cases may alone be sufficient. Boil the underclothing. Isolation 
of person, and of brushes, towels, etc., to prevent infection. In Vienna the following 
prescriptions are used: — 



R. Bals. Peruvian., 

Petrolei aa part. xv. 

Olei Pichuri part. j. 

To be applied and washed off after 3 
hours. 



R;. Acidi Salicylici, part, ij-iij. 

Aceti, part. xxv. 

Alcoholis (So per cent.) part. lxxv. 

To be rubbed on with a bit of flannel. 
One application is often enough. 



Pemphigus. 
Arsenic, increasing doses to toleration, is the main remedy to be relied on (Eustis); 
is curative, especially when chronic (B) ; largest dose, njjv of Liquor Arsenicalis 3 times 
a day on full stomach (R); exercises a powerful influence (Wa). Mercury, as Citrine 
Ointment is largely used (Wa). Potassium Iodide, improves the condition in pem- 
phigus (Wa); with good, simple diet; Quinine, Cod-liver Oil. Silver Nitrate, gr. ij 
ad 3j aquae locally in pemphigus, after the bullae have burst and excoriations remain 
i\Va). Antipyrine internally, efficient for the itching. Zinc Stearate with Bismuth 
Subgallate, has been used with benefit as a dressing. Water Dressings, on lint, covered 
with oiled silk, applied constantly, in pemphigus and rupia (Wa). Cod-liver Oil, 
with nutritious diet, is a powerful auxiliary to treatment (Wa). Puncturing the blebs 
and evacuation of their contents are necessary as soon as formed; cleanliness, the 
frequent use of a 1 in 1000 corrosive sublimate lotion, a dusting powder of equal parts 
of boric acid, zinc oxide and starch, are speedily effective (Mn); or buckwheat flour, 
lotion of Liquor Plumbi Subacetatis Dilutus, or painting with a 4 per cent, solution of 
Silver Nitrate in alcohol, after cutting off the tops of the blebs and cleaning the bases. 
The affection is highly contagious. 



Pericarditis. 

Aconite, when violent throbbing and extreme pain (R); of great value, if given 

early (P); proves in the highest degree serviceable, when object is to diminish vascular 

excitement or irritability (Wa); depressants are contraindicated, as the danger lies in 

failure of the heart (Bramwell). Veratrum Viride an extract gr. ij with gr. j of Calo- 



752 PERIOSTITIS — PERITONITIS. 

mel every two hours, is valuable (Waring-Curran); is inadmissible as it depresses the 
heart (Huchard). Sodium Salicylate in large doses frequently in rheumatism to 
prevent pericarditis, continued until the joint-pains have disappeared (Id). Digitalis 
when the heart is rapid and feeble, with cyanosis and dropsy (P); when there are marked 
nervous irritability, palpitation, and tachycardia (Huchard); in the second stage when 
the heart flags oss of the infusion ever)' 4 hours. Mercury when there is a tendency 
to fibrinous exudation (W). Spigelia Anthelmia is useful in rheumatic form (P). 
Quinine is a useful remedy in many cases (Bramwell); gr. xv-xx may suppress an 
acute attack if given at the critical moment (B). Bryonia, exceedingly valuable in 
second stage, that of exudation; fully equals any remedy in pericarditis (P). Opium, 
regularly in grain doses, every 3, 4, 6, or 8 hours, is very beneficial (Wa). Iron, the 
tincture of the Chloride in full doses, may be required in the second stage. Potassium 
Iodide, to promote absorption in chronic pericarditis (W). Collargol by inunction 
and intravenous injection, is rapidly curative (Netter). Leeches to the precordium, 
or scarification and wet cups, are very useful (Huchard). Counter-irritation, has 
been much abused; useful at commencement, but not in acute inflammatory stage (B); 
by Iodine painted over the cardiac region, or flying blisters in the second stage. Heat 
by large hot poultices, often renewed (R) ; is disadvantageous as it increases the rapidity 
of the heart's action (Huchard). Ice-bag over the heart may be useful (Id); especially 
in the early stage. Paracentesis by aspiration, if the fluid is not absorbed, after giving 
sufficient time (Id). Pericardotomy when the effusion is purulent (Id). [Compare 
Endocarditis.] 

Periostitis. 

Mezereon, in the rheumatic and scrofulous form (P). Mercury and Morphine, 
the Oleate externally (R). Potassium Iodide, in syphilitic children, also in non- 
syphilitic periosteal thickening (R) ; holds the first place for syphilitic affections of the 
bones (Wa). Ammonium Iodide, cures periostitis most readily when syphilitic (Wa). 
Staphisagria, when the long bones are affected (P). Iodine, the tincture, or blister 
locally, of great sendee in chronic form (R) ; under the external use of Iodine periostitis 
often rapidly improves (Wa). Poultices, after an early and free incision, when sup- 
puration takes place (C). Incisions, carried deeply, should be made without waiting 
for fluctuation, when great tension exists and there is a tendency to suppuration; the 
sides of the abscess should then be brought together with compresses and a bandage 
(Gross). Tonics and Stimulants, as milk -punch, Quinine, Iron, and Opium, in full 
and sustained doses, are imperatively demanded in many cases (Gross). [Compare 
Nodes, Onychia.] 

Peritonitis. 

Opium or Morphine at once, for its action on the nervous system and the circulation, 
but not in quantity to mask the symptoms and deceive the physician (Bruce); to quiet 
intestinal movements (R) ; by far the best agent (P) ; Morphine, gr. £ hypodermically, 
will often abort, if given early; Aconite and Opium, the tinctures, gtt. ij of the former 
with gtt. vj of the latter, in water every hour or two; a larger dose of opium if pain is 
severe (B); large doses of opium are easily borne in this affection (Wa). Acetphenet- 
idin, as antipyretic; efficient and safe. Aconite, of great utility when sthenic reaction; 
[see Opium above]; should be given early in all inflammations of serous membranes (P). 
Bryonia, exceedingly valuable in second stage, when exudation (P). Mercury, when 
tendency to fibrinous exudation, is employed with good effect (W); Calomel as an 
intestinal antiseptic, not as a purgative, can undoubtedly control the inflammation 
(Tirard). Magnesium Sulphate as a purgative in septic peritonitis, depletes the 
inflamed tissues, washes away the septic organisms and their toxins (Bruce); purga- 
tives should not be used in the non-septic form, and are inadmissible in peritonitis due 
to appendicitis or perityphlitis (B). Cocculus Indicus, for tympanites; a few doses 
will often remove the pain and relieve distention (P). Quinine, strongly urged by 
Trousseau; is naturally indicated in most inflammations (P). Turpentine, for tym- 
panites (P); turpentine stupes, v-xv drops of Turpentine on flannel wrung out of hot 



n ki io\i ns PERSPIB \n«>\. 753 

water during acute stage, then blisters for a short time (I!). Ichthyol undiluted u painl 

to abdomen, gave groat satisfaction in a subacute ease (Gilnther); on compress to abdo 
men and on vaginal tampons, gives excellent results in pelvic peritonitis (Stratz). Gly- 
cerin, as the official cataplasm of kaolin, as a thin abdominal poultice. Leeches to 
the abdomen to relieve pain, if the patient is plethoric and of sthenic reaction (B), 
Blisters are useful in inflammations of serous membranes (W). Poultices, thin hot, 
frequently renewed, and covered with cotton wool (R); are generally favored in this 
country (W) Ice mixed with dry meal or fine sawdust, as poultice to abdomen, earl) 
in the attack when the fever is high (W); the cold or hot poultice according to the fed 
ings of the patient (W); ice may be sucked or swallowed to relieve the vomiting, or sips 
of cold water. Posture, Fowler's position, the head and trunk elevated, is valuable 
in septic peritonitis, both for prophylaxis and treatment; Clark's position, the pelvis 
elevated, is wrong as absorption is much more active from the diaphragmatic than 
from the pelvic peritoneum (Knott). Diet should be low and liquid during the attack, 
mild and unstimulating afterwards. [Compare Appendicitis, Puerperal Periton i 
Tvphutis.1 

Peritonitis, Tuberculous. 
Quinine, in the acute form to reduce fever, as in acute tuberculosis, together with 
rest, poultices or warm fomentations, liquid diet, Opium (Whitla). Cod-liver Oil, 
by inunction with friction, also its continuous administration by the binder and mackin- 
tosh, is of great value in the chronic form of this disease (Id). Arsenic, children 
affected with tuberculosis involving the intestines and peritoneum have steadily and 
slowly improved and finally recovered under the Arsenic treatment (R). Laparotomy, 
has been done with uniform success and with complete cure of the disease in 80 per cent. 
of all cases of tuberculous peritonitis in which the abdomen was opened, cleaned and 
drained (Tait): in 131 cases so treated 84 were cured and 23 greatly improved; only in 
3 per cent, could death be ascribed to the operation (Konig); of 38 cases treated by 
simple laparotomy in 1896-97, 21 cases or 55 per cent, were completely cured (Chrobak). 
Treatment by medicine is useless, tapping is at best only of temporary sen-ice, incision 
and evacuation of the abdominal contents afford by far the best chances of recovery (Id). 

Perspiration. 

Belladonna, as liniment locally, also the tincture internally, especially in weakly 
children who sweat profusely (R). Atropine, gr. ^l tTi to r 'j rt hypodermically, or in 
exceptional cases even gr. ■%% in pill, in sweating of phthisis and exhausting diseases (R) ; 
gr. ,;',; at bedtime for sweats of phthisis (B). Duboisine, may be used instead of atro- 
pine. Pilocarpine, gr. -, 1 ,, thrice daily, checks profuse perspiration (R, Pf). Naphthol, 
in a 5 per cent, ointment or alcoholic solution, is a very efficient application for local sweat- 
ing (Kaposi). Potentilla Sarmentosa, the Cinquefoil, an infusion of the vine, leaves, 
and root, may be drunk ad libitum, and is a very efficient remedy for night-sweats, 
having stopped them when Atropine failed to relieve (Pope). Salvia, the ordinary 
Sage-tea is very- efficient, used internally and locally by sponging the body; the infusion 
for night-sweats of phthisis (Da C). Quinine, in that of exhausting diseases; in many 
cases a night-draught of Quinine, Zinc Sulphate and Sulphuric Acid is useful (R). 
Opium, as Dover's powder, may succeed in profuse colliquative sweating (R); a fact, 
though it is hard to account for it (Wa). Agaricine, is used successfully [see formula 
below]. Agaricic Acid, in dose of gr. x \- to J, not hypodermically, one of the most 
efficient agents against sweating from various causes, especially that after influenza; 
in over two years' use, it only failed me in one case (Richards). Camphoric Acid, 
gr. x-xxx, dry on the tongue, not over 2 hours before the expected sweating, is remark- 
ably efficient against sweating from various causes, especially that of phthisis even when 
very profuse (Jas. Wood). Aromatic Sulphuric Acid, to check sweats of phthisis; 
bad for digestion (B). Muscarine, has been used with great success in the sweats of 
phthisis and of other morbid states (R). Zinc Oleate, rapidly controls excessive and 
offensive sweating in the axilla? and groins on slight exertion, also the night-sweats of 

49 



754 



PERTUSSIS. 



phthisis (Murrell). Zinc Oxide, gr. iij with gr. ss of Ext. Belladonnae, in a pill at 
bedtime for the sweats of phthisis (R). Gallic Acid, is very useful for the same condi- 
tion, and may be combined with extract of Belladonna (B). Tannic Acid, mixed with 
Zinc Stearate, is an excellent application in hyperidrosis. Tannoform in substance 
or in 20 to 50 per cent, trituration with Starch, promptly checks hyperidrosis and bromi- 
drosis. Ichthyol oss to the 5 of water, sprayed over the surface of the body, proved 
entirely curative in a case of bromidrosis (White). Aluminum, the Oleate, checks 
hyperidrosis and antisepticizes the sweat, thus forming a useful application to the axillae 
and groins of children (Wa). Potassium Permanganate, gr. j in 5j of water, for 
fetid perspirations of axillae, feet, etc. (B). Salicin, profuse sweats of hectic fever (Wa). 
Salicylic Acid, in solution with Borax, the most agreeable and efficient deodorant for 
fetid perspirations (B). Phenol, 2 parts, to 3 of glycerin and water, twice daily locally 
for fetid sweat (Wa). Oils, rubbed into the whole skin to prevent sweating accompany- 
ing exhausting diseases, as phthisis; but sponging with a weak acid, wash better (R). 
Ergot, said to arrest sweating (R). Sponging, with acidulated water, or very hot 
sponging in phthisis (R). [Compare Feet.] 



R<. Acidi Tannici, gr. xxx. 

Digitalis, gr. xv. 

Ext. Cinchonas, q. s. 

Ft. pil. xx. Sig. — One pill at bedtime, for 
night-sweats. 



R-. Agaricinae (Merck), gr. x. 

Atropinae Sulphatis, gr. j. 

Acidi Sulph. Aromat., Bijss. 

Solve et filtra. Dose, njx in syrup or 
simple elixir, 5 or 6 hours before retiring. 



Pertussis. 

Antipyrine, is successfully employed, clinical experience shows that it has real 
power (W); as a preventative holds the first rank (Weill). Acetphenetidin is 
praised by many physicians. Aconite with Ipecac and cherry-laurel water, is very 
efficient as a preventive or abortive remedy (Dervieux); in all acute congestions of 
the respiratory passages (P). Lobelia in the spasmodic stage, is well tolerated by 
children, "Ex of the tincture every hour for a child 2 years old, and an additional 
dose when the cough is imminent (R, P). Amyl Nitrite, with Phenol, in a steam 
atomizer, has proved a very efficient inhalation (Bayliss). Ipecacuanha, useful in 
many cases (R); nuj for 5 years of age, every hour or two, gives the greatest relief (P); 
when bronchitic or pneumonic complications, combined with Ammonium Bromide (Wa). 
Bromides, relieve spasmodic element (B) ; that of Ammonium will readily cure many 
cases; gr. ij or iij ter die for infants (Wa). Bromoform, in daily dosage of 5 to 20 
minims, in glycerin and alcohol, very efficient for relief of paroxysms, and to reduce 
their number, but has little other influence on the course of the disease; must be pure, 
hence colorless; increasing doses should not be pushed very far, for fear of toxic symp- 
toms (Bedford) ; is almost a specific, acting as a local anesthetic on the mucous membrane 
of the pharynx and larynx, given in doses of 1 to 5 drops 3 or 4 times daily (Carpenter); 
it may be used by inhalation instead of chloroform or ether, to lessen severity of the 
paroxysms. Camphor Monobromide gr. v three or four times daily, is serviceable 
(B). Cannabis Indica, the tincture TTgij-viij as per age even- 3 or 4 hours, lessens the 
frequency and intensity of the attacks (Burton). Ichthyol internally i!EJ-iij, increased 
to ttjx-xv daily, also a 3 per cent, glycerin solution by inhalation (Maestro); gr. j 
increased to gr. iij every 4 hours, gives good results (Souther). Aristochin in dose of 
gr. j-v according to age thrice daily, as a sedative, is effective (Stursberg). Opium in 
the convulsive stage, enough to maintain slight heaviness (R); a dangerous drug for 
children. Heroin with Belladonna is palliative (Hyams); is more dangerous than 
morphine. Dionin is safer than heroin, and lessens the number and severity of the 
paroxysms. Belladonna is of value in the febrile stage and of special use when denti- 
tion is in progress; relieves the congestion of air-passages and also the determination 
of blood to the head (P); good when profuse bronchial secretion; best in spasmodic 
stage; children bear this drug well, ir&x of tinct. may be given hourly to a child 3 years 
old (R); Atropine has been largely used (W). Quinine by inhalation, employed with 
good results (Henke); in solution locally to the fauces (Dawson); the Tannate with 



I'll \KY\r.l 1 IS. 7^5 

Sodium Bicarbonate, of each 5 parts, and pulverized Acacia 100 parts, used by an 
insufflator (Pollack). Phenol, pure, with steam atomizer, is very beneficial (Smith); 
a 25 per cent, solution in an atomizer a or 3 times a day, the spray delivered 1 to 5 feet 
away from the patient (Baumel). Antitussin rubbed into the skin of the chest, b 
and abdomen, daily for a week then every other day, caused immediate improvement 
(Wright). Resorcinol in 1 to 300 solution, applied to the glottis every ihour (Wil 
applied to the perilaryngeal mucous membrane, has aborted an attack at the outset in 
24 hours, has cured well-marked cases in from q to 14 days, and is .1 perfect method 
of prophylaxis for children living with those suffering from the affection 1 M 
Naphthalene, burned in the patient's room, is of high value, as a palliative and a 
curative agent (Chavernac). Hydrogen Dioxide, the solution, in drachm doses diluted 
with 2 or 3 of water, internally, cuts short the paroxysms and lessens the duration of 
the disease. Benzol, is a reliable pulmonary antiseptic, and has been used lor many 
years in this affection with unvarying success (Robertson); the vapor may be diffused 
throughout the room, carefully avoiding a light or fire. Ouabain, in doses of gr. , 
every three hours, is highly efficient in all stages of this affection (Gemmell). Alum, 
when acute stage is over and no complication exists, gr. ij-vj every three hours or less 
every hour, in glycerin or honey (R). Conium, or the Hydrobromide of Confine, in 
doses of gr. x '„ to gr. £ according to age, an efficient remedy (W). Drosera, small doses 
are effective (Murrell). Chamomile Oil, a very useful remedy (P). Coccus Cacti 
(Cochineal), in doses of gr. § thrice daily for infants has been highly recommended (W); 
proves effective in most cases. Hydrocyanic Acid, is serviceable in cough from habit 
after cessation of whooping-cough proper, or in the nervous sympathetic cough of the 
mother (P). Myrtol, may be expected to afford a large measure of relief (B). Form- 
alin, as spray, is quite efficient. Cocaine, a 5 per cent, solution, painted on tonsils, 
fauces, back of tongue, and if possible on larynx, is very efficient (Labrie). Chloral, 
gr. v-x in spasmodic stage, relieves quickly (B); gr. iij-viij every 4 hours (Porter); 
to temporarily suppress the motor disturbance (W). Oxyphor in doses of nj;v-xxx for 
children, is an efficient remedy (Graves). Castanea, a decoction of chestnut leaves 
has been used with much success; dose ad libitum (B); the fluid extract, in 3 -doses, 
exercises a remarkable influence over the cough (W). Valerian, said to control the 
paroxysms (R). Nitric Acid, well diluted in sweetened water, after the subsidence 
of the catarrhal stage (B). Gelsemium, in spasmodic stage (B); its employment 
seems plausible in this spasmodic affection (W). Sodium Benzoate is said to be an 
efficient remedy. Zinc Sulphate in doses of gr. J-j with Extract of Belladonna, gr. 
k~h, has a varying degree of success (B). Lactucarium, the syrup as a vehicle for 
cough mixtures (B). Petroleum on rags around head of the bed, is highly efficient 
(Hildebrandt). Pyridine 5j evaporated spontaneously in the room thrice daily, is 
of great value, also Bromides internally in full doses (Mya). Manipulation of the 
lower jaw r by pulling it down and forward, checks paroxysm by controlling the glottis 
spasm (Sobel). [Compare Cough.] 

R;. Bromoformi, nixvj. 

Glycerini, 5 jss. 

Tinct. Cardamom. Co., 
Alcoholis aa 3 ij - 

M. Sig. — A teaspoonful at commence- 
ment of the paroxysm. (Bedford.) 



R<. Chlorali Hydrati, 5 j- 

Potassii Bromidi, 5 ij • 

Syr. Pruni Virgin., 

Aquae, aa 5 j . 

M. Sig. — A teasp. thrice daily for infants 

in the convulsive stage. (Dessau.) 



Pharyngitis. 
Aconite and Belladonna, for acute attacks (B); when high temperatureJR). 
Belladonna, is very useful, relaxes the pharyngeal muscles (W). Capsicum, 5j of 
the tincture to Oi of water, as gargle in the very early stage only (R). Salicylates 
when there is a rheumatic diathesis (W). Ammonium Chloride, gr. ij with ttrxv of 
Tinctura Cubebae, every half hour, often controls acute pharyngitis; when a gouty 
diathesis exists add ttjjx of the Ammoniated Tincture of Guaiac, and give every hour 
(Smith). Silver Nitrate, gr. v-xx to the o, on sponge probang, successful if systemati- 
cally applied (B); in early stage of inflammation; also on brush, or as spray in the 



756 PHIMOSIS — PHLEBITIS. 

chronic form (R); the solid stick to each diseased follicle, after scraping (A). Protar- 
gol in 5 per cent, solution applied by a swab, proved very efficient in a severe case (Van 
Hoesen). Ichthyol is the best remedy for dry pharyngitis (Ertler); applied locally 
undiluted, followed by an ointment of 10 per cent, strength (Berens). Potassium 
Chlorate has an almost specific effect in limiting the pharyngeal inflammations of 
children (Southworth); as lozenge to stimulate the follicular secretions and restore 
their healthy condition (A). Alum as gargle in chronic pharyngitis (R). Xanthoxy- 
lum, a decoction of the bark locally to throat, and njjx-xxx of the fluidextract thrice 
daily, a very successful remedy for chronic pharyngitis (B). Tannin, by insufflation 
to affected surface (B). Cubeb, powdered, locally, useful (B). Glycerin, pure, locally, 
with Tannic Acid, very serviceable (B); in chronic inflammation of the throat (R). 
Glycozone, frequently applied, is of benefit in follicular pharyngitis (Edson). Hy- 
drastis, the fluidextract locally, also itjjv-x internally (B). Alcohol, diluted, as gargle 
in relaxed throat (R). Cimicifuga, when pharynx dry and spotted over with inspis- 
sated mucus (R). Ipecacuanha, the wine as spray in non-inflammatory sore throat, 
with hoarseness from congestion of vocal cords (R). Pomegranate Bark, as gargle 
(P). Resorcinol, in strong solution, a very efficient application (Tymowski). Zinc 
Sulphate, as gargle, occasionally employed in relaxed throat (R). Inhalation of 
vapors, or of pulverized fluids, by the atomizer, found very beneficial (Wa). Food, 
of piquant kind, spices, pepper, mustard, etc., should be strictly prohibited; all fluids 
should be used at a moderate temperature (A). Water, by throat compress at night, 
relieves; also in daytime, in obstinate cases. Rest, to voice and cultivation of beard, 
are useful aids. [Compare Throat, sore, Tonsillitis.] 



R\ Tinct. Aconiti, 

Tinct. Belladonnae Fol.,.aa 3ss. 

Tinct. Guaiaci Amnion., 3 v. 

Syr. Limonis, o ss. 

Aquae Cinnamomi,..q. s. ad oiv. 
M. Sig. — A teasp. every 3 hours for acute 
pharyngitis. 



R<. Aluminis, 3 j-iv. 

Sodii Boratis, 3iij- 

Glycerini, 

Tinct. Myrrhae, aa 3iv. 

Aquae, q. s. ad oviij. 

M. Sig. — Use as an astringent gargle, 
or 5 times a day. 



Phimosis. 

Belladonna, as ointment, the extract 7 to 20 parts of Lard, has proven effectual 
(Wa). Lupulin, 5 to 15 grain doses, of advantage after operation, to keep the penis 
at rest (Wa). Surgical, division of the prepuce by bistoury and director; circum- 
cision (D). Cocaine, a 4 per cent, solution injected at several points around the edge 
of prepuce, as local anesthetic during the operation of circumcision. Chloroform, 
or Ether, as an anesthetic in paraphimosis, before attempting reduction (Wa). 



Phlebitis. 
Hamamelis, has as decided an influence on the venous system as Aconite has on 
the arterial (Pf). Mercury, in frequent and liberal doses, to early and decisive con- 
stitutional impression; the best form being Calomel or Blue Mass (Gross). Collargol 
by inunction cured a case of crural phlebitis following a protracted broncho-pneumonia 
(Van Zandt). Ichthyol in 25 per cent, glycerin solution applied on lint, gave very 
good results in a severe and apparently hopeless case of lymphangio-phlebitis of the 
leg (Robinson). Rest, fomentations, poultices, early incision of abscesses, aperients, 
Opium to relieve pain and insure quiet of mind and body (D). Blisters, over the 
course of an inflamed superficial vein (R). Diet, nutritious, also wine, especially if 
great loss of blood (D). Stimulants, as Quinine and Iron, especially the tincture of 
the Chloride, also milk -punch, are needed to combat the depression which is sure to 
arise; the disease is always dangerous and often fatal (Gross). Incisions, must be 
freely made if abscesses form, and the internal organs watched for multiple abscess. 
Ulceration, if it occur, must be watched for hemorrhage, which should be arrested 
by compression and styptics (Gross). [Compare Phlegmasia, Varicosis.] 



rill i GM VSIA \i B \ DOLENS I'll niisis. 



757 



Phlegmasia Alba Dolens. 
Belladonna, and Mercury, equal parts, as ointment, often of much benefit (Wa). 
Hamamelis, has specific action on the venous system (P); extolled bj Di Preston 
(R). Blisters, in early stage; are extremely useful if judiciously employed l I 
Ammonium Carbonate, often valuable where great prostration; full doses (Wa) 
Hydrochloric Acid, ~>j of dilute acid in Oij of Barley-water, with gas of Potassium 
Chlorate, to be taken daily (Mackenzie). Opium, large doses internally, with led 
and anodyne ointments (Wa); Laudanum, sprinkled on hot fomentations, if pain 
severe (L). Leeches, of great service during the acute inflammatory st.i 
Bandaging, when the more acute symptoms subside; at first with flannel, afterwards 
with ordinary roller bandage (L). Regimen, should be tonic (I,). Water, 
s in active stage; hot and cold douches, in chronic form. 

Phlegmon. 
Aconite, or Belladonna are certainly efficacious; Aconite best (R). Sulphides, 
to abort, or when inevitable, to promote; gr. ss-j of Potassa Sulphurata every hour 
or two (B). Phenol, injections; a 2 per cent, solution (B); are used with greal 
success (W). Iodine Injections, after evacuation (B). [Compare CARBUNCLE, 
Erysipelas, Gangrene, Inflammation.] 

Photophobia. 

Atropine, a neutral solution of the Sulphate, gr. j to the 5, for adults, dropped into 
the eye every four hours (C); if much lachrymation, so as to dilute the solution, it may 
be applied more frequently; in some cases it irritates and has to be abandoned (Wa). 
Conium, in scrofulous photophobia, gr. ss of Coniine in 5j of Ol. Amygdalae, locally 
twice or thrice daily; or the vapor of Coniine (Wa). Mercury, Calomel by insufflation 
(C). Arsenic, in the condition described by old writers as strumous ophthalmia, with 
its attendant photophobia, is very valuable as an internal remedy (C). Chloroform, 
the eye exposed to the vapor of a few drops, in severe photophobia will be speedily 
relieved (Jones). Croton-Chloral, gr. v-x, in young people and those suffering from 
syphilitic corneo-iritis (Bader). Potassium Chlorate, internally, is most useful in 
some cases (Vernon). Cocaine, in 2 to 4 per cent, solution, a few drops upon the con- 
junctiva, will be found promptly efficient in most cases of severe photophobia. Can- 
thoplasty, for the spasm of the orbicularis in severe photophobia (C). Glasses, of 
cobalt blue, the best color (R). 

Phthisis. 

Creosote, gives excellent results (Bouchard); is directly curative, at least in the 
initial stage of the disease (Frantzel); promotes the sclerotic change by means of which 
recover}- is found to occur (Jaccoud); Morson's beechwood Creosote should be used, 
it gives the best clinical results of any one remedy (Burroughs). Guaiacol, the chief 
ingredient of creosote and equally efficient; the Carbonate, Duotal, in doses of gr. vj to 
viij, up to 5jss daily, is better borne and an efficient substitute; gr. iv four times a day in- 
creased to gr. vj six times a day, also inunctions of Europhen in Olive Oil, 3j in oijss, has 
given excellent results in many cases. Benzosol, contains 54 per cent, of Guaiacol, which 
it yields up in the intestines; in doses of 4 grains, gradually increased to 12 grains, thrice 
daily, it has given results in phthisis, equal if not superior to those from creosote (Wal- 
zer). Creosotal, the carbonate of creosote, is better than Creosote itself or the phos- 
phate (Bernheim). Thiocol contains 60 per cent, of guaiacol, is less disagreeable in 
taste than other preparations of creosote or guaiacol (Braun); in doses of gr. iij-v every 
3 hours, does not irritate the stomach and stimulates appetite. Iodine should be more 
used than it is (Da C); the Bromine-Iodine compound solution hypodermically, each 
dose of 5j has of Iodine gr. ss, Bromine gr. rj, Phosphorus gr. ,,',,,, Thymol and Men- 
thol of each gr. § (Ingraham); is directed against the organisms of mixed infection 



758 PHTHISIS. 

(Clarke). Iodoform internally, has proved extremely effective in all forms, as wit- 
nessed by numerous observers in various countries (S. Smith); though not one of the 
most active germicides, it is very destructive to the bacillus tuberculosis (B). Iodol 
may be advantageously substituted for Iodoform (B). Iodipin, the 10 per cent, solution 
by injection into muscles of the back, ameliorates the symptoms (Croftan). Euro- 
phen by inunction, with Creosote internally, has given curative results even in the 
breaking-down stage, and almost always cures incipient cases (Flick). Ichthyol in 
capsules, gr. v-xxx daily, is superior to creosote or cod-liver oil (Cohn); used in 150 
cases with great benefit on all the symptoms, also on the pulmonary lesions (Scarpa); 
used in several hundred cases with good results in a large majority (Williams). Ichtho- 
form internally for diarrhea and pain, gives great satisfaction (Schaefer). Arsenic, 
valuable in chronic forms as no other remedy; but not in caseous phthisis or where 
much hectic; may be given by stomach or fumigation (B); as cigarettes, useful in the 
diarrhea, probably diminishes temperature, caution required! (R); of great value in 
early stage, in later stages it is of no use (Da C); is often of great service in chronic 
cases (W). Sodium Cacodylate is more toxic than ordinary preparations of arsenic 
(Murrell); used hypodermically in doses of 5 to 10 centigrams daily, it is free from 
unpleasant results (Gautier); under it certain forms, with excavations or with soften- 
ing of the tubercles, are greatly improved (Letulle). Sodium Cinnamate internally 
and by intravenous injection, is more effective than any other remedy (Heusser); in- 
creases the leucocytes to 20,000 and is very efficient (Guttmann). Sodium Silicate 
inhibits the progress by inducing firm scars and coarse capsules, also by changing the 
disintegration process into a fibrous condition (Robert). Chloroform by inhalation in 
small quantities for the cough and dyspnea, gave extraordinary relief to a noble patient 
of mine during the last 8 months of his life (Spencer Wells); by continuous inhalation, 
kept short of full anesthesia, may be effective as a germicide in phthisis (Potter); 5j-ij 
by inhalation twice daily, continued for a long period of time, will give better results 
than any other known remedy (Flick) : Creosote, with Chloroform as a vehicle, may be 
taken into the lungs from a globe nebulizer, producing the most happy results (Id). 
Chlorine gas, by inhalation, also the hypodermic use of Iodine and Chloride of Gold 
and Sodium, extensively employed in pulmonary consumption with good results (Gibbes 
and Shurly). Aurum, the Bromide of Gold and Arsenic internally, with inhalations 
of Papoid as glycerole by the atomizer, gave astonishing improvement in two cases of 
fibroid phthisis with cavities, due to neglected pneumonitis; also in a case of grinders' 
consumption (E. A. Wood). Tuberculin and its derivatives are fully described and 
discussed in Part I. Tuberculosis Antitoxin used early in cases of unmixed infection 
may bring about a cure, but is of no value in cases of mixed infection. Streptococcus 
Antitoxin prepared by the Hubbert process, proved very efficient in cases of mixed 
infection (Foss). Nuclein has been used with good results (Vaughn). Cod-liver Oil, 
holds first rank as a remedy and food in the chronic forms; a teasp. after meals ter die 
is enough; when not well borne may be combined with Aqua Calcis, Comp. Tinct. of 
Gentian; or with Ether when not digested (B, R); is of great utility by improving 
nutrition, and by affecting the tubercle; give §ss thrice daily one hour after meals, with 
njv-xv of Ether, or an equal quantity of malt or whiskey; do not give it in hot weather 
(Da C). Alcohol, an important remedy; may be given with Cod-liver Oil; or Spt. 
Frumenti, 5j-oij with some bitter, immediately after meals; if it disagrees, it harms: 
curiously, it induces an intractable form of phthisis (B). 

Aconite, in small doses for the irritative fever, is a remedy of much value (Da C). 
Antipyrine, in a 2^-grain dose hourly for 3 doses daily, for the hectic fever. Acetphen- 
etidin, better borne and efficiently antipyretic; extensively employed in the hectic 
of phthisis. Cinchona, for the hectic and sweats, Quinine, gr. xv-xx (B); if small 
doses fail, a dose of 6 or 8 grains at once, or in portions repeated hourly (R). Ipecac- 
uanha, the wine as spray to throat when bronchial asthma and emphysema com- 
bined with fibroid phthisis (R). Opium, or Morphine, in a viscid vehicle for cough, 
or as lozenges when cough due to inflamed throat (R); must in time be given for the 
cough, which is an irritative one. Codeine, gr. J to \ in simple elixir, is useful and does 
not constipate (Da C). Apomorphine, with Morphine, makes a good combination 
for many symptoms, especially for dyspnea, continual cough and thick tenacious mucus 



I'll I IIISIS. 



750 



1 Heroin is one of the best agents for the cough, dyspnea, and night swi 
(Hyams). Dionin is an efficient cough remedy. Orexin, the I innati is highly 
efficient for the anorexia (Kolbl). Sodium Glycocholate to promote the 

is (Keown). Hedonal is particularly efficient against the insomnia (Reisman). 
Pyramidon, the Camphorate, gr. xv daily, redmes the temperature and the ni| 
sweats (Lyonnet). Cannabis Indica in aqueous solution relieves cough and aids 
the patient in many respects (Lees). Ferrum, often prescribed, has no especial 
influence on deposit (B); is prescribed in tuberculosis (Tr); the Liquor I'erri Perchloridi, 
5j ad 5j aquae, the most serviceable local application in laryngeal phthisis, diminish 
ing irritability of the mucous membrane, and quieting cough (Mackenzie). Benzoin, 
as inhalation, to lessen cough and expectoration (R). Mineral Acids, for the indij 
tion; especially the dilute Hydrochloric (B). Prunus Virginiana, has a domestii 
reputation, probably due to its influence over cough; the syrup is much used as a vehicle 
for cough-mixtures (B). Hypophosphites, are very useful in chronic cases (B); 
have no special effect (Da C). Digitalis, as an antipyretic; deranges intestinal canal 
therefore injurious in phthisis (B). Copper Phosphate, in nascent form soluble in 
an alkaline body, is held to be specific by Prof. Luton of Rheims; his formula contains 
Neutral Acetate of Copper 0.15, Cryst. Phosphate of Sodium 0.75, Glycerin and I'ulv. 
Licorice, aa q. s. for one pill. Copper Sulphate, gr. ,'.>, or Silver Nitrate, gr. }, 
or Bismuth, gr. xx, for the diarrhea (Da C). Camphor, in oil, as subcutaneous 
injections during the period of softening, renders the patient more comfortable and 
prolongs life (Koch). Camphoric Acid gr. x-xx dry on the tongue, is very efficient 
against the night-sweats. Collargol by inunction, removed the fever and rapidly im- 
proved the general condition, in a case of acute ulcerative broncho-pneumonic tubercu- 
losis (Netter). Formalin by spray in the early stage (Green); inhalation of the vapor 
from equal parts of Formalin and Alcohol in a special apparatus containing wire netting 
and gauze, as a pulmonary antiseptic and stimulant (Shallcross). Hydrogen Dioxide, 
the solution internally, in doses of 5j to iij diluted with 3 parts of water, renders good 
service by promoting digestion, palliating cough, and increasing the activity of chaly- 
beate remedies. Terebene, with Thymol and Phenol, equal parts of each, of which 
oss to a pint of hot water as an inhalation; is extremely useful for the dyspnea 
(Camman). Verbascum, the Mullein-plant, has long been a popular remedy in 
phthisis; it facilitates expectoration, improves the general condition, and palliates the 
cough. Calcium Phosphate, in the diarrhea, and in chronic forms of phthisis with 
little or no fever (R). Cimicifuga, useless in tuberculosis, but in phthisis it relieves 
cough, improves appetite, lessens intercurrent bronchitis, and so impnTves the patient's 
general condition (Wa). Cocaine, locally for the throat symptoms, to be applied just 
before meals are eaten (Da C). Sanguinaria, helps expectoration, and revives the 
enfeebled stomach (P). Camphorated Naphthol, undiluted, or njn'j in olive oil hypo- 
dermically, used with very good results in 15 out of 32 cases so treated (Reboul). Amick 
Chemical Cure consists in the use of calomel, iodoform and guaiacol, as described 
by Dr. Shade in various journals (Waugh). Aseptolin, advocated by Edson, contains 
phenol and a pilocarpine salt. Menthol in 12 per cent, solution in pure olive 
oil, by intra laryngeal injection daily, gives good results, and in some cases caused 
remarkable improvement (Brookhouse). Eucalyptus leaves in powder burned, the 
fumes inhaled all night and for several hours during the day, has greatly relieved many 
cases (Schneider). Oxygen is contraindicated in febrile cases, in which it can only 
hasten death. Baths, sea-bathing, in chronic cases with little or no fever, without 
active deposition of tubercle, or scrofulous pneumonia; Turkish baths for the cough 
(R). Grape-cure, is serviceable (B). Aliment, should be nutritious and digestible, 
malt liquors better than wine or spirits; extract of malt, cod-liver oil, plenty of meat, 
and alcohol in moderation (Da C); warm clothing, bathing and friction of skin, moderate 
exercise, and a suitable climate. Forced Alimentation, when anorexia appears, and 
superalimentation at all times, necessary to successful treatment; washing out the 
stomach daily by syphon-tube, with warm water alkalinized with Borax, and then 
feeding through the tube (Robinson). Kumyss is an especially useful food in the 
incipient cases, to promote nutrition (Brush). Climate, the best by far is that of 
Egypt or Algeria; next coming New Mexico, Southern California, especially in the 



760 



PITYRIASIS. 



desert along the Colorado River, North Carolina and portions of Georgia and Florida; 
the latter being especially suitable for cases having a co-existing bronchitis; for some 
cases Colorado is very good, and the Adirondack region for early cases in which there 
is no tendency to hemorrhage (Da C). [Compare Cough, Hectic Fever, Hemoptysis, 
Laryngitis tuberculous, Meningitis tuberculous, Peritonitis tuberculous, 
Perspiration, Tuberculosis acute, Tuberculous Affections.] 



R. Quininae Sulphatis gr. xviij. 

Digitalis, gr. vj. 

Opii Pulveris, gr. iij. 

M. ft pil. no. xij. Sig. — One pill thrice 
daily, for the irritative fever. (Niemeyer.) 



IV 



Iodoformi, 

Creosoti, 

Benzoini, 

Bals. Tolu., aa gr. j. 

In pill, of such 2 to 4 daily. (Huchard.) 



R. Europhen 3j- 

Ol. Rosae, ttjjj. 

Ol. Anisi 3j- 

Ol. Olivas, Sijss. 

M. Sig. — §ss by inunction at bed-time; 
wash off with bay rum or whiskey in the 
morning. (Flick.) 



R. Arseni Iodidi, 

Strychnine Sulph., 

Hydrarg. Chlor. Corr., . .aa gr. j. 

Quininae Sulph., 

Iodoformi, aa 3ij- 

M. ft. pil. no. xl. Sig. — One thrice daily 
as a tonic in tuberculous cases. (Mann.) 



R. Creosoti (beech-wood), ngvj. 

Glycerini, %]. 

Spt. Frumenti, 3ij. 

M. Sig. — For one day's use, as directed 
in 5ss doses. (Robinson.) 



R- . Codeinae, gr. xv-xx. 

Alcoholis q. s. ad solv. 

Potassii Cyanidi, gr. xij . 

Syr. Pruni Virgin., §iv. 

Aquae, q. s. ad 5yj. 

M. Sig. — A teasp. 4 to 6 times daily, for 
the cough. (Poller.) 






Pityriasis. 
Alkaline and Tonic Remedies generally control mild cases, together with baths 
and emollients; the more severe ones requiring constant envelopment in linseed oil or 
cod-liver oil (Bulkley). Mercury, in obstinate cases, Donovan's solution, is highly 
successful (Wa); the yellow Iodide, gr. x to oj of lard, or a 5 per cent, solution of the 
Oleate of Mercury in Oleic Acid with one-eighth part of Ether, applied by a camel's- 
hair brush (B); Citrine ointment, especially when the hairy parts of the face are affected 
(R) ; an ointment of Ammoniated Mercury and Calomel is very useful in ordinary cases 
of dandruff or pityriasis simplex (Bronson). Sulphur, 3j to 5j of vaselin applied 
every morning to the scalp, with sweet almond oil anointing at night (Jackson). Soap, 
the liniment of soft soap as shampoo every morning for cleanliness, or Borax and water, 
or the yolks of three eggs beaten up in a pint of Limewater with oss of Alcohol, all of 
which make good shampooing mixtures (Jackson). Borax, to cleanse the scalp, a satu- 
rated solution; or the Glycerite of Borax (R). Lead, the Liquor Plumbi, with glycerin, 
equal parts of each, and two of water, as lotion for cases where there are high inflam- 
mation and abundant weeping (R). Phenol, pure, 2 parts to 3 of glycerin and water, 
twice daily, with the daily use of a phenolized soap, is often effectual (Wa). Sulphides, 
5ss of Potassa Sulphurata to Oj of Lime-water, as a lotion, or the Bareges Pomade 
(see formula below). Thyroid Extract, as a stimulant of the cutaneous circulation, 
has been used with satisfactory results. Myrtol, is curative (B). Baths, frequently, 
and hard rubbing after shampooing the scalp; avoid stimulating food in bad cases, 
as well as the use of a fine-toothed comb on children's heads. [Compare Seborrhea, 
and for Pityriasis versicolor see Tinea versicolor.] 



R. Sodae Sulphuratae, 

Sodii Carbonatis, aa o i j - 

Axungiae Sijss. 

M. Sig. — Pomade de Bareges. 



R. Hydrarg. Ammoniat. gr. xs 

Hydrarg. Chlor. Mitis, gr. x. 

Petrolati, 5 j. 

M. ft. unguent. Sig. — Local use. 



pi V.GUE IM ETHOK \ im I ( R] ns. 701 

Plague, Bubonic. 
Strychnine, should be used as a routine treatment and commenced early in the 
disease; also with or without Ammonium Carbonate in the later stages when tin- pulse 
begins to fail (Lowson). Phenol pure, ntjiv of the melted crystals with gr. i 
Quinine Sulphate internally every 4 hours, also a phenolized oil, 1 in 30, externally to 
the glands, gave a recovery rate of 75 per cent. (Seymour). Mercuric Chloride and 
Phenol solutions, were injected into the glands with temporary benefit, during 
the Hong-Kong epidemic (Payne); good results followed the injection of Mercuric 
Chloride and Potassium Iodide (Cantlie). Iodine, as liniment for indolent bubonic 
swellings (Mn). Calomel in full dose, followed by a saline, usually relieves the vomit- 
ing (Lowson). Hydrocyanic Acid and Morphine, in effervescing mixture, also ice 
pellets, for the vomiting, if calomel does not succeed (Id). Morphine, is by far the 
best hypnotic if given with judgment, gr. J-J hypodermically at the onset to relieve 
suffering and induce sleep, later on gr. J suffices (Id). Hyoscine, gr. j',,,-/-, or 
Chloral gr. xx with Potassium Bromide gr. xxx, are of service for the same purpose (Id). 
Salol, gr. x every 4 hours, as an intestinal antiseptic for the diarrhea, if urgent (Mn). 
Belladonna with glycerin, applied to the buboes in their early stage; if red and inflamed 
they must be poulticed and when softening occurs they should be incised and treated 
with Iodoform (Mn). Antitoxin, Yersin's serum, from an immunized horse, was 
used in 26 cases in China with 24 reported recoveries, but further experience in India 
has not confirmed its value (Id) ; is valuable as a remedy being both antitoxic and bac- 
tericidal (Cairns). Vaccination by Haffkine's protective inoculation of healthy per- 
sons, causes severe reaction; the results, though encouraging, are not conclusive as to 
its value (Mn) ; proved very successful at Dharwar. Cold, by ice-bags to the head and 
neck, when headache and high fever (Mn). Water, sponging the body with warm 
water every hour to reduce hyperpyrexia, is safer than antipyretic drugs (Id). Treat- 
ment is very unsatisfactory, no specific or antidotal drug has ever been discovered. 
As in other asthenic fevers, give the patient an abundant supply of fresh air, avoid 
over-crowding, use cold affusions or baths at the height of the fever, also such cooling 
drinks as may promote his comfort. Alcoholic stimulation appears to be of less value 
than in typhus (Payne). Diet would seem to be of minor importance in a malady of 
such short duration. 

Plethora. 

Aconite, is useful for affections of plethoric subjects, and is decidedly the best 
remedy for apoplexy in the plethoric (P). Arsenic, is used with advantage when there 
is determination of blood to the head (Wa). Sulphur, as a mild purgative for plethora 
from cessation of the menses (Wa). [Compare Abdominal Plethora.] 



Pleuritis. 
Aconite, no remedy more effective prior to the stage of effusion (R); is preferred to 
Digitalis in children (Smith). Veratrum Viride, gtt. viij of tincture every 3 hours, 
with a drop added to each dose until the pulse is reduced or nausea occurs (Wa); opin- 
ions differ as to whether it should be used in sthenic or asthenic forms (R). Bryonia, 
exceedingly valuable in second stage; should follow Aconite (P). Tartar Emetic, 
in early stages and young plethoric subjects, when much febrile action, small doses, 
gr. jV to i, may be useful (Wa). Quinine has abortive power, which is increased by 
the conjoint use of Morphine, and is useful as restorative tonic in low -type cases (B). 
Opium, cannot be too highly extolled (P); is especially beneficial; gr. ss of Morphine 
hypodermically at the beginning will often cut short an attack; during the disease its 
effects are very beneficial; a slight physiological effect should be maintained (B); Mor- 
phine for severe pain (R). Atropine as a stimulant to the circulation when sudden 
collapse occurs in young children (W). Salicylates as alterative diuretics in acute 
and chronic pleurisy with watery effusion (W). Aspirin gives excellent results in both 



762 PLEURODYNIA— PNEUMONIA. 

the dry and exudative forms (Merkel). Digitalis as an antipyretic (R); the tincture 
in doses of a drop every 3 hours for a child of 2 years (J. Lewis Smith). Gelsemium 
is highly serviceable (B); the dangers attending the large doses required counterbalance 
its advantages (W). Potassium Iodide to promote absorption of effusion, given 
steadily for a long time (R); is of value (W). Iodine painted over the chest daily 
on each wall alternately (B); in chronic pleurisy with large effusion (W); as injections 
with great benefit and without risk, in empyema and hydrothorax (P). Burgundy 
Pitch, the plaster externally as a mechanical support (P). Asclepias, the popular 
pleurisy-root, is a favorite remedy in the South (W). Pilocarpus, in subacute cases to 
remove fluids (Caro); or Pilocarpine Nitrate, gr. j bis die, for children (Vigier); is 
too depressing and therefore unsafe (Smith). Sodium Chloride, 5ss in 3j of water, 
flavored with Licorice, in tablesp. doses every 3 hours, often very useful in causing 
absorption of pleuritic serous exudations; but is contraindicated when exudation is 
purulent (Br). Theocine gr. iv thrice daily, as a powerful diuretic, efficient in pleuritic 
effusion (Meinertz). Diuretin has removed a large effusion by its diuretic action. An- 
tipyrine promotes the absorption of pleuritic effusions. Guaiacol painted on the chest, 
remarkably promotes absorption. Glycerin as the official Cataplasm of Kaolin, is 
an excellent application in the early stage in place of poultices. Bloodletting, by cups 
or leeches, useful by reason of counter-irritation produced, and to relieve pain, only in 
robust sthenic cases (B). Blisters, often greatly abused; are harmful during inflam- 
matory stage (B). Poultices, large, hot, and frequently renewed (R). Water, cold 
wet-pack to chest probably better than a hot one, pinned tightly to limit movement of 
chest-walls (B). Thoracentesis, by aspiration, to be done as soon as the presence of 
fluid is made out, is the only treatment needed for pleurisy with effusion; in fortunate 
cases there is no more pleurisy or effusion within 24 hours after aspiration, in a large 
number the disease is cured within a week, and none should be sick longer than 2 weeks 
if so treated (Delafield). [For Chronic Pleurisy see Empyema, also compare Hy- 
drothorax, Pleuro-pneumonia.] 



R. Potassii Acetat., 3j- 

Infusi Digitalis, q. s. ad §iv. 

M. Sig. — Teasp. every 3 hours to a child 



R. Morph. Sulph.,' gr. j. 

Tinct. Aconiti, tijxxiv. 

Liq. Potassii Citratis, Sij- 



of 4 or 6 years, in the second stage. M. Sig. — A teasp. every 3 hours. 

Pleurodynia. 

Cimicifuga, curative when rheumatic and valuable in sympathetic cases from 
irritability of uterus (P); or uterine derangements (R, Wa). Croton Oil, in obstinate 
pleurodynia especially when blackened feces (R). Belladonna, the plaster or lini- 
ment; the latter generally best (R). Chloral, made liquid with an equal weight of 
Camphor and rubbed in gently, often affords instant relief (R). Ichthyol as a lini- 
ment, also internally in doses of irjij twice or thrice daily, gives good results (Schmitz). 
Sodium Salicylate, gr. xv-xx, every 2 or 3 hours, useful in most cases (Hughes). 
Ether, as spray, sometimes immediately and permanently removes the pain (R). Opium, 
as liniment rubbed in after warm fomentations (Wa); or a hypodermic injection of 
Morphine (R). Iodine, as liniment painted on the chest, often relieves where mustard 
fails (R). Blistering, often successful when other means fail; sometimes strong 
vesication is necessary (R). Rest, is important and may be obtained by strapping the 
affected side with strips of adhesive plaster. Poultices, very hot, followed by applica- 
tion of lint and oilskin; Belladonna Liniment generally better (R). Mustard, as a 
poultice, is generally efficient, and can be renewed when the pain returns (R). Photo- 
therapy, the ultra-violet rays are specific for relief of the pain (Rosenberg). [Com- 
pare Myalgia, Neuralgia, Pleuritis.] 

Pneumonia. 

Aconite, gives good results in catarrhal and fibrinous forms (B); has marked 
effect (R) ; very valuable in first stage (P) ; in several cases it apparently cut short the 
attack (Wa); to reduce circulation either Aconite or Veratrum Viride until the pulse 



I'M I MOM \. 



:":■> 



is impressed (Da C). Veratrum Viride, valuable (P); in the very inripiem 
opinions differ as to whether it should be used in sthenic or asthenic cases il\). Ergot 
is highly efficient in the first stage (Davis); is used with good results in pulmonic con 
pstions (W). Creosote gtt. j every 3 hours gives good results (Van Zandt). Creoso- 

tal »t! xvj every 3 hours has given satisfaction (Philips); gives remarkabl) | I and 

uniform results (Weber 1 ); in acute pulmonary inflammations its use is one of the great 
life saving discoveries of the century (Van Zandt). Guaiacol Carbonate, gr. a in 
emulsion every 2 hours, gave excellent results in a case of double pneumonia (Thorn 
son); in 13 cases successfully treated it was practically the only remedy used (Cassonte); 
is almost specific in this disease (A. H. Smith); preferred to the salicylates after the 
stage of congestion, in feeble cases and when cardiac lesions exist (Bridges). Thiocol 
gr. xv every 2 hours gave prompt and excellent results in a severe case of influenzal 
pneumonia, and has some specific action in this disease (Heil); is preferable to other 
te preparations (Eberson). Quinine or Salicylic Acid, to reduce temperature 
(R); Quinine as a tonic in cases which are asthenic from the first (P); in conjunction 
with Aconite and Veratrum, gr. viij-xij daily at start, is beneficial (Da C). Quinine 
Salicylate is most useful as a tonic and general alterative (Sir J. Moore). Sodium 
Salicylate, in large doses, not less than 5ij daily, proved curative in 72 consecutive 
cases (Liegel); has antibacterial power in pneumonia (A. H. Smith). Strychnine 
Sulphate, in addition to guaiacol or the salicylate, to obviate cardiac depression, also 
for its action on the nervous system (Bridges); in a full dose hypodermically, repeated if 
necessary-, for impending cardiac failure; is more useful in 1 or 2 full doses than in 
smaller doses more frequently (Pye-Smith); gr. ^V every 3 or 4 hours with free use of 
alcohol, the uniform treatment in the U. S. Navy, and to it the Surgeon-General attri- 
butes the unusually low percentage of mortality in his service from this disease. Anti- 
pyrine may be employed as an antipyretic (W); is more serviceable than quinine (Wa); 
with Camphor successful in all of 22 cases of croupous pneumonia so treated at the Lorn 
Hospital, Antipyrine gr. viij, Camphor gr. ij, Morphine Hydrochloride gr. ,V, in powder 
every one or two hours (Ivanoff). Camphor, in olive oil, in doses of from gr. j to gr. ij 
three or four times a day, hypodermically, in adynamic cases, used simultaneously 
with the above antipyrine and camphor powder (Id); in fibrinous pneumonia these 
injections lower the temperature about a degree and ameliorate the general condition. 
Ammonium Carbonate, at crisis for depression; in infusion of Senega (B); is useful 
late in disease when lung tissue breaks down (Da C). Ammonia, the Aromatic Spirit 
as a substitute for the Carbonate, in doses of 5ss in simple elixir (Da C). Turpentine, 
as stimulant at crisis (B); 5j to oiv of boiling water, the vapor to be inhaled as an 
irritant to provoke cough and expulsion of the products, in cases so exhausted that 
expectorants fail (Murray). Serpentaria with Ammonium Carbonate in low types 
of pneumonia, as a stimulant for the crisis. Digitalis is of doubtful value; may be 
useful for high temperature, ischemia, and low tension of vessels (B); as case goes on 
and circulation is to be further controlled, Digitalis is indicated (Da C); the best agent 
to slow the heart in infantile pneumonia, with Belladonna as an adjuvant (Brown). 
Bryonia, when pleural complications (P); is often of great service in pleuro-pneumonia 
to limit the effusion and promote its absorption (P). Phosphorus, especially when 
typhoid symptoms; approved by Fleischmann (R). Belladonna is useful in the first 
stage (P); Harley esteemed it highly in pneumonia (Wa); as an adjuvant to Digitalis 
in infantile pneumonia, to soothe the irritable nervous system and curtail superabun- 
dant secretion (Brown). Atropine as a stimulant to the circulation for cases of sudden 
collapse as seen in the pneumonia of young children (W). Arnica, njjx of the tincture 
every 3 or 4 hours in pleuro-pneumonia, to control the cardiac action (Wa). Collargol 
by inunction and intravenous injection, cured a left pneumonia with purulent effusion 
by the sixth day (Netter); 6 cc. of a 1 to 200 solution, three such intravenous injections 
checked the disease in a woman of 81 years (Thiroloix). Phenol pure, in 2 per cent, 
solution by parenchymatous injection once or twice daily, is remarkably successful in 
pleuro-pneumonia (B). Pilocarpine gr. ss, or oij of the tincture, benefits in pleuro- 
pneumonia (Wa). Potassium Iodide gr. x-xv every 2 hours in milk night and day 
throughout the disease, has remarkably beneficial effect (Altshul). Ammonium 
Iodide with Arsenic to prevent the caseation of inflammatory products (R). Ethyl 



i 



764 



POISONING. 



Iodide gtt. v-xx thrice daily by inhalation, is valuable in the catarrhal form (B). So- 
dium Iodide is useful in catarrhal pneumonia (Da C). Ipecacuanha, the wine in 
infantile pneumonia, should never be dispensed with, as it promotes expectoration, 
controls hemorrhage and regulates secretion (Brown). Senega, in advanced stages 
as expectorant, when cough is dry, irritating and painful, tightness and oppression of 
chest (P). Opium, or Morphine by injection, sometimes needed for severe pain (R); 
Opium is very desirable in many cases, relieves the symptoms and arrests delirium 
(Wa); is often dangerous, as it reduces the cough, which is a necessary evil (Burt). 
Copper Acetate has proved curative, under it the mortality was only 4.3 per cent. 
(Kissel). Tartar Emetic in full doses, formerly used as part of the so-called contra- 
stimulant treatment, now abandoned (W); gr. £ every 3 hours, also Calomel purgation 
and venesection, with blisters, gave a mortality of almost nothing in former times 
(Sheets). Sanguinaria as a contra -stimulant when the fever has abated and the 
graver symptoms have amended (P). Adrenal Extract gr. j-iij every 2 or 3 hours, 
as a powerful cardiac tonic (Gray). Alcohol is adding poison to that already present 
(Anders); is dangerous, and with other anesthetic drugs is responsible for the increased 
mortality in this disease of late years (Davis); for alcoholic subjects, in asthenic cases, 
those of malignant type, and those of aged persons (Wa). Antipneumococcic Serum 
has been used with excellent results in many cases (Ed. Therap. Gaz.). Venesection 
in the first stage followed by sedatives and alteratives (Davis); is of very great value 
if a pint or more be taken (Rochester); to a pint or more and replaced by the same 
quantity of normal saline solution by hypodermoclysis, a valuable procedure in cyanosed 
cases (Reyburn). Hypodermoclysis by 600 to 1000 cc. of hot normal saline solution, 
when respiration is shallow, intermittent and irregular, extreme cyanosis, almost imper- 
ceptible pulse, and coma with profound asthenia (Thompson). Sweating by dry hot 
air to relieve toxemia (Rochester); towards the time for a crisis is very satisfactory 
(Quimby). Cupping vigorously over the lungs for pain, relieves better than morphine 
(Rochester). Blisters, useful at very beginning only, or at crisis of disease, harmful 
in inflammatory stage (B); to lessen the pain, but should be used in moderation (R). 
Wet-pack, hot, tightly pinned to limit motion of chest-walls (B). Poultices, encircling 
the whole chest in children (R) ; the poultice-jacket belongs to the dark ages of medicine 
(Rochester) : local applications to the chest have no influence whatever upon the course 
or outcome of the disease (Thompson). Glycerin in the form of the official Cataplasm 
of Kaolin, makes an excellent poultice for the chest and fulfils many indications in 
pneumonia. Diet should be farinaceous, with mucilaginous drinks and rest in bed in 
a warm room (R). 



1$. Tinct. Veratri, ttjxI. 

Spt. Athens Nitrosi, 3vj. 

Liq. Potassii Citratis, 3ivss. 

Syr. Zingiberis, q. s. ad 5 vj. 

M. Sig. — A tablesp. every 3 hours, in the 
early stage. (Da Costa.) 



I\. Ammonii Carbonat., gr. xl. 

Infusi Serpentariae, 5iv. 

M. Sig. — A teasp. every 3 hours, as 
stimulant about the crisis. (B.) 



1$. Sodii Iodidi, 3hj- 

Morphinae Sulph., gr. j. 

Elixir Simplicis, 5 iv. 

M. Sig. — A teasp. ter die, also blisters 
over the apex. In catarrhal pneumonia. 
(Da C.) 

~fy. Ammonii Iodidi, gr. xl. 

Spt. Ammonias Aromat., oij- 

Elix. Simp, et Aquae, ad Sviij. 

M. Sig. — Two tablesp. thrice daily. In 

syphilitic lobar pneumonia. (Da C.) 



Poisoning. 

A Poison, in the medical and toxicological sense, is any substance of inherent 
deleterious character and incapable of self -reproduction, which, acting chemically or 
physiologically upon the tissues or fluids of the body, will seriously injure the health 
or destroy life. 

The most energetic poisons are Hydrocyanic Acid, Potassium Cyanide, Nicotine, 
Strychnine, Phenol, and some reptile venoms. The poisons usually selected by 
poisoners for criminal purposes on others are those which produce effects resembling 



POISONING. 



76S 



the symptoms of natural disease, as Arsenic, Colchicine, Tartar Emetic, Shy, Imine, 
Morphine and Aconite. Those generally chosen for suicidal purposes are such as 
may be most readily obtained by the laity, namely Phenol, Morphine, [lluminal 
Charcoal gas ami Potassium Cyanide; the first being easily purchased lor disin- 

acting purposes, while the last is commonly used in the arts. 

General Principles of Treatment. The following Rules are laid down by high 
authority: (1) Lose no time. (2) Use the best remedy obtainable at once. t j) Get 
rid of the poison. (4) Stop its action. (5) Remedy the mischief already done. (6) 

right against the tendency to death (Tanner). In the treatment of poisoning, whethei 
by mineral or vegetable substances, if the poison is known the first indication 
administer the proper chemical Antidote, so as to render it harmless or comparatively 
Next, the stomach should be emptied and washed out, lest the newly-formed 
compound be absorbed after a time, also to remove any poison which may have escaped 
the action of the antidote. Next, the appropriate Antagonist should be administered, 
to counteract the effects of such portion of the poison as may have been absorbed. 
Lastly, such Antagonistic Measures should be employed as may sustain the action of 
any organic function showing signs of failure. In most cases of alkaloidal poisoning 
absorption has proceeded so far before professional assistance is obtained that antidotes 
are of no value, hence reliance can be placed only upon the physiological antagonist 
and such supporting measures as will tend to maintain vitality until the poison can bi 
eliminated by the natural channels. 

Antagonists. 
Antagonists are agents which oppose each other in their physiological action, and 
may be employed against each other as counterpoisons, to neutralize their effects upon 
the organism. They do their work in the blood and tissues, after absorption, and are 
especially available against poisons administered hypodermically, in which cases anti- 
dotes are useless. Substances so employed are generally the active principles of plants, 
a few being chemicals, as Oxygen and Chloral. Antagonistic Measures include such 
proceedings as tend to neutralize the remote effects of poisons, as artificial respiration, 
faradism of the respiratory muscles, hot and cold applications, douching, constant 
motion or absolute repose, etc. 

Antidotes. 
Antidotes affect a poison, either physically or chemically or both, so as to remove 
it from the body or alter its character before absorption, and thereby prevent its toxic 
action upon the organism. They do their work in the alimentary canal or in the respira- 
tory passages, and are applicable to vegetable as well as mineral poisons, but they are 
not available against poisons administered hypodermically. Among them are Emetics, 
Cathartics, Washes, Injections, Ligatures, Poultices, the use of the Stomach-pump, of 
tourniquets, etc., which are termed Mechanical Antidotes; and the Chemical or True 
Antidotes, which include Albumin, Milk, Charcoal, Soap, Starch, Oils, Tannin, Tur- 
pentine, Acids, Alkalies, Potassium Permanganate, Carbonates, Hydrates, Sulphates, 
Sodium Chloride, Iodine, Iron preparations, etc. 

Acids. Vegetable acids, as Acetic (or vinegar), Citric (or lemon-juice), and Tar- 
taric, are employed as antidotes against the poisonous alkalies and alkaline carbonates. 
Sulphuric Acid well diluted with water, is antidotal to the soluble salts of Barium and 
Lead, with which it forms insoluble sulphates; also as a prophylactic against lead 
poisoning. 

Albumin is an ideal chemical antidote, being harmless, easily procured, and form- 
ing compounds (which are more or less insoluble) with most of the metallic salts, corro- 
sive alkalies and mineral acids, as also with Iodine, Bromine, Chlorine, Creosote, Aniline, 
and alcoholic solutions of most of the Alkaloids. It is especially suitable against inor- 
ganic poisons, and was recommended by Orfila for invariable use, even on the mere 
suspicion of poisoning. It should be well diluted, the whites of four eggs to a quart of 



( 



766 POISONING. 

lukewarm water; and should be followed by emetics and cathartics, as many of its 
compounds are soluble in an excess of itself. 

Ammonia, diluted, used by inhalation, is an efficient antidote against the vapors of 
corrosive acids and Nitrobenzol, also against Chlorine, Bromine, and Hydrocyanic Acid. 

Calcium Hydroxide and Carbonate, in the form of lime-water, chalk, eggshells or 
powdered oyster-shells, are used against Acids, both mineral and organic, and especially 
against Oxalic Acid and the acid oxalates, which they neutralize and convert into the 
insoluble calcium oxalate. 

Carbonates and Bicarbonates of Sodium and Potassium are employed against 
most of the poisonous metallic salts, especially those of Zinc, which they immediately 
decompose, forming insoluble basic compounds; also against Iodine, Bromine, and 
Potassium Dichromate, forming the neutral chromate with the latter and harmless 
salts with the former. They are useful in dilute solution against Acids, but are less 
easily tolerated than magnesium sulphate. They are contraindicated in poisoning 
by Oxalic Acid, with which they form dangerous compounds. Ammonium Carbonate, 
in dose of 5 grains, administered hypodermically in the vicinity of wounds caused by 
poisoned arrows, was repeatedly used by Dr. Parke, the surgeon of Stanley's last expe- 
dition in Africa, with entire success in saving life when it was employed immediately 
after the injury. Persons so wounded, if they were at too great a distance to receive 
this treatment, invariably died within a short time. 

Cathartics are generally employed after the use of a chemical antidote, to remove 
the compounds formed thereby from the intestinal canal. The best are Castor Oil, 
Croton Oil, Senna, and Magnesium Sulphate (Epsom salt). Castor Oil protects the 
mucous membrane and obstructs absorption, but is contraindicated in poisoning by 
phosphorus, phenol, copper salts, or cantharis, the absorption of which is aided 
by oils and fats. Croton Oil is rapid and powerful in the dose of from 1 to 5 minims, in 
a bread pill. Magnesium Sulphate, in the dose of 1 to 4 oz., well diluted, is of special 
service in chronic lead poisoning and to remove antidotal compounds from the intestines. 
Senna, Gamboge, and other drastics are the best cathartics in narcotic poisoning. 

Charcoal has some antidotal value against many alkaloids, the metallic salts, and 
Phosphorus, slowing their toxic action and postponing their effects, probably by a pro- 
tective action upon the gastric walls. It has the valuable property of absorbing gases, 
but enters into no fixed compound with any mineral or vegetable poison. Fresh animal 
charcoal is the best, though wood charcoal is efficient, but in less degree. 

Chlorine, in the form of Chlorine Water, Labarraque's solution, or Javelle Water, 
is employed externally as an antidotal wash for snake-bites and other poisoned wounds; 
also, well diluted, internally against alkaloids and other vegetable and animal poisons; 
and as a spray for antidotal inhalation against coal gas (Carbonic Oxide), Ammonia, 
Phosphoretted and Sulphuretted Hydrogen, also Hydrocyanic Acid. 

Copper Carbonate, in dose of 3 to 6 grains, with sugar and water, preceded and 
followed by an emetic, is recommended in phosphorus poisoning, being supposed to 
coat the particles of Phosphorus first with a layer of copper phosphide and then with 
one of copper itself, thus preventing their solution in the fluids of the stomach. 

Emetics, when employed, should be used without delay. They are often rendered 
needless by vomiting induced by the poison itself, or by the free use of diluent drinks; 
and are contraindicated when there is severe corrosion of the alimentary canal or when 
abdominal inflammation exists. The best emetics are: Zinc Sulphate, for stomachal 
administration, being non -nauseating, 20 to 30 grains in water, 5 grains for children. 
Apomorphine, gr. tV _ £, hypodermically, when narcosis prevents the use of emetics by 
the mouth. It should be administered hypodermically, as it is very uncertain in action 
when given otherwise. The following may be used: — Copper Sulphate, 1 to 5 grains 
in water; Ipecac, in powder; Emetine, gr. T V to \; Tartar Emetic, ii grain, acts 
slowly and is depressant; Turpeth Mineral; Cadmium Sulphate; Sodium Chloride 
(common salt), 2 teaspoonsful in a pint of water; Mustard, 2 teaspoonsful in a cup of 



POISONING, 






warm water; also Olive Oil, Soap-suds, Snuff, melted Fats, and tickling the fames with 
the finger or a feather. Sodium Chloride, as an emetic, is contraindicated in poisoning 
by tartar emetic or corrosive sublimate, and so also arc Oils and Fata and substances 
containing them, in poisoning by phosphorus, cantharis, phenol or copper salts, 

Gelatin is of especial value against Iodine, Bromine and the Alums, but requires 
too much time for its preparation, as it should be broken up, soaked in wat. 
an hour and reduced to the consistency of honey. 

Gluten is of value against Corrosive Sublimate, but is less so than albumin and 
is not easily obtained. 

Gum Arabic, in the form of mucilage, is chiefly used as a protective against corro- 
sive poisons, and has been recommended in copious draughts against poisoning with 
the Bismuth salts. 

Iodine, in very dilute solution, is used as an antidote against alkaloids and their 
salts, other vegetable poisons and snake-venom. All its compounds are more or less 
soluble and toxic, and must therefore be removed from the system as soon as possible. 
Bouchardat' s Antidote jor vegetable poisons consists of 3 grains of Iodine, 30 grains of 
Fotassium Iodide, and 11 oz. of distilled water. The dose, which is from i£ to 3 02., 
should be repeated frequently. 

Iron. The Hydroxide, Fe (OH) .,, is by far the best antidote to Arsenic in solution or 
in a soluble form, as it combines with the latter to form a ferrous arsenate, and also pro- 
tects the gastro-intestinal mucous membrane against the local action of the poison. 
In the proportion of 10 parts to one of arsenic the union is very complete, but its union 
with the salts of arsenic is limited even when it is in great excess, though much more 
effectual if there is added to it a small amount of ammonia or other caustic alkali, or 
if the basic ferric acetate is mixed with it. For the preparation of the official arsenic 
antidote see Ferri Hydroxidum cum Magnesii Oxido, under the title Ferrum in Part I. 
Dialyzed Iron, Saccharated Iron, and the basic Ferric Acetate have all been used with 
more or less success in arsenic poisoning. 

Magnesia (MgO), is obtained by heating Magnesium Carbonate, which is a com- 
pound of the Hydroxide and Carbonate of Magnesium with water. When the Carbonate 
is heated at a low temperature it becomes calcined, losing C0 2 and H 2 O ; then mixed with 
25 times its weight of warm water it becomes gelatinized, in which condition it is best for 
antidotal purposes, in doses of from ij to 2 oz., at short intervals for a few doses, then at 
longer intervals. An excess does no harm, but rather benefits the patient by its cathartic 
action. Magnesia is the most efficient antidote against Acids and the acid salts, also 
against Oxalic Acid and the acid oxalates, in the absence of the calcium antidotes therefor. 
It is also valuable against Arsenic, Phosphorus, Mercury, Corrosive Sublimate and other 
metallic salts in solution, precipitating the corresponding oxides or basic salts. 

Milk is a good substitute for Albumin, its antidotal action being nearly the same 
in range and due to its casein, albumin and free alkali. It is particularly valuable 
against metallic salts, corrosive acids and alkalies (especially Ammonia) and the alka- 
line earths, but it is contraindicated when fatty antidotes are to be avoided, by reason 
of its richness in fat. 

Oils and Fats are efficient against the corrosive acids and alkalies, the metallic 
oxides and salts; but are contraindicated in poisoning by Phosphorus, Cantharis, 
Phenol, or Copper salts, the absorption of which they promote. With the caustic 
alkalies they unite to form soaps, liberating glycerin; they are inferior to albumin 
against the metallic salts, and as their action is slow they are less efficient than acids 
against alkalies. Those used are olive, cotton-seed, linseed and almond oils, also 
melted butter and lard. 

Potassium Ferrocyanide, given in doses of 30 to 60 grains in water, is of special 
value against the Copper salts, but albumin is equally efficient and more easily obtained. 

Potassium Permanganate, is the best antidote against organic poisons, if used 
promptly, before absorption has taken place, as it rapidly destroys them by oxidation 



( 



768 POISONING. 

It has been used successfully against Morphine and Strychnine salts and Phosphorus 
in the stomach, and locally for snake-poison. 

Soap, as Castile Soap, dissolved in 4 times its bulk of hot water, to make "suds," 
and given by the cupful, is one of the most efficient antidotes against corrosive acids 
and metallic salts, especially Corrosive Sublimate, Potassium Dichromate, and Salts 
of Tin and Zinc. It is inferior to albumin against these, but is preferred to caustic 
alkalies against acids, as of itself it has no corrosive action. It should not be used 
against alkalies. 

Sodium Chloride (Common Salt), in dilute solution, is the best antidote against 
the Silver salts, converting them into the insoluble chloride of silver. It may be given 
with albumin, which is also a very efficient antidote in this form of poisoning. 

Sodium Thiosulphate in doses of 15 grains, in very dilute solution and frequently 
repeated, is a valuable antidote against Bleaching Powder (Calcium Hypochlorite), 
Labarraque's solution (Sodium Hypochlorite), and Javelle Water (Potassium Hypochlor- 
ite), which it reduces to chlorides, itself undergoing oxidation to the sulphate. 

Starch, in paste, 1 to 15 of water, is the antidote for Iodine and Bromine, with 
which it forms compounds which are almost harmless. It has some value against 
Corrosive Acids, Corrosive Sublimate, and Zinc and Copper Sulphates, but it is not so 
efficient as Albumin, which is preferred for these poisons as well as for Iodine, since 
it has a greater affinity than starch has therefor. 

Stomach Pump and Stomach Siphon are efficient, and do not weaken the patient 
as emetics do, but they are not always available, and cannot be used when there is 
corrosion of the stomach or esophagus, for fear of perforation. Washing of the stomach 
at regular intervals is a measure of great importance in the case of soluble poisons, some 
of which are excreted into the stomach [see injra under Opium]. These appliances are 
almost useless when the poison is in solid form and in large pieces (as meat, sausage, 
fish, cheese). 

Sulphates of Magnesium and Sodium (Epsom and Glauber's salts), the soluble 
sulphates, are particularly efficient against Phenol and the salts of Barium and 
Lead. 

Tannin (Tannic Acid), precipitates the Alkaloids and their salts, with which it 
forms compounds (tannates), which, though comparatively insoluble are not entirely 
inactive, and should be removed at once from the alimentary canal by emetics and 
drastic purgatives. It acts well against many metallic salts, though inferior to albumin 
for these, except against Tartar Emetic, which albumin does not affect, but tannin 
renders harmless. It is given in doses of gr. xv to xlv, in a 2 per cent, solution, every 
\ hour; and if combined with about 10 per cent, of its weight of Iodine its antidotal 
effect on vegetable poisons is greatly increased. If not itself obtainable, decoctions or 
infusions of substances containing it may be used, as tea and coffee, nut-galls, kino, 
rhatany, catechu, and the barks of oak, willow and cinchona. 

Turpentine, after long exposure to the air, therefore containing much oxygen 
is one of the antidotes against Phosphorus. It should be administered immediately 
after the ingestion of that poison, alone or in hot water, and in quantity 100 times that 
of the phosphorus supposed to be present. 

Antidote Bag, designed by Martindale, of London, contains the following-named 

articles, labeled with directions for use, viz. — 

Dialyzed Iron. Spt. Ammoniae Aromat. Amyl Nitrite. 

Syrup of Chloral. Oil of Turpentine. Zinc Sulphate. 

Chloroform. Acetic Acid. Ipecacuanha. 

Spt. Chloroformi. Tincture of Digitalis. Potassium Bromide. 

Magnesia. Tannic Acid. Potassium Permanganate. 

Also a Hypodermic Syringe and Solutions or Pellets therefor of — 
Morphine Sulphate. Apomorphine Hydro- Pilocarpine Nitrate. 

Atropine Sulphate. chloride. Strychnine Nitrate. 



POISONING. -60 

General Antidotes have been devised for use when the nature of a poison ia un- 
known, with the object of a "shot-gun prescription," intended to hit something. I Ine 
of the besl is J tint mi's, composed as follow , I iquor Ferri Sulphatia (sp. gr 1 
Sijss, Magnesium (Hide .-, ij, Carbo Animalis 5j, Aqua 5joc. These ingredi 
should be kept separate— the solution of the sulphate in one vessel, the Others together. 
When needed, the former should he added to the latter and violently agitated. l>ose, 
5jss to 3iij. This is a perfect antidote for Arsenic, /.ine, and Digit delays t : 1 « - 

action of the salts of Copper, Morphine and Strychnine, and slightly influences com 
pounds of Mercury. It is valueless for Cyanide of Mercury, Tartar Emetic, Hydra 
cyanic Acid, Phosphorus, or the caustic Alkalies. Bouchardat's Antidote is described 
on a previous page, under Iodine. Bellini considers the Iodide of Starch a valuable 
antidote to alkaline Sulphides, earthy Sulphides, vegetable and caustic Alkalies, and 
Ammonia. In the first two cases he considers it superior to all other antidotes. 

A fresh mixture of the Sulphides of Iron and Sodium with Magnesia, is said to be 
a perfect antidote for Copper salts, Corrosive Sublimate and Mercuric Cyanide. If 
the nature of the poison is entirely unknown, a harmless yet effectual antidote in most 
cases is one composed of equal parts of Magnesia, Wood Charcoal, and the Ferric 
Hydroxide, given freely in plenty of water. 

Poisoning by 

Acetanilide. Antagonists, — Belladonna or Atropine, to maintain the blood- 
pressure; Strychnine, for the respiration; Oxygen inhalations, to overcome cyanosis; 
Heat, externally applied. Stimulants and supporting measures. Death has occurred 
from a dose of 5 grains. 

Acid, Acetic. Antidotes, — Magnesia or Magnesium Carbonate, freely; Soap 
and water, Lime-water, Chalk, White-wash; also milk, oils and thick gruel may be 
given. Antagonists, — Morphine, gr. \, to ward off shock. 

Acid, Carbolic (Phenol). If the case is seen shortly after the ingestion of the 
poison Apomorphine may be administered hypodermically as an emetic; in any case 
the stomach should be washed out freely with alcohol and water. Antidotes, — 
Alcohol, is a perfect antidote to the corrosive effects of phenol (Phelps). The 
routine pracdee in one emergency hospital is to wash out the stomach with alcohol and 
water, equal parts of each, and then to leave in the stomach about 5viij or 5x of the 
same mixture. This treatment has proved very efficient in a number of cases. Next 
in value is any soluble Sulphate to form the harmless phenolsulphonates; as Magnesium 
Sulphate 3j or Sodium Sulphate 5ss, dissolved in half a pint of water. Even if several 
hours have elapsed since the ingestion of the poison this treatment should be employed, 
as the anddotal action of the sulphates proceeds in the blood. In one case 3ss of the 
95 per cent, phenol was taken, and nearly oiij of Magnesium Sulphate was used, 
resuldng in complete recovery from an apparently hopeless condition. Liquor Calcis 
Saccfiaratus is anddotal in the stomach, but is much less efficient than the sulphates. 
Vinegar, especially that made from cider, is antidotal, both locally and internally (Ames). 
Soap in strong watery mixture (suds) is said to have acted perfectly as an antidote in 
the stomach. Oils are contraindicated, as they promote the absorpdon of the poison. 
Vegetable Demulcents (but no oils or glycerin), to protect the mucous surface. Sodium 
Carbonate, in strong solution locally, for the effects of its local use in excess; this also as 
a wash for the mouth, if necessary. Antagonists, — Atropine is a very complete antago- 
nist to the systemic symptoms, maintaining the heart and respiration until elimination 
occurs: gr. $$ hypodermically. Amyl Nitrite, by inhaladon, Alcoholic stimulants freely. 
Heat to the extremities, also Faradism and friction thereof. Venesection in desperate 
cases (Murrell). 

Acid, Carbonic (Carbon Dioxide). See under Illuminadng Gas, below, for the 
treatment of poisoning by Carbonic Acid and Carbonic Oxide gases. 

Acid, Hydrocyanic (Prussic). Forty minims of the official diluted acid have 
proved a fatal dose. Antidotes, — if time to do anything, Cobaltous Nitrate has proved 
5° 



( 



770 POISONING. 

a perfect antidote in over 40 cases (Antal). Ammonia, diluted, by inhalation, or Chlo- 
rine Water by spray, for the vapor. Per- and Proto-salts of Iron with Magnesia. Cal- 
cium or Sodium Chloride, gr. xxx-xl, in water. Sodium Thiosulphate is said to be an 
efficient antidote. Emetics or the stomach-pump. Antagonists, — Stimulants, as 
Brandy, Chloric Ether, Ammonia, ad libitum. Alternate hot and cold Douche, from a 
height. Artificial Respiration, the faradic current (mild) to chest walls and over cardiac 
region. Atropine, has antagonistic action, but is too slowly diffused to be of any value. 
Ammonia by inhalation, by the stomach, and by intra-venous injection, with cold 
affusion to the spine, and artificial respiration, are the measures most likely to avail 
in cases where there is time to do anything. 

Acid, Oxalic, also the Acid Oxalates, as Potassium Oxalate, known as "Salts of 
Lemon," or of " Sorrel," used for removing ink -stains. Antidotes, — Calcium Car- 
bonate ox Hydroxide (as lime-water, chalk, whiting, wall-plaster, in water), or Magnesia. 
Avoid Potassium and Sodium Carbonates and Bicarbonates. Bland mucilaginous 
drinks and poultices to the abdomen. 

Acids. Antidotes, — Alkalies for the least irritant acids, Magnesia, Magnesium 
Oxide, slaked Lime, Chalk; plaster from wall with water, milk, oil, white of egg, bland 
mucilaginous drinks and poultices (R). Antagonists, — See under Acids, Mineral, 
below. 

Acids, Mineral. Antidotes, — Alkalies, as Sodium Carbonate or Bicarbonate, 
Magnesia, or Chalk, Soap, Whiting, Wall-plaster, in water. Albumin, Flour, Milk, 
Starch, Olive Oil, to protect the mucous membrane. Avoid water in Sulphuric Acid 
cases. Antagonists, — Opium, Ammonia (intra-venously), Alcohol, as stimulants, 
to combat the depression of the vital powers. 

Aconite. Antidotes, — Tannic Acid, or Animal Charcoal, powdered, in water. 
Emetics or the stomach-pump. Castor Oil, or other purgatives. Bland fluids, and 
poultices for abdominal irritation. Antagonists, — Atropine, Caffeine, Morphine, 
Ether, Ammonia, Amyl Nitrite, antagonize its effects on the heart and respiration. 
Atropine seems to be the antagonist from which most good is to be expected (Cushny). 
Digitalis antagonizes its action on the heart and its relaxation of cardiac inhibition 
(Fothergill). In Aconite-poisoning the stomach should be evacuated, warmth applied 
to the extremities, stimulants administered, artificial respiration if necessary, and the 
recumbent posture strictly maintained. Caffeine may be administered hypodermically, 
and strong Coffee by the mouth. 

Alcohol. Antidotes, — Emetics or the stomach-pump, if much alcohol recently 
swallowed. Antagonists, — Caffeine is powerfully antagonistic in doses of gr. j-ij every 
hour to 3 hours (Hall). Hydrated Chloral in dose of 30 grains repeated in 2 hours if 
necessary, is very efficient to secure sleep, or 30 grains each of Chloral and Potassium 
Bromide for the same purpose. Chloral is said to be dangerous to the heart in old 
alcoholics, but the experience of physicians of inebriate asylums does not corroborate 
this statement. Nutritious, digestible diet in liquid form and small quantity frequently 
repeated, is an essential feature of the treatment. Ammonium Chloride, 3ss in £ pint 
of water at one draught, or the Liquor Ammonii Acetalis, in doses of Sj, are said to 
have marvellous power in straightening up a drunken subject, restoring the faculties, 
and antagonizing stupor. Ammonia by inhalation cautiously. Cold affusion to the 
head. Warmth to the extremities. Faradism of the muscles of respiration. Artificial 
Respiration. [Compare the articles on Alcoholism and Delirium Tremens.] 

Alkalies. Antidotes, — Acids, diluted, especially the vegetable acids, as Vinegar, 
Lemon-juice, etc. Albumin, Milk, Gelatin. Oils to protect the mucous surfaces. 
[Compare Ammonia below.] Antagonists, — Opium for the shock and vital depression; 
also Caffeine, Alcohol, and other stimulants. 

Alkaloids. Antidotes, — Tannin holds high rank, forming tannates, which are 
comparatively insoluble. Potassium Permanganate is capable of destroying many and 
probably all alkaloids, acting rapidly on morphine and cocaine, slowly on strychnine 




POISONING. ~~ t 

\\ i. Albumin to form albuminates. Iodine. Charcoal. Emetics and cathartics 
Twards. Antagonists, — differ for each. [See their several tides in this section.] 

Alum. Antidotes, — Carbonates of Ammonium, Potassium, etc. Other treat- 
ment as for corrosive salts. [See Metallic Salts, in this section.] 

Ammonia. Sources oj Danger, the use of Smelling Salts or Spirit of Hartshorn 
in excess, and the strong solution of Ammonia kept by housekeepers for laundry pur- 
poses. Antidotes, — Vinegar, Lemon- or Orange-juice, any Vegetable Acid, followed 

demulcents to protect the mucous surfaces. When inhaled, give vapor of Acetic or 
Hydrochloric Acid or Chlorine-water by inhalation, the two latter forming the chloride. 
Antagonists, — Aconite, Veratrum, Digitalis, as cardiac sedatives. 

Amyl Nitrite. Antagonists,— Ergotin, Atropine, Strychnine, also Brucine, Digi- 
talis, Picrotoxin, and all other agents which increase the functional activity of the spinal 
cord and sympathetic, are antagonistic, though not always available by reason of their 
slower rate of diffusion. Stimulants, artificial respiration, the alternate cold and hot 
douche, with cold to the head, and Ergotin or Atropine hypodermically, are the best 
measures to be used in cases of poisoning by the Nitrites. 

Anesthetics (Ether, Chloroform, etc., by inhalation). Antagonists, — Atropine, 
hypodermically, is of great value in combating the cardiac and respiratory failure of 
ether (Amidon); and is equally efficient in chloroform poisoning, as I have found by 
experience (Potter). Strychnine, hypodermically, has done good service in chloroform 
narcosis and has many advocates; it is the most valuable antagonist in chloroform 
poisoning (Vance). Oxygen by inhalation is the best antagonist to chloroform (Sayre). 
In danger from Chloroform inhalation prompt measures must be taken. The tongue 
should be pulled out with forceps and kept out. The doors and windows should be 
thrown open so as to produce a current of fresh air, but care must be taken that the 
body is not cooled thereby. The face and chest should be slapped with a wet towel, 
and Artificial Respiration should be commenced at once and kept up for some time, 
not faster than 20 to the minute. A succession of quick, sharp blows on the chest, over 
the cardiac region, will sometimes provoke the heart to renewed action after it has 
apparently failed. Venesection is wrongly neglected in such cases; it relieves the right 
cardiac engorgement; supplemented by Galvanism to stimulate the heart into action 
(Spooner). Amyl Nitrite by inhalation, has been used, but is dangerous as it lowers 
the blood pressure and depresses the heart and respiration (Vance). Adrenalin hypo- 
dermically for the vaso-motor paralysis (Takamine). Faradism of the muscles of 
respiration. Heat to the body and limbs, Ice in the rectum. Ammonia, 10 minims 
of the Aqua in 40 of water, intravenously, — unsuccessful (Bartholow). Invert the 
patient, draw the tongue well forward with forceps, compress and relax the chest, 
maintain the inverted position until the pulse and respiration are good (Ne"Iaton). 
[Compare the article on Anesthesia.] 

Antimony (Tartar Emetic, etc.). Antidotes, — Tannin, or any substance contain- 
ing it, is the antidote, forming the insoluble tannate. Albumin or Milk. Carbonates of 
Magnesium and Sodium. Magnesia, in milk, especially for the chloride of antimony. 
Alkalies and Salts of Lead decompose tartar emetic. Emesis by tickling the fauces. 
Demulcent drinks freely, to protect the mucous membranes. Water, warm, in large 
draughts; or lavage of the stomach with water first, then with a solution of Tannin. 
Antagonists, — Opium, Alcohol, Ether, and other antispasmodics. 

Antipyrine. See under Acetanilide, for the treatment of poisoning by Antipyrine, 
\cetphenetidin, Kairin, and similar compounds. 

Arsenic (Arsenic Trioxide). Two grains have been fatal. Common Sources of 
Danger: arsenical wall-papers, Arsenic mistaken for "salts" or for "magnesia," adul- 
erated confectionery, also Paris Green (Cupric Aceto-Arsenite) taken with suicidal 
ntent. Antidotes, — Ferric Hydroxide, freshly prepared by precipitating a solution 
if Ferric Chloride with Sodium Carbonate or Ammonia,— or the official Ferri Hydrox- 
dum cum Magnesii Oxido, in the proportion of gr. viij for each grain of the poison. 
Oialyzed Iron, is quite efficient as an antidote, is more easily obtained than the hyd rated 



772 POISOXIN'G. 

oxide, and has rendered good service in many cases of poisoning from inhaling arsenical 
fumes. Ferri Subcarbonas is equally good, oij followed by Castor Oil (Leale); or 
Hydrated Magnesia, or Magnesia and Sugar (Carl). Magnesium Bicarbonate or other 
alkalies (R). Charcoal, §ss or more (R). Saccharated Ferric Oxide. Basic Ferric 
Acetate. Apomorphine, hypodermically, or Zinc Sulphate, as an emetic (avoid tartar 
emetic). Emesis by feather-tickling. Oil and Lime-water mixed, before and after 
emesis (Taylor). Milk or other bland fluids to wash stomach. Castor Oil after emesis. 
Magnesia and Linseed tea. Poultices and fomentations over abdomen. Potassium 
Iodide afterwards to promote elimination. Antagonists, — None. 

Barium Salts. Antidotes, — Sulphate of Magnesium or Sodium (Epsom and 
Glauber's salts), of Calcium or Potassium. Diluted Sulphuric Acid. 

Bee and Insect Venom. Antidotes, — Aqua Ammonia, Sodium Bicarbonate 
or Chloride, or pure Phenol, applied to the wound; or ttjjxv of a 2 per cent, solution 
of the first hypodermically, with Liquor Ammonii Acetatis internally. [Compare the 
article on Stings.] 

Belladonna and Atropine. Antidotes, — Tannin, Zinc Sulphate or Apomor- 
phine, as emetics, or the Stomach-pump. Purgation. Magnesium Bicarbonate, 
and other alkalies (R). Charcoal, §ss or more is necessary (R). Antagonists, — 
Morphine is the physiological antagonist to the effects of Atropine on the cerebrum, 
pupils, heart, respiration, arterial tension and kidneys; Aconite, Physostigmine, Pilo- 
carpine and Quinine are each antagonistic to some of its effects, Muscarine to most of 
them. Brandy or strong Coffee. Capsicum. Faradism of respiratory muscles. Fla- 
gellation. Cold to the head. Ammonia, the vapor inhaled into air-passages (R). 
Frequent catheterization is important (Kemp). Hypodermoclysis to promote elimina- 
tion (Id). 

Bromides. Antidotes, — Nitrous Ether is incompatible with Ammonium Bro- 
mide, Acids and Metallic Salts are so with all the bromides. Poisoning thereby is 
always chronic, never acute, hence antidotes can not be employed. Antagonists, — 
Morphine is the most efficient, especially for the mental symptoms. Digitalis, Ergot, 
Belladonna, and other vaso-motor stimulants, antagonize many of the effects of the 
bromides. Cocaine is useful in chronic depressant poisoning thereby, and Alcohol with 
Opium as a nervous stimulant. 

Bromine. Antidotes, — Albumin, Starch, Gelatin, Sodium and Potassium Car- 
bonates and Bicarbonates. Against the irritant vapor, Ammonia vapor by inhalation, 
or steam inhalations. Antagonists, — Opium and Alcohol as stimulants, if much 
depression ensues. 

Calcium Chloride. Antidotes, — Albumin, Mucilaginous drinks, or Oils, Milk 
Flour and water. Avoid acids. Antagonists,— Opium, Alcohol, for vita depression. 

Camphor. Antidotes, — Water to precipitate it from the alcoholic solution. 
Alkalies and earthy salts precipitate even the small quantity which is soluble in water. 
Emetics to remove as much as possible. Antagonists, — Aconite and other arterial 
sedatives. Amyl Nitrite or Nitroglycerin. Alcohol. Coffee. Cold. Opium and Bro- 
mides for the convulsions. 

Cannabis Indica. Antidotes, — Emetics to remove as much as possible. An- 
tagonists, — Alcohol, as stimulant. Strychnine as respiratory stimulant. Faradism 
of muscles of respiration. Lemon-juice is said to antagonize its effects, which last 
over 24 hours from a large dose. 

Cantharis. Avoid Oils, fats and milk, which promote its absorption. Antidotes, 
— Emetics. Demulcents, as linseed tea, gruel, barley-water, freely. Water in large 
quantities, to flush the kidneys. Oleaginous injections into the bladder to allay irrita- 
tion. There is no chemical antidote. Antagonists,— None, but Opiummzy be given 
for the gastro-enteritis. 

Carbonic Oxide. See under Illuminating-gas, for the treatment of poisoning by 
Carbonic Oxide and Carbonic Acid gases. 



POISONING. J** 

Chloral, Hydrated. Antidotes,— Liquor Potassii Hydroxidi, in hourlj do 
well diluted, which will decompose 30 grains of chloral each time in the blood 
Ugall). Emetics, or the Stomach-pump, if patient is seen shortly after in- 
the poison. Reliance must be placed on antagonists rather ti uitidotcs. 

Antagonists, — Strychnine is the most efficient; in a ease in which 5j of hydrated 
chloral was taken, recovery occurred after the use of nearly a grain of Stryi hnine h 
dermically in broken doses (Colenso). Heat to the body and limbs is a ienl 

antagonist. Atropine antagonizes its cardiac, respiratory and spinal depression, and 
should be used hypodermically, in small doses (gr. ., ,',„), frequently repeated, until its 
effects are apparent. Morphine administered with chloral antagonizes its tendency to 
produce cardiac failure, while synergistic to the hypnotic action of the drug. Cocaine is 
of value for the cardiac and respiratory depression. Alcoholic stimulation. Amyl 
'ite by inhalation. Frictions. Coffee, black, a pint injected into the rectum, as 
for narcotic poisoning. Artificial respiration. 

Chlorine. Antidotes, — Albumin for chlorine preparations in the stomach, also 
Aqua Ammonia in small quantity, well diluted. Ammonia vapor, inhaled against 
chlorine inhalations, forming ammonium chloride. Ammonium Sulphide has similar 
reaction, but should be used in great moderation. Fresh air. Steam inhalations. 
Emesis with warm water, then white of egg or milk, flour, or lime-water. Antago- 
nists, — Chloroform by inhalation, to ease the irritant cough. 

Chloroform (swallowed). Recovery has occurred after the ingestion of one, two 
and even three ounces of chloroform (H. C. Wood). Antidotes, — Sodium Carbonate 
in plenty of water. Emetics. Treatment as for irritant poisoning. Antagonists, — 
Atropine or Strychnine, hypodermically. Adrenalin hypodermically for the vaso- 
motor paralysis. Artificial Respiration as soon as possible. Oxygen or Amyl Nitrite, 
by inhalation. Coffee, black, a pint into the rectum. Heat to the body and especially 
to the cardiac region. Rouse by slapping with wet towel. Mustard to calves of legs 
and over the heart. Relapse may occur, hence the patient should not be left for some 
time after apparent restoration. [Compare Anesthetics in this section.] 

Cocaine. Antidotes, — See under Alkaloids. Antagonists, — Chloral is the most 
direct antagonist, so also are Chloroform and Ether. Morphine is directly antago- 
nistic at almost all points of action. Amyl Nitrite combats the earliest symptoms of 
cardiac depression, then Alcohol and Opium as cardiac stimulants. Artificial Respira- 
tion, may be required. Adrenalin hypodermically, for the vaso-motor paralysis. 

Colchicum. Antidotes, — Tannic or Gallic Acid, followed by emetics and 
cathartics. Demulcent drinks, warm. Antagonists, — Alcoholic stimulants. Morphine, 
hypodermically for the cardiac depression. Treatment is the same as that for Aconite 
poisoning. 

Conium. Antidotes, — Tannic or Gallic Acid, followed by emetics and cathartics. 
Antagonists, — Nux Vomica and its alkaloids, also Picroloxin and other tetanizers. 
Alcohol. Muscular Movement. Heat applied externally, as soon as the stomach has 
been evacuated. 

Copper Salts. Antidotes, — Albumin, Soap, Gluten, Milk, Sugar, Magnesia. 
Potassium Ferrocyanide, is the most efficient antidote, but Magnesia or Albumin may 
be used. In the absence of eggs, give a thin paste of flour and water. Any antidote 
should be followed by prompt evacuation of the stomach, and Potassium Iodide to 
saturation of the system. Antagonists, — Opium and Demulcents for the gastro- 
enteritis. 

Corrosive Sublimate (Corrosive Mercuric Chloride). Antidotes,— Albumin, 
Gluten, Magnesia, Milk, Lime-water. Albumin, in some form, is the most efficient; 
the white of one egg to each 4 grains of the poison, forms the albuminate, which must 
be at once evacuated by emesis or the stomach-pump, it being soluble in an excess of 
albumin, also in the alkaline contents of the intestines. Potassium Iodide for after- 
treatment, converts the poison into soluble combinations andpromotes their elimination. 
Charcoal, ,$ss or more necessary (R). Hydrated Protosulphide of Iron, if given within 



( 



774 POISONING. 

20 minutes, is said to be an efficient antidote. Antagonists, — See under Mercury. 
Fatal Dose, — gr. iij have proved fatal. 

Creosote. Antidotes, — Mucilage, Oils, are the most easily obtained. Antago- 
nists, — Ammonia, for depression. Treatment is the same as for Phenol, which 
see under Acid Carbolic, ante. 

Curare. Antidotes, — Ligate above the wound, if any; incise the part freely and 
suck it strongly. Evacuation of the bladder repeatedly, to prevent reabsorption. Caus- 
tic Alkalies destroy the poison. Antagonists, — Artificial Respiration is the most 
efficient antagonist, maintaining life until elimination occurs. Strychnine, though from 
a member of the same family of plants, is antagonistic as to its action upon the heart 
and respiration. So also is Atropine. 

Cyanide of Potassium. Antidote, — Ferrous Sulphate to form Prussian Blue 
(Ferric Ferrocyanide), followed by evacuation of the stomach. Ferrous Sulphate is a 
theoretical antidote, but is said to be practically worthless. Cobaltous Nitrate, is a 
perfect antidote (Antal). Sodium Thiosulphate. Antagonists, — Ammonia, intra- 
venously. Digitalin, Strychnine, Alcohol. Artificial Respiration, general friction and 
galvanism. [Compare Acid, Hydrocyanic] 

Digitalis. Antidote, — Tannic Acid, to form the tannate, which, however, is not 
inert, so that the stomach should be immediately evacuated. Antagonists, — Aconite 
for the effects of large doses, Opium for those due to its continued use. Saponin and 
Senegin are its most complete physiological antagonists. Alcohol, Galvanism, Hori- 
zontal posture. The treatment is similar to that for Aconite. 

Ergot. Antidote, — Tannic Acid, followed by an emetic. Antagonists,— 
Amyl Nitrite, Aconite, Veratrum Viride, Tobacco and Lobelia, antagonize its action 
on the circulation. 

Fish-poison. Antidotes, — Emetics and Cathartics. Antagonists, — Potassium 
Chlorate freely, Liquor Ammonii Acetatis, Opium, Capsicum, Chloroform. 

Formaldehyde. Ammonia is the antidote, forming Urotropin. Administer the 
vapor produced by heating a 25 per cent, aqueous solution of ammonia. 

Fungi, Poisonous. Antagonist, — Atropine, is practically specific as an antago- 
nist in many cases of fungi poisoning. [Compare Muscarine.] 

Gamboge. Antidotes, — Potassium or Sodium Carbonates. Magnesia in milk. 
Emetics. Mucilaginous drinks. Antagonists, — Opium for the depression. Alcoholic 
stimulants. 

Gases and Vapors. See Ammonia, Acid Hydrocyanic, Chlorine, Illuminating- 
gas, Nitrous Oxide Gas, Sulphur. 

Gelsemium. Antidote, — Tannic Acid, followed by an emetic or the stomach- 
pump, if recent. Antagonists, — Morphine is the most complete. Digitalis, Am- 
monia, Alcohol, Atropine, and to some extent the tincture of Xanthoxylum, are also 
antagonistic. Heat externally. Faradization of the respiratory muscles, and Artificial 
Respiration are measures of prime importance. Brandy and Capsicum are useful. 

Glass (coarse or powdered). Antidotes, — Bread-crumbs freely to envelop it, 
then emetics. 

Gold Salts. Antidotes, — Ferrous Sulphate. Albumin, as eggs or flour. Muci- 
lage. Emetics. Antagonists, — Belladonna for the salivation, Hyoscine for the tremor, 
Morphine for shock. Treatment is the same as for Corrosive Sublimate. 

Hyoscyamus. See Belladonna. 

Hypochlorites, as Javelle Water (Potassium Hypochlorite), Labarraque's Solution 
(Sodium Hypochlorite), and Bleaching Powder (Calcium Hypochlorite). Antidote, — 
Sodium Thiosulphate, in dose of gr. xv, well diluted and frequently repeated, reducing 
them to chlorides, itself undergoing oxidation to the sulphate. 



POISONING. 775 

Illuminating-gas. Antidotes, Chlorine-water as spray, inhaled, Am too 
— Oxygen by inhalation, or Hydrogen Dioxide solution internally. Ii 
piration is the chief antagonist, and should be maintained steadily for several I 
Phlebotomy and infusion of normal salt solution is most satisfactory treatment (Thomp 
son). Ammonia vapor by inhalation. Galvanism, the interrupted i the 

extremities. Rhythmic traction of the tongue. Fresh air in plenty; open all 'loots and 
windows. Coffee, black, a pint as enema. Douche, alternately cold and 
head and chest. Horizontal position, clothing removed. Alcohol moderate!] 
mouth or rectum. Catheter may be required in prolonged cases. Subsequently, a 
warm bed, heat applied to the body and limbs, open windows, perfect quiet, Condy's 
fluid about the room, stimulants sparingly, cold acid drinks freely. 

Iodine. Antidotes,— Starch, Albumin, Flour, Gelatin, Sodium and Potassium 
Carbonates and Bicarbonates. Starch is the antidote to free Iodine, but the stomal It 
must be evacuated, as the Iodide of Starch is not inactive. In chronic poisoning by 
the Iodides, a free salivary flow induced by chewing Pyrcthrum-root will hasten elimina- 
tion of the drug. Antagonists, — Quinine, Digitalis, and other restorative agents and 
vaso-motor tonics. Amyl Nitrite by inhalation. Morphine for pain. 

Ipecacuanha. Antidotes, — Vegetable Acids and Astringents arc incompatible with 
Ipecac, and maybe used as antidotes. Antagonists, — Bismuth, Phenol, and Il\ 
drocyanic Acid, also Narcotics, antagonize the emetic action. 

Iron Compounds act as simple irritants. Antidotes, — -Magnesia, Carbonates of 
Ammonium or Sodium. Mucilaginous drinks. Antagonists, — Opium. Ice. [See 
also Metallic Salts.] 

Lead Salts. Antidotes, — Sodium or Magnesium Sulphate, Sodium Phosphate, 
Diluted Sulphuric Acid, Magnesium Bicarbonate, Ferrous Sulphate, freshly precipi- 
tated. Albumin, Milk. Emetics or the stomach-pump. Potassium •■ Iodide, gr. xv-xxx, 
3 or 4 times daily, in cases of chronic poisoning as eliminative (R). The cachexia is 
much relieved by a combination of Quinine Sulphate, Ferrous Sulphate and Diluted Sul- 
phuric Acid (B). Baths of Potassa Sulphurata (Bj or more in the necessary water), 
are also very useful in chronic poisoning by lead (R). Antagonists, — Opium, to 
allay irritation. Belladonna, the extract, gr. J, with Pulv. Rhei, gr. ij, in pill twice daily, 
for the great pain at defecation (Da C). Alum, is the most efficient remedy for the 
colic; to a pint of boiling milk add 90 grains of powdered Alum, separate the curd and 
sweeten with sugar; give a wineglassful every hour or two (B). Tetranitrin in \ grain 
doses, to reduce the high arterial tension. Strychnine, for the paralysis, gives good 
results; also Atropine, gr. y^, with Potassium Iodide, gr. v. Electricity, a slowly 
interrupted current until it causes reaction, for the paralysis of extensors (dropped 
wrist); cure to be completed by the faradic current (B). Marked Diagnostic Signs 
of chronic poisoning by Lead are — the dropped wrist, due to paralysis of extensor 
muscles and a dark, blue line around the margin of gums. [Compare the article on 
Colic, Lead.] 

Lime. See Alkalies. 

Lobelia. Antidotes, — Tannic Acid, to form the insoluble tannate. Charcoal, 
powdered in water [see under Aconite]. Antagonists, — Alcohol, Digitalis, Belladonna, 
Ergot, the vaso-motor excitants, antagonize its effects on the circulation; Strychnine, 
Picrotoxin, and Thebaine, antagonize those on the nervous system. 

Mercury. [See Corrosive Sublimate, also Metallic Salts]. Antidotes, — Albumin, 
Gluten, Flour, Milk. Vegetable astringents. Hydrated Protosulphide of Iron. Char- 
coal. Alkalies, especially Magnesium Bicarbonate (R). Potassium Iodide, to satura- 
tion of the system, as after-treatment; converts the metal into soluble combinations (B). 
Baths, simple or sulphurous (R). Antagonists, — Bismuth, Tannin, Sodium Sulphite, 
Diluted Nitric Acid in water, as gargles and mouth-washes for salivation. Belladonna, 
itrv-x of tincture every 4 to 6 hours, to lessen secretion in ptyalism (B). Hyoxyamine, 
for the tremor, gr. ^ gradually increased to gr. ,'.- (Oulmont). 



776 POISONING. 

Metallic Salts. Antidotes, — Albumin, Milk, Magnesia, Starch, Soap. Oils and 
other demulcents. Sodium or Potassium Carbonate or Bicarbonate. Lavage of 
stomach. Emetics and cathartics. Antagonists, — Opium, Alcohol, Cocaine and 
other stimulants, for shock and vital depression. 

Mezereum. Antidotes, — Albumin, Milk, Oils and Fats, Mucilaginous drinks. 
Antagonists, — Opium, as stimulant against shock and depression. Poultices, cool, 
to abdomen. 

Morphine. See Opium. 

Muscarine. Antidotes, — [see Alkaloids]. Antagonists, — Atropine exactly op- 
poses Muscarine, and vice versa. Digitalis is antagonistic to some extent, so also is 
Physostigmine. There is no example of physiological antagonism so complete in all 
particulars as that between Atropine and Muscarine. 

Mushrooms. Antidotes. — Emetics, if poisoning very recent; Cathartics, espe- 
cially Castor Oil, if some time has elapsed. Tannic Acid, has been recommended. 
Antagonists, — Atropine. Alcoholic Stimulants. Poultices, warm, to the abdomen. 
[Compare Muscarine, above.] 

Narcotics. See Alkaloids, also Opium, Belladonna, Alcohol, Chloral Hydrated, 
Cannabis Indica, Carbolic Acid, Chloroform, Illuminating-gas, Hydrocyanic Acid, etc. 
Vegetable Acids antagonize their after-effects to some extent. 

Nitrites. See Amyl Nitrite. 

Nitrobenzol. Antidotes, — Ammonia, diluted, by inhalation. Emetics. An- 
tagonists, — Alcohol, Aq. Ammonia? (5ss in water), or Chloric Ether (3j in water), 
frequently repeated, as stimulants, given internally, by enema or hypodermically 
(brandy). Atropine. Artificial Respiration. Galvanic current, interrupted, to chest- 
walls, and over cardiac region. Fatal Dose, — Death has resulted from merely tast- 
ing it. 

Nitroglycerin. See Amyl Nitrite. 

Nitrous Oxide Gas. Antagonists, — Artificial Respiration, to be commenced at 
once and kept up for two hours if necessary, not faster than 18 per minute. Fresh air, 
open all doors and windows, and fan the patient. Oxygen by inhalation, 3 or 4 pints. 
Douche to chest, alternately hot and cold. The tongue should be pulled well forward 
and the mouth cleared of any obstruction to respiration, as artificial teeth. In appar- 
ently hopeless cases, two or three violent blows on the chest, delivered in quick succes- 
sion, may restore the cardiac action (Murrell). 

Nux Vomica and Strychnine. Antidotes, — Tannic Acid, forms the very insolu- 
ble tannate. Iodine in dilute solution, or a soluble salt thereof. Animal Charcoal, 
largely. Potassium Permanganate, has been taken in large dose by Dr. Fahr, of Mil- 
ford, N. J., after having ingested gr. f of Strychnine, resulting in the entire absence of 
any symptoms of strychnine poisoning. Lard, is the antidote, as shown by numerous 
experiments on dogs and other animals (Turner). Eucalyptus, a decoction as a wash 
for the stomach; has a true antidotal action in frogs (Masmeci). Emetics or the stom- 
ach-pump should follow the administration of any antidote. The bladder must be 
frequently evacuated to prevent reabsorption. Antagonists, — Quiet, as perfect as 
possible, is very important. Chloral is the antagonist, gr. xxx as soon as possible, 
repeated in 20-grain doses at hourly intervals, as long as reflex exaltation continues. 
Butyl-chloral Hydrate, is a very energetic antagonist (Grigorescu). Potassium Bromide, 
is almost too slow of action to be of much practical sendee. Chloroform or Ether inha- 
lation, to procure muscular relaxation. Physostigma, is antagonistic (R). CliamomUe 
Oil, remarkably subdues reflex excitability in frogs after poisoning by strychnine or 
brucine (P). Amyl Nitrite, by inhalation (R). Veratrum Viride, cured a bad case; 
3j was given at once, then gtt. ij every ten minutes (R). Ethyl Carbamate. Methyl and 
Ethyl compounds of Strychnine, 'and Thebaine. Monobromated Camphor. Ice to 
spine. Tobacco, by enema. Valerian mitigates the spasms (P). Curare, gr. J hypo- 
dermically; is warmly recommended, but its claims are doubtful (P). Apomorphine, 



POISONING. iii 

hypodermically, to relax the spasm (Howard); is very effective in dogs (Wills) 
/j«t', many cases prove its antagonistic and curative power (P). Hyarastinme in d 
of gr. j hypodermically, has bi .sfully employed. Artificial Respiration, il p 

ble. Minimum Fatal Dose of Strychnine, gr. J for an adult, gi , hud. 

Opium and Morphine. Antidotes,— Tannic Add, or vegetable astringents 
followed by evacuation of the stomach, if the poison has been taken bi outh! 

rcoal, 5ss or more (R). Apomorphine, as emetic, gr. ,'„ to ,',, hypodermically; 
must be administered before narcosis sets in (B). Stomach-pump better than emi 
which by the mouth are generally useless in these cases. Potassium Permanganate, an 
efficient antidote if given soon after ingestion of the poison. Compound Tincture of 
Iodine. Antagonists, — Cocaine is the most rational antagonist against Morphine, in 
doses of gr. i every half hour until consciousness returns and the respiratory and cardiac 
functions are sufficiently aroused (Barnes); is effective as to the respiration, arterial 
tension, body temperature, and psychic functions, and should be given in small doses 
cautiously repeated (Reichert). Caffeine acts similarly to cocaine but with less marked 
effect (Id). Atropine is antagonistic but if given too freely may deepen the narcosis, 
no one is warranted in omitting it (P); is synergistic in many important actions and may 
prove dangerous, even fatal (Reichert). Strychnine has found favor with some, espe- 
cially for the respiratory paralysis, but must be pushed to a dangerous physiological 
effect (Reichert). Coffee strong and black, frequently given by the mouth or per rectum, 
or caffeine hypodermically (see above). Adrenalin is useful in the collapse (Takamine). 
Scrum of animals immunized against morphine, was successfully used in a case of 
acute opium poisoning (Hirschlaff). Amyl Nitrite, by inhalation, or Ammonia by in- 
travenous injection, when the heart shows signs of failure; the former proved eminently 
successful in a case wherein Atropine proved useless to restore the patient. Capsicum, 
the tincture, 5SS-J by rectal injection, is said to antagonize the stupor almost instantane- 
ously. Vegetable Acids, as Vinegar and water, Lemon-juice, Cream of Tartar in water, 
etc., every 10 minutes (R); to antagonize the narcotism. Douche, alternately cold 
and hot, or hot water and ice alternately to nape of neck, for the narcosis. Artificial 
Respiration, should be kept up for at least two hours (Murrell). Oxygen, by inhalation, 
is of great value (Macalister). Venesection, has proved effective after all other meas- 
ures failed; is especially beneficial when death is impending from failure of respiratory 
action due to distention of the right heart with backward pressure (Marshall). Potas- 
sium Bromide removes some of the cerebral effects of Opium, as the vertigo and mental 
confusion; others are antagonized by Quinine, and the general intracranial effects of 
the drug are to some extent opposed by Digitalis and Tartar Emetic. The Important 
Measures indicated in Opium or Morphine poisoning are — (i) the removal of the 
poison, (2) the maintenance of respiration, (3) the keeping up of the circulation. The 
stomach should be evacuated at once, and then washed out repeatedly at short intervals, 
in order to recover the morphine which is constantly excreted into that viscus. Fara- 
dization of the chest muscles, cold affusion and artificial respiration are of great value, 
and evacuation of the bladder frequently is important, to prevent reabsorption. Flagel- 
lation is a very dangerous procedure, from the exhaustion which may be thereby induced, 
— strong faradic currents are much more efficient. The anode should be placed over the 
lowest conjoined root of the phrenic nerve, the cathode three inches below the ensiform 
cartilage and a little to the left of the median line. Common Sources of Danger,— 
Overdosing with cough mixtures, or Paregoric, or the Soothing Syrups so much used for 
quieting children, all of which contain Opium. The American Journal of Pharmacy 
estimates the loss of life from the latter cause at 150,000 yearly. 

Phenacetin (Acetphenetidin) . See under Acetanilidc, for the treatment of poisoning 
by Phenacetin, Antipyrine and similar compounds. 

Phosphorus. Antidotes, — Potassium Permanganate, is probably the most reliable. 
Copper Sulphate, as an emetic and a chemical antidote, doses of 3 grains in dilute solu- 
tion every 5 minutes, until emesis occurs; is recommended by authority, but does more 
harm than good. Turpentine, old and acid, containing oxygen, given rapidly in a gum 
emulsion, is said by some to be the best antidote; it is generally unattainable and has 
proved useless in many cases. Lime-water or Charcoal, to prevent action on the 



778 POISONING. 

tissues. Hydrated Magnesia, as a quickly acting purgative; may be given in Linseed 
tea. Copper Carbonate, with sugar and water. Avoid Oils, Fats and Milk, as they 
dissolve the poison and promote its absorption. Antagonists, — Opium, to counteract 
the cardiac and systemic depression. Transfusion, to repair the blood. 

Physostigma. Antidotes, — Emetics or the stomach-pump. Tannic Acid or 
vegetable astringents. Antagonists, — Atropine, as to the effects on the respiration, 
heart and pupil; gr. ? \> to ^V hypodermically, repeated until effects are evident. The 
one nine-thousandth of a grain of Atropine, injected 5 minutes before giving a minimum 
fatal dose of Physostigma, prevents its fatal result (R). Chloral, is also antagonistic, 
and over a greater field of action, but to be effective must be administered very early 
in the case (R) ; gr. x by mouth or rectum every J hour. Strychnine, gr. -$ T) of the sul- 
phate or gr. y 1 ^ of the nitrate, hypodermically; or the tincture of Nux Vomica, ttjjxx by 
mouth or rectum, in very bad cases (Murrell). St imulants, freely. Artificial Respira- 
tion. Fatal Dose, — gr. iy^ is given as the minimum fatal dose. 

Picrotoxin. Antidotes, — Emetics or the stomach-pump. Acetic Acid gives relief 
in overdosing, and may have some antidotal power. Antagonists, — Chloral, is antago- 
nistic to its cerebral and spinal action, but synergistic to its depressant power over the 
heart and respiration. Anesthetics, against its spasm-producing action. Potassium 
Bromide, in addition to Chloral, if tetanus (Murrell). 

Pilocarpine and Jaborandi. Antidotes, — Persalts of Iron and salts of the metals 
generally, are chemically incompatible. Antagonists, — Atropine, gr. T ^y for gr. £ of 
the poison, is a complete antagonist, the most so known to physiological experimenta- 
tion. Conversely, Pilocarpine is exactly antagonistic to Atropine, but Jaborine acts 
similarly to the latter. Morphine controls the nausea and vomiting. 

Potash. See Alkalies. 

Potassium Dichromate. Antidotes, — Sodium and Potassium Carbonates and 
Bicarbonates. Soap. Antagonists, — Opium or Alcohol, for the nervous and muscu- 
lar depression. 

Potassium Cyanide. See Cyanide of Potassium. 

Potassium Nitrate (Saltpetre). Antidotes, — No chemical antidote. Emetics or 
stomach-pump. Demulcent drinks and emollient enemata. Milk. Antagonists, — 
Opium, for the subsequent depression. Aromatics. Brandy. 

Ptomaines in meat, fish, etc. See Fish-poison. They cause symptoms of gastro- 
enteritis and great prostration. The stomach should be evacuated and irrigated, 
sedatives administered, supporting measures when required, and Opium for pain. 

Pulsatilla. Antidotes, — Tannic Acid, followed by emetics. Antagonists, — 
Alcohol, Opium, Digitalis. 

Quinine. Antidotes, — Emetics and cathartics, also diuretics and sudorifics to 
promote elimination. Antagonists, — Alcohol, Opium, Coffee. Morphine antagonizes 
its cerebral action; Atropine that on the nervous system and heart, also its antipyretic 
power. 

Rat-pastes, — contain Phosphorus or Arsenic. Ratsbane is Arsenic Trioxide 
(Arsenic). Rough-on-Rats contains Arsenic (which see). 

Resorcinol. Antidotes, — Albumin. Soda or Saccharated Lime, in plenty of 
tepid water, as wash for stomach. Emetics or the stomach-pump. Antagonists. — 
Stimulants freely. Heat to the extremities. Amyl Nitrite, inhaled. Atropine and 
other cardiac and respiratory stimulants, cerebral excitants, and agents which raise the 
arterial tension, are physiologically antagonistic. Friction with warm hand. Galvan- 
ism, the interrupted current. Fatal Dose, — 3ij nearly proved fatal (Murrell). 

Rhus (Poison Oak or Ivy). Antagonists, — Cocaine, a 5 per cent, aqueous solu- 
tion, or a 10 per cent, oleate, locally, is by far the most efficient application, promptly 
relieving the burning and itching. Grindelia Robusta, the fiuidextract, 1 to 10 of water, 



POISONING. 



77«> 



or undiluted, is a very serviceable lotion. Ichihyol is one of the most effective local 
remedies (KloU). Other applications found useful are: Phenol, in a 5 per cent solu- 
tion; Lobelia, as infusion, 5j to the pint; solutions of Corrosive Sublimate, Lead Acetate, 
Chlorinated Soda, Lime-water with Linseed Oil, Alum-curd. K. Plumbi Acetatis, 
3ij; Ammonii Chloridi (crude), 3ss; Aquse, 5 viij ; as lotion on clot! intly 

wetted therewith, is used with uniform success (Burns). Soap-suds and Hoi U 
frequent washing therewith the surest, speediest and best treatment (Couch). Thymol 
Iodide, dusted over.the part, gives magical relief (Lcvick). Hydrogen Dio it ion 

washed over the face and hands, as a preventive (Behringer) .Sassajras, an infusion 
of the bark, taken internally and applied locally, is almost specific for the rash (Hinton). 
Sodium Sulphite, granular, oj; Glycerin, 5ss; Camphor-water, q. s. ad 3iv, is pre- 
ferred as a topical application (Behringer). Opium or Coffee, to relieve the nervous 
irritability. Rest, low diet, and laxatives are appropriate measures. 

Sanguinaria. Antidotes, — Tannin, Alkalies, and most of the metallic salts are 
incompatible. Antagonists,— Opium, Atropine, Amyl Nitrite, to antagonize the 
depression of the circulation and the local irritant action. 

Savin. Antidotes, — Epsom salt. Demulcents. Emetics and purgatives, espe- 
cially Castor Oil. Antagonists, — Morphine, gr. J hypodermically. Poultices of lin- 
seed meal to abdomen. 

Serpent-venom. Antidotes, — Potassium Permanganate, hypodermically into the 
vicinity of the wound, after ligating the part above it (Weir Mitchell). Chloride 0} 
Lime (Chlorinated Lime) in solution, 1 in 60, injected in doses of 20 minims, produced 
recovery (Hodgson); after ligature applied above the wound, a solution, 1 in 12, was 
injected in doses of 30 minims, 25 injections in all in different parts of the body, brought 
about recovery' after severe symptoms from the bite of a tiger snake (Mackenzie). 
Hypochlorites of Lime or Sodium, Chloride of Lime, and Gold Chloride, are absolute 
antidotes against serpent-venom (Calmette). Phenol, strong, or a Mineral Acid, 
as caustic, after forcible sucking of wound by a person with perfect mucous surface of 
lips and mouth, and thorough cleansing. Ammonia, irjyrij of Aqua Ammoniae, diluted 
with 3 volumes of water, hypodermically into the radial vein, for snake-poison (Halford) ; 
is shown to be unavailing by Brunton and Fayrer (B). Antagonists, — Strychnine, 
hypodermically, has proved eminently efficient in numerous cases (Baron von Miiller). 
Alcohol, as brandy or whiskey freely. Arsenic, for the rapid prostration (B). Bromine, 
R. Potassii Iodidi, gr. iv; Hydrarg. Chlor. Corr., gr. ij; Bromi, 3v; Aquse, 3j; of 
which gtt. x (or iitjiij) in 3ij of Brandy, repeated if necessary (Hammond). Viola 
Cucullata, the common Violet, is used in Pennsylvania against rattlesnake venom. 
Agave Virginica, is known in South Carolina by the name of " rattlesnake's master." 
Antivenene has antagonistic and immunizing powers against the effects of the bites 
of poisonous serpents (Calmette). Bile of the biter snake is an active antidote to the 
poison (Fraser); should be injected into the immediate neighborhood of the wound 
when possible (W). 

Silver Salts. Antidotes, — Sodium Chloride (common salt), dissolved in water, 
largely diluted and freely used; precipitates the silver as the insoluble and harmless 
chloride, and acts as an emetic (R); vomiting should be induced at once, as silver 
chloride is soluble in a solution of sodium chloride and in the digestive fluids. Large 
draughts of salt and water should be taken and vomited, this being repeated until no silver 
remains. The stomach should then be filled with milk and the bowels moved by castor 
oil. Alkalies, especially Magnesium Bicarbonate (R). Albumin. Antagonists,— 
Milk, to allay the resulting irritation; it may serve as food until the stomach is restored. 
Opium, against results of irritation. [See Metallic Salts.] 

Soda and Sodium Salts. See Alkalies, Potassium Nitrate, Metallic Salts. 

Stramonium. See Belladonna. 

Strychnine. See Nux Vomica. 

Sulphonal and Trional. Antidotes, — Sodium Bicarbonate in solution freely, 
by the mouth and by hypodermoclysis (W). Water in large quantities freely to wash 



( 



780 POLYPUS. 

the poison out of the system (W). Saline cathartics and diuretics. Antagonists, — 
Strychnine gr. ^ a ever}' 4 hours, used in a case in which oj of Trional was taken, the 
patient having then slept 4 days, but after six injections he was awake (Alksue). Alco- 
holic stimulants may be required. 

Sulphur and Sulphides. Antidotes, — Chlorine-water. Sodium Chloride (com- 
mon salt). Potassium Chloride. Ferrous Sulphate. Chlorine Gas or Calcium Hy- 
pochlorite, for Sulphuretted Hydrogen; the former should be well diluted with common 
air. Antagonists, — Artificial Respiration is the best treatment for poisoning by 
Sulphuretted Hydrogen. 

Tartar Emetic. See Antimony. 

Tin. Antidotes, — Albumin, Ammonium and Sodium Carbonates, Milk. [See 
also Metallic Salts.] 

Tobacco. Antidotes,— Tannin, followed by emetics, or the stomach-pump. 
Iodides. Antagonists, — Strychnine is the true physiological antagonist to Nicotine 
(or Tobacco) and vice versa. Alcohol, Ammonia, Ergot, Digitalis, Belladonna, antago- 
nize its action on the circulation; Brandy is efficient, also strong Coffee. Warmth 
applied to the surface, also friction. Artificial Respiration. Recumbent position should 
be strictly maintained. 

Trional. See Sulphonal. 

Turpentine. Antidotes, — Magnesium Sulphate (Epsom salt), 3j in water. 
Emetics or the stomach-pump Demulcent drinks, as milk, barley-water, etc. An- 
tagonists, — Opium or Morphine, if much pain, and for shock. 

Tyrotoxicon (in milk, cheese, ice-cream, etc.). Antidotes, — Emetics, if vomiting 
is not free; also the stomach-pump or siphon to rinse out the stomach with water. 
Thymol, Salol, Naphthalene, or other antiseptics. Antagonists, — Opium, or other seda- 
tives, to allay irritation. Stimulants, when prostration. 

Veratrum and Veratrine. Antidotes, — Emetics or the stomach-pump. An- 
tagonists, — Alcohol, Opium, Ammonia, Digitalis, and Belladonna counteract the car- 
diac depression. Morphine with Atropine hypodermically, or Laudanum internally, 
with alcoholic stimulants. Heat, dry, applied to the body. Recumbent posture 
strictly maintained. Coffee, strong, as enema. [See also Aconite.] 

Wounds, Poisoned. Antidotes, — Ammonium Carbonate, gr. v hypodermically 
in the vicinity of wounds caused by poisoned arrows, was repeatedly used with entire 
success by Parke, the surgeon to Stanley's last African expedition. [Compare Serpent- 
venom above, also the article on Wounds.] 

Zinc Salts. Antidotes, — Sodium or Potassium Carbonate dissolved in warm 
water, largely diluted, used freely. Albumin, as eggs and milk, with tepid water, freely. 
Tannic Acid, or vegetable astringents, or strong tea. Lime-water. Soap-suds freely 
Mucilaginous drinks. Antagonists, — Opium, or Morphine hypodermically. Lin- 
seed-meal as poultices to abdomen. Enemata of gruel or starch-and-water, if much 
abdominal pain. 

Polypus. 

Sanguinaria, has been employed as snuff for nasal polypi (P); with doubtful 
benefit (W). Tannin, finely powdered, as snuff blown daily into nostrils through a 
quill, is especially adapted to the soft and gelatinous varieties; while it has apparenrly 
no effect on the healthy mucous membrane it causes the complete withering of the polypus 
(Wa). Zinc Chloride, has been injected interstitially with success in a case of naso- 
pharyngeal polypus (Barthelemy) . Iron, a solution of the Chloride is advised as an 
interstitial application (Auger). Acetic Acid, glacial, injection into the body of the 
tumor, will cause it to shrink up and to drop off in a few days. Alum, in powder, 
applied to point of origin to prevent recurrence (D). Surgical, — a nasal polypus 
should be seized with polypus forceps and twisted off at the neck; it may be removed 






PREGNANCV PHO] IPSUS PROS! \ I I . 7N1 

Aurough tlu- mouth or the nostril; in a few cases the nostril must be dilated with a 
speculum, or the ala slit to give access to the rool of the tumoi (D) 

Pregnancy, Disorders of. 
Mercury, a few grains of blue pill to correct clay-colored stools (L). Iodine, the 
tincture internally for cardialgia (Wa). Aloes, has cured piles in pregnancy, by re 
■wring constipation; cautiously! (P). Alum, Tannin or Catechu, in medicated 
pessaries for vaginal leucorrhea (L). Castor Oil, an excellent laxative (I'); to clear 
out the bowels in diarrhea (L). Cocculus Indicus, when intestines mush distended 
with flatus, and frequent desire to urinate from flatulent pressure on bladder (P), Bis- 
muth, Calumba and Antispasmodics, with minute doses of Opium, for gastrodynia 
and pyrosis (L). Potassium Bromide, with Chloroform, as an antispasmodic in 
dyspnea (L). Sumbul, is invaluable in the restlessness; njfxxx-xl of the tincture with 
a little Chloric Ether, giving quiet nights for a long time (P). Galla, Unguentum 
Galke cum Opio, the best local application to hemorrhoids, also fomentations with 
sponges wrung out in very hot water, to relieve pain (L). Digitalis, in infusion, very 
beneficial in the albuminuria (L). Potassium Acetate, with Basham's mixture (Liq. 
Ferri et Ammonii Acetatis), when albuminuria with anemia. Calcium Phosphate, 
believed to exert an influence on the fetus if administered during pregnancy, so that 
mothers who have borne only rachitic or scrofulous children will bear healthy ones 
(Wa). Berberine, found very useful in the periodical neuralgia? of pregnancy, even 
in cases in which Quinine had previously failed (Maclagan). Camphor Liniment, 
for lumbar pains (Wa). Senna, the confection proves a mild and efficient purgative 
in the constipation of pregnancy (Wa). Milk-diet, the best remedy for albuminuria 
of pregnancy, if strictly carried out (Parvin). Injections, must be used carefully, 
even tepid water often induces uterine contractions (L). [Compare Albuminuria, 
Bright's Disease, Nervousness, Ptyalism, Vomiting of Pregnancy.] 

Prolapsus Ani. 
Nux Vomica, or Strychnine, especially when in children, with constipation; in 
the latter event add Nux Vomica to a purgative, as tincture of Rhubarb (R, P); Strych- 
nine hypodermically, gr. -^ for an adult every 48 hours, f inch from anus and parallel to 
rectum, into the cellular tissue; generally requires 4 to 8 injections (Weber). Piper, 
the Confectio Piperis in doses of gr. lx to exx, persevered in for 3 or 4 months, in chronic, 
weak subjects (Wa). Sulphur, has a beneficial effect in addition to its laxative value 
(R). Alum, in solution, gr. vj to the o (R). Ice, locally, when parts inflamed (R). 
Ergot, the fluidextract injected into the perineum, is followed by immediate relief 
(Vidal). Ferrous Sulphate, 5j to oviij aquae, of which one-third by enema twice 
daily. Podophyllin, in small doses for rectal prolapse in children (P). Tannin, by 
injection to restrain the prolapsus (R). Hydrastis, by enema, or as a lotion (P). 

Prolapsus Uteri. 
Cimicifuga, to prevent miscarriage in prolapsus uteri (R); has a remarkable effect 
upon the uterus (P). Astringents, as Decoctum Quercus, Decoctum Galke (Wa); or 
Pomegranate bark (P). Tannin, as Catechu, Kino, Rhatany. Alum, a solution, gr. 
vj to the § (R); lb. j ad C j aquae, as hip-bath; should also be passed well up vagina 
(Wa). Ice, locally when parts inflamed (R); applied to the spine (Wa). Pessaries, 
in any form, are of but temporary benefit, and in the end positively detrimental (E); 
they insure a better position than any operation (Kustner). Operation by ventral 
fixation, or by shortening the utero-sacral ligaments, permanently relieves the majority 
of cases. 

Prostate, Hypertrophied. 
Alkalies, for the cystic irritation with acid urine; great benefit from Liq. Potass. 
Hydroxidi or the Citrate of Potassium (B). Triticum Repens, benefit follows its 



782 PROSTATITIS — PROSTATORRHEA — PRURIGO. 

use in the prostatic enlargement of old men (Sir H. Thompson). Ammonium Ben- 
zoate, for the cystitis, urine alkaline (B). Ammonium Chloride, is occasionally 
useful, gr. xv-xxx, 3 or 4 times daily (Wa). Iodine Injections, through rectal walls 
(B); a weak ointment applied by rectum (Wa). Iodine, has been tried in all forms, 
but is of no value (Thompson). Iodoform, as suppository in the rectum, has proven 
of great value (B). Colchicum, in persons of gouty diathesis (Wa). Medicine is 
not likely to have any control over this condition, which is a simple hypertrophy; cas- 
tration was suggested by J. Wm. White, and has been performed with successful results 
in three cases by Haynes, also by other operators. [Compare Cystitis.] 

Prostatitis. 

Cantharides, a drop of the tincture, 5 may be required, 3 or 4 times a day (R). 
Triticum Repens, is found to be of benefit (Sir H. Thompson). Urino-Genitals, 
especially Turpentine, Cubeb, Juniper, Cantharis (B); Cubeb, in doses of gr. xx daily, 
is found of much benefit (Wa); Buchu relieves (P). Silver Nitrate, a solution, gr. 
v-x to the S, applied to the prostatic urethra, may be useful in chronic prostatitis (Wa). 
Ichthyol in 10 per cent, aqueous solution injected 3 or 4 times daily per anum, was 
used in 40 cases with most gratifying results, a small syringeful each time, without 
abscess in any instance (Scharff). Helmitol as a urinary disinfectant, is valuable in 
cases having a tendency towards alkaline decomposition of the urine (Goldschmidt). 
Blisters, in chronic prostatitis, a small blister on each side of the raphe" of the perineum, 
kept open 4 to 6 weeks, has given the best results (Wa). Tonic medicines and regimen 
should be prescribed (Wa). Hot Injections, to relieve pain (R). [Compare Pros- 

TATORRHEA.] 

Prostatorrhea. 

Iron, the Tincture of the Chloride, when there is much debility (B); chalybeate 
tonics with Quinine and Strychnine (Gross). Atropine, indicated in all cases, with 
Potassium Bromide (Gross). Potassium Bromide, when irritability and excitement 
(B); indicated in all cases (Gross). Lead, injections of Goulard's Extract, oj to Sx 
of water, night and morning, for 10 minutes at a time (Gross). Ergot, when relaxation 
exists (B). Bougie, methodically introduced, is one of the best local measures (Gross). 
Hydrastis, locally applied, a useful medicine (B). [Compare Prostatitis.] 

Prurigo. 

Antipyrine, as a symptomatic remedy, is efficient in true prurigo. Alkaline Baths, 
followed by a phenolized ointment, and Phenol internally, are of value in the 
papular eruption known as prurigo (Bulkley). Sulphides, Potassa Sulphurata, with 
Tar and Benzoinated Lard, as ointment in genuine prurigo (R). Arsenic, in doses 
of ttjv of Liquor Arsenicalis thrice daily and gradually increased, has exercised a more 
or less powerful influence (Wa); has only a moderate effect (Bulkley). Belladonna, 
controls cases which have resisted ordinary treatment (B). Phenol, both locally and 
internally, is especially serviceable in prurigo senilis (B). Mercury, the Bichloride 
gr. xx with Ammonium Chloride gr. xxx, in Oj of pure water, as lotion in prurigo 
contagiosa, the so-called army-itch; nothing equal to it (White). Ichthyol has cured 
when other remedies proved useless (Mueller) ; cured a severe case which had resisted 
other treatment for ten years (Lorenz). Epicarin as a parasiticide, is used with satis- 
faction, one inunction sufficient in most cases (Pfeiffenberger). Borax, a saturated 
solution in rose-water locally (R); gr. v-x to oj of hot water for pruriginous eruptions 
on mucous membrane of vulva and vagina (R). Galvanism, when prurigo is refera- 
ble to alterations in the cutaneous nerves (B). Tonics, are required, nerve-tonics 
as well as general ones, Cod-liver Oil, Quinine, Strychnine and Phosphorus 
(E. Wilson). Quinine, in large doses, gr. v-x, will control violent exacerbations (Wil- 
son). Baths, the Turkish, frequently repeated, with inunctions of the skin, may be 
regarded as curative in most cases (Wilson). [Compare Pruritus.] 



PRURITUS. 






Pruritus. 

Cocaine, in 5 percent, solution or oleate, is by far the most efficient of all anti 

pruritics; relieves the itching of scrotal eczema, pruritus ani et pudendi, ami especially 
in lesions of the epidermis where the oleate or solution can penetrate al once to the ti tie 
skin. Phenol, is the opium of the skin (Unna), and the most useful antiprm 
agent; in combination with glycerin, as lotion to the itching surface, gives great relief 
(Bulkley); internally and locally in pruritus senilis (B); a one per cent, solution as 
lotion in pruritus ani (R). Chloral, with Phenol, gr. x of each to ,'j of water 
or oil, in the pruritus of the eruptive fevers. Camphor ami Chloral, rubbed together, 
make a liquid which, added to vaselin, gives an ointment which is powerfully antipruritic 
(Bulkley); added to dusting powders, allays heat and itching of eczema and intertrigo 
(R). Tumenol, as tincture, is used locally with almost universal success (Xeisser). 
Menthol, seems to be of marked value in almost all cases of pruritus, from whatever 
cause (Squibb); in 2 to 4 per cent, alcoholic solution, is one of the most valuable remedies, 
and the most generally serviceable (Bronson). Resorcinol 2 to 5 alcoholic or aqueous 
solution, modifies and cures persistent pruritus (Leredde). Picric Acid in 1 per cent, 
solution locally, for pruritus ani (Maddock). Antipyrine internally as a symptomatic 
remedy against itching, is promptly efficient in nervous pruritus, true prurigo, urticaria, 
erythema, pemphigus vulgaris and lichen ruber. Alkaline Baths, locally, followed 
by the application of phenolized ointment, give great comfort in all forms of pruritus 
(Bulkley); Sodium or Potassium Carbonate preferred (Tr); in solution locally, oiij ad 
oiv (B). Tar, as ointment, is strongly recommended (Tr); for general pruritus, if no 
cause can be found, the two best remedies are Tar and Sulphur, as lotion or bath 
(.Sparks); ointments containing Tar give relief in many instances (Bulkley). Sulphur, 
may be employed as a bath, Potassa Sulphurata, oij ad C xv of hot water (Sparks); 
or the alkaline sulphites locally (Wa); the Iodide of Sulphur externally and internally 
in pruritus senilis (Wa). Ichthyol 5j to the 5 of Vaselin, gives prompt relief in pruritus 
ani (Schmitz); also in pruritus vulvae and in general pruritus (Griffith). Mercury, 
strong solutions of the Bichloride, Black or Yellow Wash or Mercurial Ointment, in 
the itching of skin affections (R) ; Yellow Wash is one of the most efficient applications 
for pruritus ani: solutions of the Bichloride are very useful applications in pruritus 
vulvae et ani (Tr) ; for pruritus vulvae a lotion of the Bichloride 1 to 2500 parts of water, 
with Alum and Starch, is recommended (B): Calomel 3j to 3j of Lard, as ointment, 
is the best application, except in the pruritus of urticaria; very useful in pruritus ani, 
less so in pruritus pudendi (R): the Oleate, a 5 per cent, solution in Oleic Acid with 
one-eighth part of Ether, applied by a camel's-hair brush, in pruritus ani et pudendi 
(Marshall). Alum, a strong solution is very useful for pruritus vulvae (Tr). Hydro- 
cyanic Acid, diluted as lotion, often very serviceable; may be prescribed in solution 
with Borax (B); or Laurel-water as lotion, especially in pruritus senilis (P). Potas- 
sium Cyanide, 5j to Oj of water, as lotion, for pruritus of various kinds when the skin 
is unbroken (R); as ointment or solution, if strong enough, relieves greatly, but must 
be used with caution (B); or tijxxx of the dilute Hey Acid of the Br. Ph. in 5j of water 
or glycerin, may be used instead (R). Silver Nitrate, a solution, gr. xx to the 5, 
painted over the affected parts in pruritus vulvae, is very effective (B). Tobacco, is 
an effective but dangerous application (B). Iodoform, as ointment, 3j ad oj Adipis 
(R). Iodine, for itching of the nose or inner canthus, and sneezing, its inhalation 
has a marked effect (R). Arsenic, for itching of the nose accompanying asthmatic 
symptoms (R). Benzoin, the compound tincture painted on the skin, for the itching 
of eczema, urticaria, etc. (R). Boracic Acid makes an excellent lotion in pruritus 
pudendi, a teasp. to the pint of hot water (R). Borax, gr. v-x to the 3 of hot water 
(R). [See Prurigo.] Balsam of Peru, is a very good application in pruritus ani, 
scabies, and many other forms of itching (Auerbach). Zinc Sulphate and Alum, 
equal parts of each, are almost a specific in pruritus ani (Agnew). Chloroform, as 
ointment to allay itching of skin diseases. Gelsemium, ttjxv of the tincture every 
half hour, up to 3j in all, for itching which is out of proportion to the cutaneous lesion 
(Pelcher). Lead Lotions, to ease the itching of urticaria, pruritus pudendi, etc., 



784 PSORIASIS. 

especially when the mucous membrane is red and excoriated (R). Piperazin, gives 
immediate relief in the pruritus of the uric acid diathesis. Salicylic Acid, as ointment, 
in pruritus ani et vulvae (R). Sodium Salicylate, in 15-grain doses by mouth every 
four hours, will greatly relieve pruritus vulva, when due to diabetes (G). Sulphuric 
Acid internally in ascending doses until the urine becomes acid, proved effective in a 
case of severe general pruritus with alkaline urine and excess of earthy phosphates 
(Leo). Zinc Stearate with Tar or Menthol is very effective in pruritus vulvas (Knapp); 
with Aristol is excellent for pruritus ani (Allison). Brucine in 20 per cent, solution 
locally, gives satisfaction in chronic pruritus (Mays). Thyroid Extract a serviceable 
remedy in the pruritus of jaundice (Gilbert). Chlorine, the Liquor Sodae Chlorinatae, 
diluted, a useful application in pruritus ani (Wa). [Compare Eczema, Erythema, 
Pedicuii, Prurigo, Scabies, Urticaria.] 



R<. Potassii Cyanidi, gr. xv. 

Aquae Laurocerasi, o viij. 

M. Sig. — Lotion. (Anderson.) 



B;. Acidi Benzoici, gr. ex. 

Olei Caryophylli, gtt. xl. 

Alcoholis, 3ijss. 

Solve et adde — 

Cerati Simplicis, 5 viij. 

Balsami Peruviani, gj- 

M. ft. unguentum. Especially good for 
scabies, but may be used for any pruritus. 



R<. Gummi Camphorae, 

Chlorali Hydrati, aa 3 J — ij - 

Rub together until liquefied, 
then add slowly, with friction, — 

Unguenti Aquae Rosas, 5 j- 

Sig. — Ointment for itching. 

(Bulkley.) 

R. Phenolis 3ij. 

Glycerini, 5j- 

Aquae Rosae, q. s. ad 3 viij. 

M. Sig. — Lotion for pruritus. 






Psoriasis. 

Chrysarobin, has the most decided effect on psoriasis, 3 ss— i j ad 5j of ung. aquas 
rosae; often irritates, and should be employed at first with caution (Bulkley); gr. x-xxx 
to the 5 of Petrolatum, applied to each spot twice daily, invariably successful (Hughes). 
Thyroid Extract, several cases of psoriasis treated with this remedy alone recovered 
completely in the course of a few weeks (Bramwell). Arsenic, at first apparently 
aggravates, but soon cures the disease (R); must be persistently used for a long time 
(B); exercises a powerful influence (Wa); maximum dose of Liquor Arsenicalis tijjv 
ter die, never on empty stomach (R). Mercury, in patches of obstinate psoriasis, 
especially of hands, even when not syphilitic; Calomel and Mercuric Nitrate ointment 
may be mixed and Tar ointment added (R). Lappa Major, a tincture of the seeds 
in whiskey, used by tablespoonful doses, cured several cases of long standing (Reiter). 
Sulphur, internally (R); a solution of Potassa Sulphurata in water, is excellent in 
chronic psoriasis (B); not in acute (R). Sulphur Iodide, externally and internally, 
in doses of gr. j-vj used with great advantage (Wa). Ichthyol with Chrysarobin or. 
Pyrogallol is very effective, and prevents dermatitis from the use of chrysarobin (Brooke). 
Thiol the dry form, used as a dusting-powder, is very efficient (Squibb). Thymol 
Iodide'an excellent application. Iodipin gives excellent results (Rille). Silver Nitrate, 
occasionally in psoriasis of tongue and buccal mucous membrane; if syphilitic, mer- 
curials best (R). Nitric and Nitro- Hydrochloric Acids, when symptomatic of 
imperfect digestion and assimilation (B). Phosphorus, as substitute for Arsenic (B). 
Coptis, has reputation in New England (B). Copper Sulphate, applied solid to spots 
(R). Lead, the ointment of the Iodide (B). Tar, painted on, in obstinate cases (R); 
with Zinc Stearate makes an excellent application. Roentgen Rays cured a case of 
extensive psoriasis of 20 years' standing, which had resisted all the ordinary treatment 
(Ferris). Oils, Cod-liver Oil internally and locally, is the sheet-anchor, especially 
when of strumous origin (B); oils and fats to lubricate skin, also warm baths (R). 
Diet and Hygiene, nourishing diet, frequent small quantities of raw vegetables, Cod- 
liver Oil for growing persons, especially when stale fish the cause. Rest and change 
for overworked subjects. Open-air exercise is most useful. Warm or tepid soft-water 
baths at night, with use of pure soap; daily baths or cold sponge-baths. 



1M 1 KAV.llM l'l 1 KIM R \| ( ( >\\ I LSIO 

1>. Ichthyolis, K. [chthyoli ~ v j 

Chrysarobini aa gr. \w. I.i,|. p,, ,., Carboni 

V Salicylici gr. xv. 

Petrolati q. s. a 

M Ft. unguent. Sig. use. 

(Brooke.) 



Pyrogalloli ,., ~ 

Wua q 

M. Ft. lotio. Sig. \n.lvnn tin: to large 
surfao (Brooke.) 



Pterygium. 
Silver Nitrate, locally, especially when pterygium with catarrhal conjunctivitis 
t). Treatment is unavailing, and benefit is seldom derived from any operation 
Arlt's Operation, the most satisfactory; cut away as little tissue as possible, 
dissect cleanly, close with suture (Green). 

Ptosis. 
Veratrine, gr. x in 5ij of Sulphuric Ether and 5j of Alcohol, brushed over the eye- 
lids, brows and temples every morning, till a slight burning sensation is produced; 
conjointly with the use of electricity (W). Ergot, aqueous infusion as collyrium (Wa). 
Electricity, the constant current may often relieve recent cases (C). Operation for 
shortening the lid, by removing an elliptical piece of skin and subjacent muscle (C); 
is not advisable unless the ptosis is nearly or quite complete, and of great inconvenience. 

Ptyalism. 

Acids, as astringents, small medicinal doses (R). Sulphuric Acid, internally 
and with Decoctum Cinchona; as a gargle, of great benefit in mercurial ptyalism (Wa). 
Potassium Chlorate, in simple or mercurial ptyalism (R); in the latter form 3j ad 
3\ j aquae as mouth-wash, and internally in teasp. doses, 4 or 5 times daily (St). Bella- 
donna, very effective in mercurial ptyalism, and that of pregnancy; gtt. v-x, or Atro- 
pine, gr. 2-Jfi to T , 1 ,,, every 4 to 6 hours (B); is good treatment when ptyalism is the 
result of some reflex action, but not so when it is an effort of nature to eliminate some 
drug-poison, as mercury, iodine, etc., from the system (Whitla). Pellitory, to stimu- 
late the salivary flow in the latter case, unless the gums are swollen and ulcerated (Id). 
Hyoscine or Opium, may be used instead of Atropine (Id). Astringents, in ptyalism 
from excessive mercurialism when the gums are swollen and ulcerated; Alum 1 in 40, 
Zinc Chloride 2 grains to the 5, Tannic Acid 1 in 40, or other vegetable astringents 
(Id). Tannic Acid, in mercurial ptyalism is an excellent gargle, 5j of Tannin to 5i] 
of Mel Rosas, and 5vj of water (B). Alcohol, diluted, as a gargle (R). Potassium 
Iodide, is sometimes beneficial in mercurial ptyalism, but often aggravates it (R). 
Iodine, the tincture 3ij in oviij of water, as a gargle (R); is worthy of trial (Wa). 
Borax, the glycerite is an efficient local application, but must be used almost continuously 
(Whitla). Potassium Bromide, has proved useful in the salivation of pregnancy; 
it may be combined with small doses of Belladonna or Hyoscyamus (Id). Chlorinated 
Lime or Soda, in weak solution, for the fetor (Id). Stimulants, may be needed in 
severe cases. Diet, liquid food when swallowing is difficult. 

R-. Acidi Sulphurici, 5ss. j 1$. Sodii Boratis, 5ij- 

Tinct. Myrrhae, 5 j • Myrrhae, 5 j- 

Aquae, q. s. ad §vj. Aquae, ovj. 

M. Sig. — Mouth-wash. M. Sig. — Mouth-wash or gargle. 

Puerperal Convulsions. 

Chloroform, by inhalation to narcosis (R); its utility unquestionable when con- 
vulsions are not due to cerebral hemorrhage (B) ; the combined chloroform and chloral 
treatment results in a death-rate of only 7.6 per cent. (Winckel). Chloral, after the 
chloroform, given with Bromides by the rectum to keep up the effect; full doses, 20 to 



786 PUERPERAL DISORDERS. 

30 grains every 2 hours (B); a remedy of the greatest value, in full dose before proceed- 
ing to one of the bromides (Playfair, Barnes). Bromides, in large doses by enema, 
are distinctly indicated (P); Potassium Bromide, oj-ij by the rectum, after venesection 
if convulsions return (Whitla). Veratrum Viride, in 3ss doses of fluidextract every 
15 minutes, to nausea, invaluable (R); thefluidextr.,indosesof njviij-x hypodermically, 
may be repeated in half-hour with Morphine, or ttrx by enema, promptly efficient in 
the worst cases (Elmer); a very bad case cured by 20-minim doses every hour for 5 days 
(Dunn); the worst case seen in my 30 years' experience, after 14 seizures was promptly 
cured by a hypodermic injection of njjiv of Norwood's tincture in a little water (Ether- 
idge). Aconite, one of the best agents (P); gtt. j-ij of tinct. every 10 or 15 minutes 
for the first hour, then at longer intervals (B). Belladonna, the tinct. internally with 
Atropine hypodermically, of verified utility (P). Potassium Bitartrate, administered 
for a month prior to confinement, in quantity sufficient to bring about free action of 
kidneys and bowels, will certainly prevent puerperal convulsions (Anderson). Opium 
is apt to induce eclampsia, unless its use be preceded by free purgation or venesection 
(Id). Morphine used in 60 cases with but two deaths (Veit); in the intervals to prevent 
recurrence, is efficient and of rapid action (Krusen) ; most cases are due to parenchy- 
matous nephritis, in which morphine is used with comparative safety and with brilliant 
results, but a few are due to interstitial nephritis and in them it is a dangerous agent 
(Ty). Apomorphine gr. & hypodermically, an excellent sedative and hypnotic 
(Kitchen). Pilocarpine, the Nitrate gr. A hypodermically every 2 hours, successfully 
used in several cases (Finniss) ; dangerous, being liable to cause edema of the lungs (P). 
Amyl Nitrite by inhalation (B); may cause alarming hemorrhage (W). Tropaco- 
caine by spinal sub-arachnoid injection, gave prompt relief in eclampsia (Kamann). 
Thyroid Extract in full doses, fulfils all indications for treatment in threatening eclamp- 
sia (Nicholson) ; the chief symptoms of eclampsia are those of hypothyroidea, and a cer- 
tain number of cases are probably due to thyroid insufficiency (Richardson). Oxygen 
administered during the seizures (Strogonoff); may be used in conjunction with chloro- 
form, also during the intervals (Krusen). Ice-bags to the back of the neck and head, 
have decided efficacy in warding off and controlling the convulsions (Id). Vene- 
section during the intervals, is superior to veratrum viride to reduce the pulse and pre- 
vent recurrence (Id) ; is by far the most efficient measure (Wallace) ; when great cere- 
bral congestion and vascular tension, shown by a livid face, a full and bounding pulse, 
and strong pulsation in the carotids (Playfair): remove 15-20 ounces of blood, and 
follow by enemata of Potassium Bromide, 5j-ij, if convulsions return; Chloroform 
should be very cautiously used, if at all, after blood-letting (Whitla). Compression 
of the Carotids, Trousseau's method, often stops or materially modifies the attack, 
and may be used in most cases to gain time until chloroform narcosis is established (Id). 
Saline Purgatives, the best being Magnesium Sulphate, or the compound Jalap 
powder, with free use of the wet pack to act upon the skin, for the rapid elimination 
of the retained excrementitious products, urea, leucin, tyrosin, etc. (Id). Salt Solu- 
tion copiously by hypodermoclysis or enteroclysis, to dilute the toxins and counteract the 
depressant effects of phlebotomy (Krusen). Delivery of the child as soon as possible, is 
indicated in all cases (Id); promises better results than any other treatment (Ballan- 
tyne). [Compare Convulsions.] 



Puerperal Disorders. 

Cimicifuga, in puerperal hypochondriasis, and depression (Wa, P). Opium, 
either alone or with alteratives, highly serviceable in puerperal intestinal irritation; a 
few drops of the tincture effectually arrests the diarrhea (Wa) ; when shock and marked 
exhaustion, a moderate dose is of benefit (L). Castor Oil, undoubtedly the best laxa- 
tive (L); purgatives generally are not required, castor oil the very worst (Fordyce 
Barker); action uncertain (Parry). Rhubarb, or enemata, best means of stimulating 
bowels after fourth day (L); gr. xx-xxx in some aromatic water a good aperient (Wa). 
Aliment, in puerperal state should be easy of digestion and sustaining (L). Catheter, 
necessary often for several days when bladder paralyzed, if warm water lavements fail 



'1 i RPEB w. m v\i \. 

{ {.). Water, tepid sponging of external p.uts, vaginal washings daily with warm 
water, with , ,',„ part of Phenol (L). pains, Hemorrhai 

rATiON, Mastitis, Nipples, Phlegmasia Vlba Dolens, etc.] 



Puerperal Fever. 

Aconite, drop doses every one or two hours steadily, with an i 
Castor Oil, and repeated hot poultices or Laudanum fomentatio isful 

treatment, even-in the worst eases, but useless if not promptly efl Veratrum 

Viride, is used with great benefit in most cases (Barker). Quinine, only largti dose 
useful; gr. v-xx every 4 hours (B); reduces the temperature (P). Warburg's Tinc- 
ture, is more efficient than the largest doses of Quinine in cases of puerperal malarial 
fever, oss every four hours until fever abates, then in diminishing doses to nj-ij, until 
convalescence is established (Fordyce Barker). Resorcinol, doses of irr. xl repeated 
when required, as an antipyretic (Braun); is less efficient and more dangerous than 
other members of its class (W). Antipyretics are dangerous and should not be used 
(Davis). Opium, for wakefulness and delirium (B); a very valuable remedy, ten; 
to allay pain, and reduce excitement of the nervous and vascular systems (Wa). Alka- 
line Sulphites, especially valuable in early stages, internally and locally; gr. xv-xxx of 
Magnesium or Calcium Sulphite every 2 or 3 hours, with injections every day (Wa). 
Stramonium, when cerebral excitement (P). Potassium Permanganate, gr. J-j 
ter die, has been given with benefit (B). Alcohol, freely used, until all evidence of 
sepsis subsided, caused recovery in one of the most desperate cases of puerperal septice- 
mia of three weeks' standing, with temp, falling to 95 and rising to 107 (Hills). Tur- 
pentine for depression of the vaso-motor system, cardiac weakness and tympanites (P). 
Collargol by inunction and intravenous injection, is efficient in all forms of puerperal 
infection (Netter). Digitalis does good by its action on the heart, by contracting the 
uterine arterioles and lowering the temperature (Winkel). Ergotin contracts the 
uterine lymph channels and thereby forms a barrier against infection (Solt). Strepto- 
coccus Antitoxin was used in 14 cases of puerperal septicemia with only two deaths 
(Williams); successfully employed in cases due to streptococcus infection (Marmorek). 
Irrigation by Lysol or Creolin in 1 per cent, solution, or by the normal salt solution, 
after the uterus has been emptied; not with Mercuric Chloride which is very dangerous 
in the uterus (Davis). Curettage may be done once with extreme care lest the uterus 
be perforated or injured, may be of value in removing contaminated decidual and 
placental debris (Bacon). Rest in bed, quiet but attentive nursing, liquid food fre- 
quently. [Compare Puerperal Peritonitis, Septicemia.] 



Puerperal Mania and Melancholia. 
Stramonium, will allay cerebral excitement and soothe the nervous system; when 
delirium wild and furious, but intermittent; tendency to suicide or to destroy the child; 
ttrx-xx of tinct. every 3-4 hours (P). Hyoscyamus, in the milder cases; when nervous 
system is greatly excited (P). Duboisine, as calmative and hypnotic, acts efficiently 
for a time in puerperal mania. Aconite, in puerperal mania with high fever and rest- 
lessness; speedy and marked success follows if given soon after the chill (P). Gimici- 
fuga, has cured (B); its effects are truly remarkable in the mania and hypochondriasis 
of the puerperal state (P). Chloral, often alleviates symptoms (B); to produce sleep 
(Wa). Potassium Bromide, in sthenic cases (R); its effects are very variable (Wa). 
Anesthetics, Chloroform or Ether inhaled in violent paroxysms of mania (B). Tartar 
Emetic, in frequently repeated doses (Wa). Quinine, when much weakness; skin 
cold and sweating (B). Chalybeates, Tinct. Ferri Chloridi, njjv-xx, in the anemic 
form (B). Opium, cautiously (B); gives the best results in such doses as may be 
necessary to allay irritation and procure sleep (Wa). Poultices, hot fomentations, 
enemata, or gentle laxatives; nutritious and stimulating diet. Lochia, should be 
watched (P). Weaning, imperative in melancholia; not so in acute mania. 



788 PUERPERAL PERITONITIS — PYROSIS. 



Puerperal Peritonitis. 

Aconite, has cured cases of the usual type (P). [See under Puerperal Fever.] 
Cimicifuga, especially in rheumatic form, has remarkable effects (P). Opium, its 
curative power in this, one of the best established facts in therapeutics (B); is good, 
but Aconite often better (P); especially valuable in adynamic cases (Wa); the drug 
of all others to be relied on (Godson). Mercury, Calomel is strongly advocated by 
some and as strongly condemned by others; is indicated in the sporadic or sthenic form, 
but not in the epidemic or asthenic variety (YV). Turpentine, as stimulant, njjx fre- 
quently repeated, better than Alcohol (B); by enema, also hot turpentine epithems 
may be used with advantage (Wa). Quinine, in considerable doses, with or without 
Opium (B); gr. x-xx twice daily as an antipyretic (Wa). Antimony, as Tartar 
Emetic, gr. tV to £ every hour to shorten attack and render it more mild (R). Cathar- 
tics, advised by many, prohibited by as many; evidence is in favor of mild aperients 
combined with Dover's powder or Hyoscyamus (Wa) Venesection is strongly indi- 
cated in the same form of the disease as Calomel (W). Poultices made thin and hot, 
are of very great value (B). Water, Ice in mouth or swallowed, hot fomentations to 
abdomen; in some cases cold compresses best. [Compare Peritonitis, Puerperal 
Fever.] 

Pulse. 

Aconite, for a quick, resisting pulse (P); a moderate dose, while it slows the pulse, 
renders it fuller, stronger and less compressible (R). Veratrum Viride, reduces febrile 
heat with abnormal rapidity of pulse (P). Veratrine, pulse at first quick and strong, 
then slowed; afterward quick, weak and irregular (R). Digitalis, for weak, quick pulse. 
[Compare Heart Diseases, Fever.] 

Purpura. 

Sulphuric Acid, often acts happily (B). Ergot, has been strongly urged (R); is 
most useful in removing purpura (P) ; many cases are recorded as cured by hypodermic 
injections of Ergotin (Wa). Turpentine, has been used (R); with invariable benefit 
(Wa). Nux Vomica, no prescription more generally useful than the Syrup of Iron, Qui- 
nine, and Strychnine (B). Iron, when due to anemia; the tincture of the Chloride (B); 
is preeminently the curative remedy for purpura haemorrhagica, arresting the hemor- 
rhagic tendency in 24 to 48 hours (Pize). Gelatin 2 per cent, in normal salt solution, 
of which 3vj by hypodermic injection in purpura haemorrhagica, promptly arrested the 
hemorrhage in two girls aged 10 and 13 years (Arcangeli); a 6 to 10 per cent, solution 
containing 0.6 per cent, of common salt, of which §ij per rectum every six hours, cured 
a case of purpura hsemorrhagica in three weeks (Saroni). Vinegar, and water, is an 
excellent application by sponging over the body (E. Wilson). Quinine, or Huxham's 
Tincture of Bark, are much used (H). Potassium Nitrate, gr. x thrice daily in purpura 
simplex, used successfully (Wa). Styptics, as the Ammonio-ferric Alum, tincture of 
Ferric Chloride (Tr); Tannic and Gallic Acids, used in some cases (H). Alum, and 
brandy or whiskey and water at such temperature as is not chilling, applied by sponging 
the body, is the best local measure (H). Wines are generally indicated (B). [Compare 
FLemorrhage, Scurvy.] 

Pyrosis and Cardialgia. 

Capsicum, in atonic dyspepsia, with heartburn and diarrhea (P). Nux Vomica, 
of the highest possible value in atonic dyspepsia with heartburn, hiccough, and regur- 
gitation; an excellent combination is ttj;v-x of the tincture with tijxv of dilute Nitric 
Acid for one dose (P). Pulsatilla, a good medicine in the heartburn of dyspepsia in 
phlegmatic subjects (P). Podophyllin, gr. yVf night and morning in obstinate heart- 
burn, with liver derangement (P). Almonds, blanched, six or eight are said to relieve 
heartburn (P). Rhubarb, and other purgatives are often useful; also Magnesia, 



RACHITIS RECTUM. 

Bismuth, and Ginger (Beale). Opium in small doses Ins been advocated for wal 
brash (Id). Catechu and Kino, also other astringents, sometii od, and bitter 

infusions, especially that of Calumba, have been given with advantage in wal 

Diet, lemon-juice, aerated bread, plain biscuit; I 
vegetable food, and pastry. [Compare Gastric Acidity, Dyspepsia.] 

Rachitis. 
Lime, as Lime-water, or the Carbonate, or the Syrupus Calcii Lacto-phosphatis 

in small doses (R); the Phosphate may be advantageously combined with Cod 
liver Oil (Wa). Phosphorus is valuable in rachitic eases, especially whi is a 

tendency to osteoporosis, and should be given in dos< is can be borne without 

derangement of the digestion (W). Iron, the Syrup of the Iodide preferred; Calcium 
and Ferric Phosphates excellent in combination (B); must be continued a long time 

Nitro-hydrochloric Acid, as baths, gives excellent results (Wa). Quinine, 
often very valuable (P). Thymus Extract, is suggested as probably useful. Aliment, 
food rich in Calcium Phosphate and other phosphatic salts; oatmeal, Graham bread 
(B): Cod-liver Oil, the best constructive agent (B); a full animal diet (Wa); cold 
sponging (R). 

Rectum, Diseases of. 

Podophyllum, in doses of gr. .}„ to ,',, night and morning, for a child, may re 
prolapsus of the rectum (P). Belladonna, the extract locally in fissure (R); and 
irritable ulcers (P); internally and locally to remove ulcers, also excellenl foi 
pain following defecation; or with mercurial ointment, equal parts of each, for lis- 
and ulcers (P). Acetanilide, in tine powder, is an excellent application to ulcers of 
the rectum. Phosphorus, in chronic inflammation of the rectum, has been highly 
recommended (R). Cocaine, gr. xl to oj of glycerite of starch, applied by Seek 
Pile-pipe, very efficient in controlling spasm of the rectum. Potassium Bromide, 
in 5 parts of glycerin, locally, for fissures and painful growths (R). Iodoform, as sup- 
pository in painful diseases, relieves greatly (R). Pepper, the confection, as gentle 
stimulant in fistula, ulcers, hemorrhoids (P). Castor Oil, in fissure and hemorrhoids, 
is commonly used as purgative (R, P). Sulphur, with Confcctio Sennae, in irritable 
rectum, is very soothing (Wa). Stramonium, an ointment of the fresh leaves to 
alleviate pain (P). Conium, the extract in doses of gr. x to allay pain and irritability 
in rectal cancer (Wa). Spigelia Anthelmia, an enema of the juice, also a decoction 
internally, are used by the Venezuelan natives with success in the epidemic gangrenous 
proctitis of that country (Ackers). Lemon, roasted, and one of the quarters introduced 
into the rectum once or twice daily, is used with very satisfactory results in the same 
affection (Id). Purgatives, are best for proctalgia (D). Surgical, an incision through 
mucous membrane, and in severe cases to divide part of the sphincter, in ulcer or fissure; 
a flake of cotton should be laid in the wound, so that it may heal by granulation (D). 
[Compare Anus, Diarrhea, Dysentery, Hemorrhage intestinal, Hemorrhoids, 
Prolapsus, Rectum ulceration of, Sprue.] 

Rectum, Ulceration of. 
Mercury, the Red Oxide, 5j to the oj of Unguentum, as ointment in flat ulcers of 
rectum existing just within the anus (Coulson). Belladonna, the extract locally for 
rectal ulcers, is very efficient (P). Carbonic Acid, per anum, is strongly advised (Wa). 
Chloroform, as ointment, in irritable ulcer of rectum (Curling). Iodoform, in 
suppository, extremely useful in painful ulceration (R); used in many cases with satis- 
factory results, but in some instances poisoning occurs; hence it should be used with 
caution (Wa). Phosphorus, as an internal remedy, is highly recommended in chronic 
inflammation of the rectum (R). Copper Sulphate, with Opium, may often be used 
internally with advantage, and a weak solution of the same, or of Silver Nitrate, locally 
("Curling); the writer had a case resisting treatment for three years, in which a cure 
was effected by the persevering use of a pill of Cuprum Sulphate, Extract of Opium, 



790 RELAPSIXG FEVER — REMITTENT FEVER — RETINA. 






and Quinine Sulphate [see formula below]. Silver Nitrate, gr. J-j combined in pill 
with Opium, gr. ss; and a solution, gr. x-xx to the pint, by enema (B). Glycozone, 
3j in 5xij of lukewarm water, mixed immediately before using, and given by enema 
once daily, in ulceration and chronic inflammation of the rectum and lower gut (Edson). 
[Compare Dysentery.] 

B- Cupri Sulphat., B- Chloroformi 3j-ij- 

Morphinae Sulphat., aa gr. ij. Zinci Oxidi, 3ss. 

Quininse Sulphat., gr. xxiv. Olei Olivae, 3j. 

M. ft. pil. no, xxiv. Sig. — One pill thrice Cerati Cetacei, 3iv. 

daily. (Poller.) M. ft. unguentum. (Curling.) 

Relapsing Fever. 

Cathartic, a mild one at beginning (H); if jaundice or other hepatic derangement, 
a Calomel purgative, cautiously lest irritation (Wa). Potassium Citrate, as cooling 
diaphoretic. Quinine, in moderate doses after the crisis, at least until the relapse, 
which will not be prevented by any amount of Quinine (Wa). Leeches or Cupping, 
best for headache (A). Alcohol, required by some patients. Diet, supporting, 
especially in third week, beef-tea, etc. Urine, should be watched carefully (A). [Com- 
pare Typhoid Fever, Typhus Fever.] 

Remittent Fever. 

Antipyrine or Acetphenetidin, during pyrexia, to lower the temp., is very 
efficient treatment, especially if conjoined with Quinine during the remission; the latter 
drug being too slow of action to be of immediate service in the pyrexia. Aconite, in the 
hot stage, if any febrifuge is required, frequently repeated doses (B); is next in value to 
Quinine for high fever and headache, gtt. j of a good tincture every hour (Da C). Qui- 
nine, 20 to 30 grains in single dose once or twice daily until the temperature is reduced, 
with other appropriate remedies (B); 15 to 20 grains at most (Maclean); 30 to 50 or 60 
grains in severe cases of pernicious remittents several times a day without regard to 
exacerbation (P, B); 10 or 15 grains should be administered at once in bilious remittent 
and other severe forms of malarial fever, without waiting for the remission or sweating; 
an aperient may be given at the same time, 5 or 10 grains of Calomel is the best (Mn); 
when vomiting is severe the rectum should be cleared out with an injection of warm 
water and then an enema of Quinine gr. xxx in Water oiij, with a few drops of acid to 
aid solution, and 5 or 10 grains of Calomel may be given at the same time by the mouth 
(Id). Warburg's Tincture, has achieved a high reputation, but must be used in less 
dosage than directed, and supporting treatment given when its sudorific action com- 
mences (Wa). Gelsemium, exercises a really beneficial influence; depresses the 
temperature (B); valuable in bilious remittents of the South (Pf). Morphine, gr. \ 
hypodermically to abort pernicious remittent fever (B). Purgation, by Calomel with 
Jalap or salines afterwards, is necessary during the course of the disease (Da C). Quassia, 
an excellent tonic in the convalescence, combined with mineral acids (Wa). Packing, 
by the wet sheet, is resorted to with advantage, except when hepatic or splenic congestion 
exists (Wa). [Compare Fevers tropical, Hemoglobixtjric Fever, Intermittent 
Fever, Malaria.] 

Retina, Affections of. 
Mercury, in syphilitic retinitis, is of great value; Calomel gr. j-ij with Opium gr. 
J-i every 4 or 6 hours; also mercurial inunction till the gums are affected or the disease 
yields (Wa). Potassium Iodide and Bromide, in combination, in retinal hemorrhage, 
to promote absorption of the effused blood and to relieve the congestion (C). Physos- 
tigmine, locally, to contract the pupil, and diminish the amount of light admitted to 
the eye (Wa). Iron, in full doses, generally the tincture of the Chloride, in pigmentary 
retinitis; seems to have a tendency to arrest the malady (C). Leeches, to the temple 
better than general bloodletting (Wa) ; when much local congestion present, depletion 
by artificial leech is almost always indicated (C). Pilocarpus, in detached retina and 






Kill! M \IIS\1. - t)l 

optic neuritis; has been found a ver) useful remedy in retinal affections generally, 
[Compare A\i u rosis.] 

Rheumatism, Acute. 

Plans of Treatment, may be resolved inti that by Salicylic Acid or the 

Salicylates, that by Alkalies, and that by Iron (Da C). Salicylic Acid is suited to vig- 
orous, sthenic subjects, whose stomachs will bear it, in these it often effects a cure in 5 
or 4 days; it is better than the salicylates, but should he abandoned it' not effective in 
the time stated (Da C). Salicylates are the standard remedy in all forms of rheuma- 
W); large doses of the Sodium salt frequently (Huchard); Sodium Salicylate is 
specific, but must be used in larger doses at first than those commonly em] 
xxx every hour in severe cases (Moule). Quinine Salicylate has few equals and is sur- 
passed only by the sodium salt (Sir J. Moore). Methyl Salicylate, Oil of Gaultheria, 
in doses of njyc-xv in emulsion or capsules (W); is used with success (B); locally 
applied to the joints is especially helpful (McCraA. Aspirin is an effective salicylate 
and has but slight effect on the digestion (W); gives excellent results, reducing the 
fever rapidly and relieving the joint-pain and swelling (Thesen). Salophen is alleged 
to be almost equal to the ordinary salicylates and much less disturbing to the digestion 
(W). Salipyrin has been used in all forms of rheumatism (YV); the daily dose should 
not exceed 45 grains (Kollmann); it has been frequently used in 15-grain doses every 
§ hour or hour, until about 5ij have been taken, continuing with smaller doses for a 
long time after convalescence, to prevent relapses. Salol, the great remedy, none 
superior (B); given in doses of 15 to 30 grains, up to 5ij in 24 hours, and continued for 
some time after acute symptoms have subsided; may prove toxic in large doses, with 
symptoms of phenol poisoning. Mesotan contains 71 per cent, of salicylic acid, 
and is used locally with rubbing to relieve the pain and swelling (Ruhemann); or Salicy- 
lic Acid with lard as an ointment is very satisfactory (Curtiss). Alkalies, for flabby, 
fat subjects; alkaline carbonates, as Potassium Carbonate ojss in 24 hours, alone or 
with a vegetable acid, until the urine becomes neutral or alkaline, when it may be reduced 
one-half, and so maintained for some days, when Quinine or Iron may be used; if 
successful, this treatment brings about a cure in two weeks: the alkaline treatment is 
now seriously questioned; an injurious dyscrasia results from their use (B). Potas- 
sium Bicarbonate, gr. xxx every 4 hours, in a dilute solution, until joint-symptoms 
and fever disappear (Wa). Sodium Bicarbonate in solution on lint locally, for the 
joint-pains. Ammonium Carbonate in 5-grain doses frequently, for cardiac com- 
plications (B). Potassium Acetate freely, followed after a few days by Potassium 
Iodide and tonics; or gr. xxx of the former and gr. x of the latter 3 or 4 times a day, 
is sometimes very efficient in cases subacute from the beginning (W). Ammonium 
Bromide, an excellent treatment, followed by Quinine; gives a very low proportion of 
cardiac complications; gr. xv-xx every 4 hours (Da C); is disagreeable but strongly 
recommended (B). Iron, the tincture of the Chloride is suited to feeble, anemic and 
nervous subjects, itjjxxx every 4 hours, with an occasional saline laxative, blisters around 
joints, and Atropine, as an anodyne rather than Opium, used hypodermically in the 
vicinity of the affected joint (B); very serviceable in pale, delicate subjects, njjxx-xxx 
every 4 hours; also as prophylactic where tendency (Anstie); harmful to the plethoric 
and overfed (B). Iron and Salicylic Acid in combination, should be most valuable, 
but as heretofore prescribed has always made an insoluble precipitate; this is over- 
come by Dr. Peabody in the formula given below, which makes a ruby-red mixture, 
and has advantage of preventing the anemia which results from the Acid given alone. 
Aconite, very serviceable when much heat and dry skin (B); subdues pain in 
inflamed joints and perhaps shortens the fever (R); in small closes frequently repeated 
is of the greatest value, and if used from the start prevents organic cardiac disease (P) ; 
not reliable as a curative agent, but is a valuable adjunct to other remedies (Wa). 
Veratrum Viride, said to be useful (R); small doses as antipyretic, may be combined 
with Opium (P). Antipyrine has some specific action in rheumatism but is inferior to 
salicylic acid (W); in large doses gr. xlv-5j is fully as efficient as the salicylates, and 
markedly lessens the tendency to cardiac complications (Linnosier). Acetphenetidin 



792 RHEUMATISM. 

is efficient and safe. Phenocoll is a safe, prompt, and efficient antipyretic (W); 
is valuable in rheumatism (Hertel). Acetopyrin is effective in doses of gr. xlv-5j 
(Braun). Ichthyol in 10 per cent, ointment painted over the affected joint and 
covered with cotton wool, is very effective (Unna); used in 117 cases with most 
satisfactory results (Kolbl); its results are superior to those of any other drug (Lorenz). 
Opium, strongly recommended as anti-rheumatic; gr. j every 2 or 3 hours, increased 
to gr. xij in 24 hours; tolerance remarkable in this disease; in rheumatic carditis indis- 
pensable (Wa); a very good remedy in moderate doses (Da C); as Dover's powder 
when it is desired to relieve pain and increase the action of the skin (W). Quinine 
after the acute symptoms have abated, when the patient is weak and sweats profusely 
during sleep, gr. xv daily are often of great service (W); is efficiently used for head 
symptoms (Da C). Phenol, itjixv of a 3 per cent, solution by parenchymatous 
injection (Senator). Formic Acid, -git. v of a 2 per cent, solution hypodermicallv, 
preceded by gtt. viij of a 1 per cent, cocaine solution, gives instant relief (Couch). Arnica, 
lowers pulse and temperature, relieves articular pain and swelling, diminishes urea (P). 
Trimethylamine, njjiv-viij in Peppermint-water, often has remarkable power in acute 
rheumatism and gout (B). Bryonia, after the swollen joints have been reduced by 
other means, is extremely efficient for the pain and stiffness (P). Spigelia Anthelmia, 
for rheumatic pericarditis and endocarditis; rheumatic fever with pain shifting from 
joint to joint (P); seems to fix the disease in certain joints, and prevents its shifting 
around (P). Sulphurous Acid, by fumigation, the patient covered with blankets and 
exposed to strong fumes, produces perspiration, sleep and relief (R). Colchicum, 
alienates the symptoms, and shortens their duration (Wa). Laville's Mixture, is said 
to be a tincture of Quinine and Colocynthine, but it is more than probable that Colchi- 
cine is the active agent therein. Rhus Toxicodendron, positively invaluable in after- 
stage, also in subacute forms, muscular or tendinous, worse at night (P, Pf). Hydri- 
odic Acid, the Syrup, in dessertsp. doses every 2 or 3 hours, the best remedy for acute 
and subacute rheumatism, relieving pain and swelling in 18 to 24 hours (Craig). Cimi- 
cifuga, has excellent reports (B); much used, and is said to quell the pain speedily (R); 
found very serviceable (P). Dulcamara, recommended especially for persons who are 
subject to catarrhal affections in cold and damp weather (P). Digitalis, in powder, 
gr. ij every 4 hours, usually effective after 2 to 7 days; especially useful in cardiac 
complications with cyanosis and edema. Lime-juice, 5 viij daily, Lemon-juice 
inferior (R). Blisters, are a very effective method; a number of small blisters ap- 
plied to vesication around a joint (B); large flying blisters around a joint (R). Water, 
cold baths for the hyperpyrexia (Da C) ; the wet pack efficacious in rheumatism, also 
a vinegar vapor bath (B); the wet pack* 20 or 30 minutes, and tepid (70 F.) shallow 
bath 1 or 2 minutes. Cold applications only when skin hot and dry, and temperature 
high. Warm baths, or hot compresses very useful. Spongiopiline an excellent sub- 
stance for applications. Diet, low during the fever, water, barley-water, milk-and- 
water, gruel; use liquid food throughout, avoid malt liquors, port wine and sugar. 
Lemon-juice may be used freely. Blankets, instead of sheets to sleep in, and flannel 
underclothing, are useful adjuncts. Pack the joints with cotton covered with rubber 
cloth or oiled silk. Dry Heat, applied by the Tallerman apparatus is of great value 
in tendinous inflammations, also in subacute rheumatism through its sweating and local 
influence (W). 

B;- Olei Gaultheriae, 3j- B- Acidi Salicylici, oij- 

Acidi Salicj'lici, gr. lxxx. Ferri Pyrophosphate 5j- 

Sodii Boratis, 5j- Sodii Phosphatis gr- xij- 

Syr. Picis Liquidae, Aquae, Svj. 

Aquae Anisi, aa oij- M. Sig. — A tablesp. every two hours. 

M. Sig. — A dessertsp. even- two hours. (Peabody.) 



}$. Potassii Iodidi, oij • 

Vini Colchici Sem., 

Syr. Simplicis, aa oiv. 



B- Sodii Salicylatis, oss. 

Tinct. Lavand. Co., oiij- 

Glvcerini, 5 v. 



AquseMenthae Pip., gv. Aquae, q. s. ad 5v). 

M. Sig. — Tablesp. every 4 hours. M. Sig. — A tablesp. even- three hours, 

(New Orleans Charily Hosp.) well diluted. 



RHEt \1 \lis\l. 



Rheumatism, Chronic. 
Arsenic, is very good in most cases, given in small d ily (Da < 

efficient than Sulphur and should be used instead of the latter in the Chel 
mold remedy for chronic rheumatism (Fothergill). Sulphur wains are undoubti 
efficienti Da C); Sulphur locally, also the Sulphides as baths (R); is certainly o 
(B). Guaiac is another ingredient of the Chelsea Pensioner; is used with 
success (B); the ammoniated tincture in milk often gives excellent results (Da ( 
vile to the taste. Potassium Iodide, especially when pains are worse at night, o 
syphilitic origin (R); should always be fairly tried in chronic rheumatism 
was Sir Astley Cooper's remedy; Iodides often prove very satisfactory, especially in 
strumous or syphilitic subjects (B). Ichthyol in 10 to 50 per cent, ointment applied 
over the affected part, no remedy equally efficient (Unna); also internally in d 
3 to 5 drops, continued for several months, has cured a number of obstinate chronic 
cases (Schmidt). Salicylates are often temporarily of great service (W); thai of 
Lithium gives good results in lingering subacute cases remaining after acute attacks 
('Da C). Saloquinine always allays the pains (Tauszk). Mesotan, a salicylic 
paration, locally by rubbing, is efficient in the acute exacerbations (Ruhemann). Cimi- 
cifuga, sometimes has wonderful success, yet often fails; no indications (B); is rheu- 
matic neuralgias and headaches, and rheumatism of uterus (P); signally beneficial in 
many forms (R). Lithium Bromide, gives excellent results, when smaller joints 
are swollen and tender (B). Rhus Toxicodendron, a very powerful agent in subacute 
muscular or tendinous rheumatism worse at night (Pf); the tendons, ligaments, and 
fasciae are most benefited; externally, as lotion on compresses; also internally, small 
doses every two hours (P). Aconite, the extract as plaster to joints is unquestionably 
very useful (P); is more useful in chronic than acute rheumatism (Wa); the liniment 
of the B. P. locally over the sciatic nerve when affected (Fothergill). Colchicum is 
of decided benefit in the neuralgia of chronic rheumatism (B). Colchicine Salicylate 
is used with benefit. Bryonia is often useful, especially for stiff and painful joints (P). 
Formic Acid gtt. v of a 2 per cent, solution, preceded by gtt. viij of a 1 per cent, cocaine 
solution, hypodermically in several places on the extensor side of limbs, efficiently relieves 
pain and proves curative (Couch). Mercury, the oleate of Mercury and Morphine 
locally (R). Mezereon is strongly recommended (P). Phytolacca, has proved 
useful (B). Dulcamara, has been used with benefit (P). Iodine, locally, for pain 
around joints (R). Quinine, in rheumatism with debility, shown by night sweats or 
sweats during sleep and only then (Wa). Arnica, the tincture and infusion are useful 
(P). Cajuput Oil, internally and externally in muscular rheumatism (P). Turpen- 
tine, benefits and relieves the pains; internally and externally as liniment (P). Aletris, 
is extensively advertised as an efficient remedy. Nuclein, has been used with decided 
advantage (Vaughn). Eucalyptus, the leaves wrapped around the affected part, 
renewing them daily for a week or more, often very efficient as a local stimulant, but 
will produce vesication if too long continued (Gibbons). Xanthoxylum, has long had 
deserved reputation, njjxv-3ij of fiuidextract (B). Thuja Occidentalis, is useful 
for rheumatic pains (P). Manganese Sulphate, is one of the remedies (B). Bella- 
donna, the extract locally very valuable for pains (P). Cod-liver Oil, internally and 
externally, exercises some influence (B). Chimaphila, may prove useful, especially 
when lithiasis (P). Lupulin, as an anodyne (P). Burgundy Pitch, as plaster locally 
(P). Aliment, avoid spirits and malt liquors, coffee, also starchy, animal and sac- 
charine food; the farinaceous vegetables and acid fruits suitable (B); Alkaline mineral 
waters have deserved reputation (B). Turkish Baths, in chronic muscular rheuma- 
tism (B); steam bath daily of great benefit, may be obtained at home by pouring water 
on hot bricks in a tub, the patient sitting on a board or chair above, enveloped in a 
blanket (Brick). Carbonic Acid Baths are sometimes beneficial. Red Flannel 
next skin, very popular, but white is better, as the red often gives rise to eruptions 
(Da C). [Compare Arthritis, Gout, Lumbago, Myalgia, Pleurodynia, Sri \tica.] 



794 RHEUMATISM — ROSEOLA. 



B;. Guaiaci, 

Potassii Iodidi, aa 5j- 

Tinct. Colchici Seminis, 5iij. 

Aquae Cinnamomi, 

Syrupi, aa q. s. ad 5vj. 

M. Sig. — A dessertsp. to a tablesp. thrice 
daily. {Pepper.) 

B- Arseni Trioxidi, gr. iij. 

Guaiaci, oiij- 

Capsici, 3ss. 

Pil . Aloes et Myrrhas, oiij . 

Ft. pil. no. cxx. Sig. — One thrice daily. 
The modified Chelsea Pensioner. 

(F other gill.) 



B;. Olei Sinapis 3ss. 

Olei Terebinth., oiij. 

Camphoras 3iv. 

Aqua; Ammon. Fort., 3iij. 

Tinct. Capsici, 3>v. 

Alcoholis q. s. ad 5vj. 

M. Sig. — Russian Spirit, a liniment for 
rheumatism. 

B;. Potassii Iodidi oj- 

Potassii Nitratis, 3ss. 

Fluidextr. Cimicif. 

Glycerini, aa 5ss. 

Vim Colchici Sem.,.q. s. ad 5ij- 
M. Sig. — A teasp. after each meal. 



Rheumatism, Gonorrheal. 
Opium, as Dover's powder, full doses in the acute stage (Wa). Potassium Iodide, 
with tonics and stimulants, after the acute stage has passed, followed by friction, sham- 
pooing, and passive movements of the joints (Wa). Ammonium Chloride, in free 
doses, especially when the muscles are affected (Fuller). Potassium Chlorate, 
internally, and as urethral injection, until urethral discharge is entirely stopped, then 
ttrxx of Tinct. Ferri Chlor. 4 times daily, with gr. x. of Quinine daily, and good food 
(Da C). Aspirate, when pus is discovered around the joints; the case will be one of 
pyemic rheumatism, and may involve more joints than one (Da C). 

Rheumatism, Muscular. 

Salicylates possess the greatest power for good of all known agents in muscular 
rheumatism, rheumatic neuritis, and other irregular forms of rheumatism (W). Aspirin 
is an excellent salicylate for this affection (Merkel). Saloquinine benefits the most 
obstinate cases (Tauszk). Mesotan rubbed in locally is very efficient (Ruhemann). 
Lithium Bromide, is almost specific (B); Lithium and its salts where there is a uric 
acid diathesis. Colchicine, a 10 per cent, solution in 5-minim doses hypodermically 
thrice daily into the affected muscles, very effective in cases resisting other treatment. 
Colchicine Salicylate, is used with benefit. Aurum, the Bromide of Gold and 
Arsenic is employed successfully (Barclay). Pilocarpus, or Pilocarpine hypodermi- 
cally, to get the skin acting freely, a great desideratum (Da C). Potassium Iodide 
and Colchicum, or Quinine, gr. xij-xvj in 24 hours, if the case lingers over a week 
(Da C). Capsicum, powdered, with Lard, 5ij to the 5, rubbed over the part, night 
and morning, with a gloved hand, is very efficient (Macdonald). Cimicifuga, is often 
very efficient in lumbago, myalgia, pleurodynia, and similar conditions (Wa). Xan- 
thoxylum, gives relief in some cases of muscular rheumatism (B). Morphine and 
Atropine together hypodermically, for severe pain; are of great sendee in most forms 
(R). Diaphoretics, as Dover's powder made with potassium nitrate, or Ammonium 
salts, with dry heat to the part involved, and rest in bed (Da C). Liniments are of 
little use except to amuse the patient, but Chloral oj in ovj of Linim. Saponis, makes 
a good one (Da C). Electricity, the constant current daily renders good service. 
[Compare Gout, Lumbago, Myalgia, Neuritis, Pleurodynia, Rheumatism chromc, 
Torticollis.] 

Roseola. 

Aconite or Belladonna, according to the symptoms, in epidemic roseola or Ger- 
man measles. Ammonium Carbonate may be indicated in severe cases. Treat- 
ment is expectant and symptomatic, and very little is required; saline expectorants 
and gargles for throat symptoms, as in measles, also rest in bed in a warm room. Local 
applications are seldom called for, the rash being but slightly irritant. [Compare Erup- 
tions, Erythema, Measles; and for other forms of Roseola see Syphilis, Typhoid 
Fever, Vaccination.] 



SARCINiE -SCABI1 S SCAR] I I FEVER. 795 

Sarcinae. 
Sulphites and Hyposulphites, have been employed to d< ins and I 

in the stomach (R); or Sulphurous Acid, diluted, before each meal (Wa). The 
treatment of these microscopic fungi is that of the primary gastric affection, [Com- 
pare Cancer, Dyspepsia, Gastric Dilatation.] 

Scabies. 

Sulphur, a solution of Potassa Sulphurata oss in 3j, as Local application; an 
extemporaneous Sulphide may be made by boiling one part of quicklime and two of 
sulphur in ten of water (B); Sulphurous Acid, as gaseous bath, the quickest methi 
Hebra's mixture of Sulphur, Chalk, Tar, Soap and Lard, less irritating and equally 
sure (R). Calcium Sulphide, as a bath (W). Sulphuric Acid, internally, has cured 
when other remedies failed (Wa). Storax, equally serviceable and not irritating as 
is Sulphur, one part to two of Olive Oil, with a warm bath (R). Mercury, the Bichlor- 
ide is very efficient, if used strong enough, but caution is required in its employment 
(B). Epicarin in 5 to 10 per cent, ointment, is an excellent parasiticide (Leitch). 
Phenol 5j to the 5 of glycerin locally (B). Creolin as a 5 per cent, ointment 
with vaselin, has been largely used with great success (W). Thigenol is very efficient. 
Staphisagria, a certain remedy; 3 to 5 of Lard, boiled for 24 hours, when cooled, after 
straining add a little essence; friction with this 4 times daily (Wa). Balsam of Peru, 
the best of all applications, killing the acarus, relieving the itching and dermatitis, and 
disinfecting the parts; rub in oj over the body after a warm bath (Bruce); is fatal to 
the itch-mite (Oldberg). Manganese, the Oxide, oij to 5j Adipis as ointment (B). 
Copper Sulphate, as lotion, oj to Oj, has been used with great success, after crusts 
are thoroughly removed with soap and water (B). Alkalies as soaps or ointments to 
soften the cuticle and break up burrows (R). Cocculus Indicus as an ointment, is 
efficient (P); or Picrotoxin in ointment, gr. x to the 5, if not applied to an abraded 
surface. Tar as ointment relieves the itching quickly and cures in 10 or 12 days (P). 
Benzoic Acid in 1 to 200 aqueous solution as a lotion for the itching (R). Naphthol, 
in 3 to 5 per cent, alcoholic solution or as a 10 per cent, ointment, is by far the best appli- 
cation (Shoemaker); a 2 per cent, ointment applied by friction has caused acute nephri- 
tis in two brothers aged 6 and 8 years, one of whom died therefrom (Baatz). Linen, 
should be immersed in boiling water, other garments should be baked in an oven or 
well fumigated with Sulphur vapor, to destroy the acari and their ova (R). 



B- Hydrarg. Chlor. Corr., gr. iv. 

Alcoholis, 3 vj. 

Ammonii Chloridi, 5ss. 

Aquae Rosae q. s. ad ovj. 

M. Sig. — Lotion for scabies, phthiriasis, 
and tinea versicolor. (Fox.) 



R«. Sulph. Sublimat., 

Olei Cadini, aa oij- 

Cretan Preparatae, oijss. 

Saponis Viridis, 

Adipis, aa Sj- 

M. ft. unguentum. (Bulkier.) 



Scarlet Fever. 

Aconite, of the highest value for all marked increase of temperature (R); helps 
development of the eruption when due (P); in the early stage, when patient is not de- 
cidedly adynamic, is very useful (W). Belladonna, during the eruptive stage, when 
depression exists, and rash is imperfectly evolved (B); as prophylactic has been recom- 
mended (R); is often efficacious as prophylactic (P); the preponderance of evidence is 
certainly in favor of such use of the drug (P*f) ; this virtue is claimed by imposing authori- 
ties; when so given its dose is gr. I several times a day (Tr). Mercury, gr. \ of Gray 
Powder every hour has marked effect on inflamed tonsils (R). Ammonium Car- 
bonate, feeble circulation, cyanosis, delirium (B); in all forms, especially if .given 
early (R); one of the most reliable remedies; gr. iij-vij, according to age, in milk or 
Cinnamon-water, every hour or two (Wa). Potassium Iodide, in full doses, a very 
satisfactory remedy (Mitchell). Salicylic Acid, given in 125 malignant cases, with 



796 



SCIATICA. 



mortality of only 3$ per cent. (Shakowaki). Salol, in doses of 7 to 30 grains daily, 
according to age, internally, with gargles of a solution of Phenol, used in several 
cases with recovery in all and without albuminuria or other complications (Quioc). 
Quinine Salicylate is an excellent adjuvant, especially in the advanced stages when a 
tonic is required (Sir J. Moore). Phenol used internally and as a gargle, is used 
with benefit; seems to exercise some influence as prophylactic (Wa); is good for the 
vomiting and for its general effect on the disease; njjss, every 2 or 3 hours (Da C). 
Sodium Phenolsulphonate, as a means of introducing Phenol into the system; 
has been successfully employed (Wa). Chloral with Paregoric, is highly efficient for 
calming the patient. Potassium Chlorate, in grain-doses every £ hour, will not 
injure the kidneys, and will give results equal to those of larger doses on the throat 
inflammation (Smith). Asclepias, to promote the eruption (W). Zinc Sulphate, 
gr. ^V every 3 hours, believed to have specific influence on the disease (Hoyt). Sodium 
Benzoate, is highly efficient, having slower but more permanent effects on the fever 
than Quinine or the Salicylates (Klebs). Boric Acid, makes an excellent gargle 
(Da C). Juniper, as diuretic when dropsy (R). Magnesium Sulphate, as purga- 
tive, to prevent sore throat and other sequelae (R). Collargol by inunction, cured a 
grave case in a child of 2$ years (Netter); employed with good effect in an epidemic 
of malignant type (Crede). Ichthyol in 5 per cent, ointment, causes rapid decline of 
the cutaneous symptoms (Seibert). Antipyrine for high temperature (W). Mineral 
Acids, Hydrochloric internally and as gargle, Nitric locally to sloughs in the throat 
(R). Veratrum Viride for convulsions (R). Rhus Toxicodendron, of great ser- 
vice, if typhoid or rheumatic symptoms (P). Digitalis, very useful; lowers tempera- 
ture and maintains kidney action (B); the best antipyretic and diuretic, the infusion 
with dry cups for the renal dropsy in its inception; later on a milk diet and Basham's 
mixture (Da C). Potassium Permanganate, locally to throat, and internal!} 
£-j ter die, of undoubted benefit (B). Sulphurous Acid, by inhalation, spray, or 
fumigation, in malignant sore throat (R). Chlorine Water, in sloughing of throat 
(R); seemingly prophylactic (Wa). Quinine, small doses in adynamic states, large 
in hyperpyrexia (B); very successful when used systematically from the start (Wa). 
Ferric Chloride, the tincture in doses of ttjjx-xv, according to age in advanced stage; 
when albuminuria and hematuria, is very valuable (Wa). Streptococcus Antitoxin 
may be of service (W); has been used with benefit (Josias). Blood-serum from 
scarlatinal patients has been used, with the result of shortening the course of the disease 
and ameliorating the symptoms. Mustard Bath, on recession of rash, to bring it back 
(R). Oil Inunctions, very grateful, especially useful in desquamative stage; Cacao- 
butter the most elegant (B). Ice, sucked, for the sore throat (R). Water, cold baths 
with oil inunctions, are all that are needed in mild cases; when temperature above 
104 , urine scanty and rash retroceding, the cold-wet pack renders signal service (R); 
cold wet compress to neck, through the whole course, renewed every 3 hours (R). Diet, 
fruit, if ripe, in season, toast, gruel, etc., in simple cases; in malignant, extract of beef, 
stimulants as per pulse. Milk the most suitable aliment, both as nutrient and as diu- 
retic; a strict milk diet was enforced during the illness in all the cases mentioned above 
under Salol (Quioc). [Compare Albuminuria, Bright's Disease, Uremia.] 



R<. Acidi Borici, 3ss. 

Potassii Chloratis, 

Tinct. Ferri Chloridi, aa 3 ij . 

Syrupi, 

Aquae, aa 3ij- 

M. Sig. — Tablesp. every 2 hours, to 
child of five years. {Smith.) 



R. Acidi Salicylici, oij- 

Tinct. Aconiti, gtt. xij. 

Infusi Digitalis, o jss. 

Spt. Ammon. Aromat., 5»j. 

Syr. Aurantii Cort., oss. 

Aquas, 5 j- 

M. Sig. — Teasp. every 3 hours, for 
child of five years. {Brown.) 



Sciatica. 

Opium, internally and externally (Wa). Morphine, hypodermically, is especially 
curative in sciatica (B) ; 3 or 4 injections of gr. \ each may almost be regarded as specific 
(Wa); a single injection sometimes cures long standing cases permanently; if not it 



MI \ I 



797 



ni.iv be repeated everj' second day or so (R); should be injected deeply into the adjacent 
muscular structure I'eppcr). Apomorphine, gr. ,'„ hypodermically, given 
instead oi morphine, caused immediate disappearance of the pain in a very 
intractable ease, not returning again for 1 .• months, and then only a slight attaek which 
progressed favorably under Potassium Iodide and Gelsemium (Owen). Antipyriiu- ... 
Acetanilide, efficiently analgesic. Salipyrin, has been employed with excellent results 
in rheumatic sciatica. Salicylic Acid, as paste locally, 5j with 7)iv of Lanoli 
()1. Olivae, q. s., also Rhus [ox., gtt. j of a i per cent, solution of the fiuidextract in- 
ternally every 4 hours, cured one very obstinate case (Aulde). Salol, gr. vij in evening 
and gr. xv more at midnight, completely cured me after 3 we 1 Led, unre- 

lieved by other remedies (Aschenberg). Salophen in 10 per cent, solution by inje< tion 
into the gluteal muscles, successful in two cases of long standing 3 loqui- 

nine in 30-grain doses, is very efficient (Overlach). Guaiacol, painted over the nerve 
as a local anesthetic. Aurum, the Bromide of Gold and Arsenic has rendered good 
service in chronic cases. Chloroform, applied on flannel along the course of the nerve, 
and covered with oiled silk (Wa); njxv of the official spirit, or m>v -xv of pure chloro- 
form, by deep hypodermic injection into the vicinity of the affected nerve, gives the best 
results in old cases (B). Cocaine, a 4 per cent, solution, hypodermically along the 
course of the nerve, affords instant relief (Wa); gr. £ by subarachnoid spinal injection 
proved curative (Manega). Turpentine, causes an exquisite sensibility along the 
track of the great nerves v Tr); occasionally of great value in sciatica, yet not a specific, 
nor have we scientific indications for its use (P); 5ss doses for 4 to 8 suo 
nights (R). Sulphur, locally, believed to relieve the pain; effect probably due to the 
tlannel surrounding it (R); is worthy of trial after active symptoms are subdued (Wa). 
Ichthyol in 10 to 50 per cent, solution applied by rubbing, is superior to any other 
established remedy (Schweninger); frequently gives surprising results (Eulenberg); 
also internally in doses of njjij twice or thrice daily (Crocq). Veratrine, in strong 
ointment or oleate locally; also the tincture of Veratrum Viride internally is recom- 
mended (R). Aconite, locally (P); as ointment controls sciatica in some cases (R); 
valuable in many obstinate cases (Wa). Ammonium Chloride, in mild forms (R); 
in cases occurring in the young (Anstie). Iodides, in syphilitic or metal poisoned sub- 
jects (B); often fails (R); Potassium Iodide in daily doses of 5j dissolved in decoction 
of Sarsaparilla, most efficacious in subacute or chronic ( Wa) ; much is to be hoped from 
it (W). Iodipin 75 minims hypodermically along the course of the nerve, has suc- 
ceeded after all other remedies had failed (Baum). Formic Acid gtt. v of a 2 per cent, 
solution preceded by gtt. viij of a 1 per cent, cocaine solution, by deep injection along- 
side the nerve, is remarkably efficient (Couch). Nux Vomica is often successful in 
chronic sciatica (Wa). Strychnine Nitrate hypodermically into the gluteal region at 
intervals of one to several days, is the most effective remedy yet employed (Sartsin). 
Gelsemium has been used with varying success (B). Belladonna, has afforded 
relief fR); Atropine, hypodermically, is curative, gr. T V to 3*5 in the vicinity of the nerve 
1 B). Stramonium, gr. \ to \ every 3 or 4 hours for 4 or 5 doses, often affords decided 
relief, but should be stopped when the slightest symptoms of narcotism appear (P). 
Duboisine, is a good substitute for Atropine, and equally effective. Phosphorus, 
in neuralgic form; less satisfactory in sciatica than in other neuralgias (R). Rhus 
Toxicodendron, a very powerful therapeutic agent in various rheumatic affections 
of the fibrous tissues (P). Cimicifuga, is highly extolled (R). Nitroglycerin, in 
doses of rnij thrice daily, gradually increased to tijv, of a one per cent, solution, promptly 
curative in a long-standing and severe case (Lawrence); its powerful anti-neuralgic 
properties were well exhibited in 3 cases which would not respond to other agents, 
two being cured and one remarkably improved thereby (Mikhalkine). [See formula 
below.] Cold of intense degree, produced by refrigeration of limb by Methyl Chloride, 
extremely efficient (Jacoby); has been found effectual when applied to the sound limb. 
Cantharides, as counter-irritant, to free vesication (R). Aquapuncture, has had 
extraordinary success (B). [See under Neuralgia.] Acupuncture, occasionally 
affords instant relief (B); often cures cases of long standing (R). Nerve-stretching, 
by forcibly flexing the thigh on the abdomen (Lange). Poultices, applied very hot 
(R). Turkish-Baths, are often very useful (R). Electricity, produces excellent 



( 



79§ SCLERODERMA — SCLEROSIS — SCROFULOSIS. 

results (B); does great good, but often aggravates; the continuous current best, when 
stage of acute inflammation past (W); galvanism often quickly relieves the pain (Pepper). 
Cod-liver Oil, should always be tried in obstinate cases (W). [Compare Neuralgia, 
Rheumatism chronic] 

R. Tinct. Colchici Seminis, R. Spt. Glycerylis Nitratis, 3jss. 

Tinct. Belladonna Fol., Tinct. Capsici, 5ij. 

Tinct. Aconiti, aa 5j- Aquas Mentha Piper., giv. 

M. Sig. — TTJLvj every 6 hours. Remark- j M. Sig. — 5 to 10 drops to be taken three 

ably efficient. (Metcalj.) j times a day. (Mikhalkine.) 

Scleroderma. 
Cod-liver Oil, our sheet-anchor, used internally and locally (B). Electricity, is 
used successfully (B); with stimulating inunctions offers the best prospect of improve- 
ment (Bulkley). Strontium Iodide, has been used, with varied results. Ichthyol 
as 10 per cent, ointment with vaselin, to be renewed daily, to the limb first affected, 
also oj in water as a hot bath thrice weekly, caused marked improvement in a case of 
diffuse scleroderma (Mosler). Treatment should be based on general principles. 
Arsenic and Quinine are often serviceable, also hot baths and inunctions. 

Sclerosis. 

Aurum, the preparations of Gold are among the remedies which are believed by 
some writers to retard the progress; others being Arsenic in full doses, Silver Nitrate in 
J grain doses, Physostigma and Ergot (Osier): Gold is a specially curative agent in 
all forms of sclerosis, including cirrhosis of the liver, interstitial nephritis, cirrhosis of 
the lungs; Dr. Barclay's Liquor Auri et Arseni Bromidi is very efficient in these affec- 
tions, and much superior to the Chloride of Gold and Sodium (E. A. Wood). [Com-, 
pare the titles mentioned in this article, also Atheroma, Locomotor Ataxia, Paraly- 
sis Agitans, Spinal Sclerosis.] 

Scrofulosis. 
Ammonium Iodide, when glandular enlargement (Wa); Ferrous Iodide, when 
debility and emaciation, a powerful and efficacious remedy; also in anemia of scrofula, 
the syrup itjjxx-5j ter die (Wa); useful in simple glandular hypertrophy, but disap- 
pointing in scrofulous (B). Strontium Iodide has been used with varied results in 
scrofulous otorrhea. Iodine, tinct. or oint. applied over scrofulous glands — take care 
not to increase inflammation (R) ; Iodine and Iron the best remedies, but all medicines 
utterly useless without strict hygiene (A). Aurum, the Bromide of Gold and Arsenic 
has rendered good service in a case of adenitis with enormous enlargement of the neck 
(E. A. Wood). Calcium Salts, the Chloride in doses of gr. x-xx in milk after food, 
when glandular enlargement of neck and chronic diarrhea; the Phosphate of great use 
for sores (R) ; is of eminent service as a palliative (Wa). [See Sulphides below.] Spongia 
Usta, formerly held in high repute; has fallen into perhaps unmerited neglect; con- 
tains sodium iodide, magnesium bromide, calcium phosphate and ferric protoxide, all 
in small quantities (Wa). Iron, Ferrum and Calcium Phosphates combined give 
good results, also chalybeate waters (B); must be long continued (R). Sulphides, 
for sores, abscesses, suppurating glands; gr. ^ or -j^ of Calcium Sulphide every hour 
or two (R). Ichthalbin has been highly praised in scrofulous conditions with lowered 
general nutrition (W). Coniine, gr. J to oj of Almond Oil applied two or three times 
a day to conjunctivae in scrofulous photophobia; has proved very successful (P). Cod- 
liver Oil, the best remedy to promote assimilation (B) ; of great sen-ice in the various 
manifestations of this disease (R). Stillingia, a domestic remedy, used with much 
success (B). Capsicum, in scrofulous and fistulous ulcerations, a weak infusion is a 
useful stimulant (P). Mezereum, strongly recommended (P). Sarsaparilla, useful 
by reason of its tonic and alterative properties (P). Hyoscyamus, the bruised leaves 



St'l K\ \ -i v si, kN! 

cataplasm for scrofulous ulcers (P). Prunus Virginiana, is found very useful in 

the hectic (P). Chimaphila, holds a certain amount of reputation as a useful remedy 
Tussilago, was employed in Cullen (P). Gentian, is valued; the infusion ,, 
useful vehicle for chalybeates, etc. (P). Blisters, for scrofulous glands (R). Gr.r 
cure, renders much service (B). Alcohol, no doubt as to its great value; with I 
liver Oil, or in small amounts at meals (Wa). Phosphorus, eminently serviceabli 
scrofuloderma, gr. x in 01. Olivae 5j, doses of itrv-x, thrice daily alter meals (15, 
bent). Phosphates, see above, under Calcium and Iron. Aliment, raw or broiled 
meat, the latter for children. Abundance of fresh air and sunshine. Sea-air, sun- 
light, moderate exercise, and light digestible food are necessary. [Compare C.uiikxi \, 

COXALGIA, GLANDULAR AFFECTIONS, OPHTHALMIA.] 



Scurvy. 

Citric Acid, used_ with great advantage, though inferior to Lemon-juice (Wa I 
Lemon- or Lime-juice, of the utmost value, both as preventive and a curative 

at; its efficacy believed to be due to its Potassium salts; Oranges arc highly useful 
(Wa). Acids, especially Vinegar, to prevent scurvy, in the absence of lime-juice or 
fresh vegetables (R); dilute Hydrochloric Acid, gtt. v, thrice daily with juice of three 
lemons daily, vegetables and fresh meat (Da C). Potassium Chlorate, is probablv 
a remedy of some value (Wa) ; is not (W). Cinchona, a decoction, or the dilute tincture 
with Myrrh or the Chlorates, a very useful gargle. Quinine, internally when much pros- 
tration, combined with mineral acids (Wa). Alcohol, diluted, as gargle (R). Atro- 
pine, hypodermically for salivation (R). Myrrh, the tincture locally for spongy gums. 
Alum should not be used, as it acts very destructively on the teeth (W). Liquor Sodas 
Chlorinatae, 3vj ad oxij aquae, as a mild application to gums (Wa). Dietetic Treat- 
ment, alone required; Lemon-juice plays no essential part in the treatment; the full 
'diet of an hospital, comprising fresh meat, vegetables, and milk, is generally sufficient. 
[Compare Cancrum Oris, Gums, Purpura.] 



Sea-sickness. 

Antipyrine, is successfully employed. Hydrated Chloral dilates the cerebral vessels 
and is preferred to all other agents (Binz) ; in doses of gr. xv-xxx every 4 hours is the 
most effective remedy (R). Chloretone gr. x followed by gr. v ever)' 3 hours, is a 
reliable remedy (Still). Bromides, in full doses (Beard); the Sodium Bromide pre- 
ferred, in doses of 30 grains thrice daily for 3 days before sailing and continued for the 
first 3 or 4 days of the voyage, is by far the most effective treatment and never produces 
evil effects (Rockwell). Bromipin in doses of oij every 2 or 3 hours, gives very good 
results, both in preventing and curtailing the attack (Wulff). Atropine hypodermically 
will relieve (B); small doses given with Strychnine are specific in most cases, and in 
many cases a single dose administered before sailing will effectually prevent seasickness. 
Orexin Tannate gr. v-viij in a cup of broth before sailing and repeated 2 hours before 
each meal if necessary, has proved very effective (Wild). Menthol Valerate 
(Validol) gtt. x-xv on sugar, has failed in but few cases of many hundred (Koepe). 
Cocaine, is quite efficient: the Hydrochloride 1 in water 100, of which nj>iv-v on a bit 
of ice thrice daily (Otto); a 2 per cent, solution, as spray high up into nasal passages, is 
specific against nausea. Morphine, gr. T V to £ hypodermically, will often relieve 
severe cases (B) ; often fails (Wa). Amyl Nitrite, by inhalation (B) ; is strongly recom- 
mended, but must be cautiously used. Creosote to check the vomiting (R). Chloro- 
form in drop doses (R); in doses of itj>ij-v on sugar (B). Staphisagria has given 
relief (P). Calomel followed by Salines every other day for a week before sailing, 
also a full meal about an hour before going to sea, and the recumbent posture, will do 
much to prevent seasickness in most cases. Champagne iced, in small doses every 
quarter-hour (B). Icebag to the spine, is often successful (R). [Compare X 
Vomiting. 1 



8oO SEBORRHEA — SEPTICEMIA — SHOCK. 



fy. Atropinae Sulph., gr. ss. j R,. Sodii Bromidi, 5j. 

Strychninae Sulph., gr.j. Ammonii Bromidi, 3ss. 

Fhenolis, HRnj- 

Aquas Destillatae, §ij. 

Solv. Sig. — n£.\~v hypodermically every 
2 hours for 3 doses. (Poller.) 



Aquae Mentha; Pip., § v. 

M. Sig. — A tablespoonful before meals 
and at bedtime, for 3 days before sailing. 

(Bedard.) 



Seborrhea. 

Glycerin, especially useful; with Lead Acetate, Borax or Zinc, diminishing secretion; 
also acts efficiently when there is a want of sebaceous secretion (W). Zinc Oxide, 
5j, Lead Carbonate 5j, Cetaceum §j, Olive Oil to make an ointment (B). Arsenic 
is useful in seborrhea of neurotic origin (Duhring); the Oleate is of benefit (Wa). 
Resorcinol in solution locally, is very successful (W). Mercury, an ointment of the 
White Precipitate is serviceable on the scalp, with an occasional shampoo with tar 
soap in solution, followed later by mildly stimulating lotions (Bulkley). [Compare 
Acne, Pityriasis.] 

Septicemia and Pyemia. 

Antipyrine in doses of gr. vij to a daily maximum of 5ss-j, has given satisfaction in 
puerperal septicemia (Curschmann); antipyretics are dangerous and should not be 
used (Davis). Collargol by inunction and intravenous injection, is highly efficient 
(Crede); a powerful agent in general sepsis (Manges); rapidly improved and finally 
cured a case of pyemia with many complications (Netter). Quinine in large doses (B); 
acts as an antipyretic (R) ; to cinchonism the best remedy in childhood (Wa) ; is prob- 
ably the most useful remedy in full and frequently repeated dosage (Haward); is re- 
commended as a germicide (Binz); has no such influence (W). Formaldehyde, 500 
Cc. of a 1 to 5,000 solution by intravenous injection in puerperal septicemia (Barrows); 
proved futile in two cases (Bauer); a temporary check only (Shrady). Salicin, to 
reduce the temperature in septicemia and to relieve the cerebral symptoms (R). Sali- 
cylic Acid, has decided value (B). Potassium Permanganate, is given with advan- 
tage, gr. J-gr. j thrice daily in distilled water (B). Boracic Acid, a saturated solution 
to wounds, ulcers, etc.; also Chlorine as disinfectant (B). Oleum Caryophylli, 
locally, or oleum gaultherire, oleum thymi (B); as antiseptics. Sulphites, may do 
some good in chronic cases, but the use of Sulphurous Acid has not given the results in 
man which Polli obtained from its use on animals (Haward). Streptococcus Anti- 
toxin, has been used successfully in 14 severe cases of puerperal septicemia with only 
two deaths (Williams); also in acute hemorrhagic septicemia (Ballance). Hypoder- 
moclysis aids elimination of the toxins (Kemp); injection of a quart of normal salt 
solution into the subcutaneous cellular tissue, has given excellent results in acute septi- 
cemia (Lanphear); hypodermic injection fully as effectual as intravenous, used in 12 
cases of which 10 recovered (Duret). Water, hot water as dressing for wounds, to 
avert pyemia, Hamilton's immersion plan (B); stumps to be immersed in warm bath 
(R); every wound, however slight, should be immersed in Bichloride solution, 1 to 
10,000, as prophylactic, then dried with a sterile cloth and coated with collodion (Wyeth). 
Aliment, plentiful, with wine and good ventilation, are not to be neglected (Wa); 
concentrated food, milk and alcohol (Currier). Stimulants are necessary, brandy the 
best (Wa); alcohol should be given boldly in pyemia (W); Turpentine is a better 
stimulant than alcohol (B). Abscesses must be opened early, especially when in 
joints, to prevent pyemia. 

Shock. 

Atropine in sudden collapse, marked by subnormal temperature, loss of arterial 
tension, and free sweating, is of great value (W). Adrenalin in minute doses frequently, 
may restore and maintain a normal arterial pressure, even when the vaso-motor centre 
is incapable of radiating impulses (Crile); in 1 to 10,000 dilution intravenously, is the 
most powerful stimulant known of the cardiac and vaso-motor apparatus (Martin). 



SICK ROOM sm.i ; 

Codeine, in large dose, gr. j, hypodermically, immedial laparotomy, quieta 

pain, pn-vcnts intestinal contracl relaxes the tonic spasm ol the vessels which 

forms the first stage of slunk, shown by the small and rapid pulse, cond 

stage, that of paresis of the vasomotor system, sets in, .is shown by I impressi- 

ble pulse; Morphine is the ideal relaxer of spasm, but has man a ible qua! 

which Codeine is free from (Boise). Amyl Nitrite also Nitroglycerin, relax arterial 
spasm, indicated in the first stage of shock. Strychnine hy] illy, is the 

medicinal agent in the second or paretic stage ot shock, when the vess I ued and 

the pulse is soft and compressible; a full dose, gr. ..'„, is necessary, and may be repeated 
in * hour (W); therapeutic doses are useless and effective ones are harmful (Cl 
Caffeine hypodermically, when prompt action is required (W). Digitalin gr. j h 
dermically, or 20 to 30 minims of the tincture of Digitalis may be injected, as a cardiac 
stimulant (W). Alcohol, as Brandy or Whiskey, hypodermically or by 1 
commonly used; is harmful, being a vaso-motor paraly/.er, encourages hemorrha 
increases restlessness and in large doses weakens the heart; Strychnine is far b 
(Estes). Ether as a stimulant is open to the same objections as alcohol (Id). Heat, 
is a potent preventive of shock; the room should be warmed to at least 72 1\, ex- 
posed limbs should be wrapped in cotton batting, and hot water bottles wrapped in 
towels should surround the patient's body both during and after operation. Hot 
Water, as clyster, a pint injected into colon, and repeated as required, after laparotomv, 
in which operation the handling of the intestines sets up irritation of the sympathetic 
system, and is a potent cause of shock; this acts as a sedative thereto, and restores fluid 
to the blood, allaying thirst and supporting patient. Normal Salt Solution, consisting 
of j of one per cent, of Sodium Chloride in sterilized water, intravenously or subcutane- 
ously to raise the volume of the pulse, stimulate the heart and restore volume to the 
blood, renders good service in the second stage of shock. Saline intravenous injections 
are inferior to saline rectal injections, the effects of the former being evanescent, but the 
latter are frequently used with most satisfactory results (Estes). [Compare Anesthesia, 
Collapse, Syncope.] 

Sick-room. 

Every home of any pretensions should contain a room especially arranged and 
kept ready for the use of sick members of the family. Such a room should be on the 
upper floor, and preferably in the south-east corner, so as to have the best sunny expo- 
sure; or still better, should be itself the upper floor of a two-story annex, separate from 
the main building, but joined thereto by a light, latticed bridge. It should have no 
upholstered furniture, a bare but painted floor, and rough-plastered and painted walls 
and ceiling, without pictures or paper, curtains or hangings. It should contain no 
sink, wash-basin, water-closet or any other convenience which connects with the sewers, 
but should communicate with the kitchen by a dumb-waiter, or have connected with it 
a smaller room, furnished with a gas-stove and the other requirements of a diet-kitchen. 
It should contain everything requisite for nursing a case of typhoid fever, scarlatina, 
diphtheria, measles or small-pox; and all its arrangements should be supervised by 
the family physician. The possession of such an adjunct to the home would enable 
the owner to defy the mandate of a Health Officer, in regard to removing an inmate 
thereof to a public pest-house, as it could be shown to the satisfaction of any reasonable 
court, that a case of infectious disease could be better isolated and more humanely 
treated in such a room than in any " pest -hospital" yet erected by our political admin- 
istrators of health laws (Potter). 

Sneezing. 

Arsenic, a drop of Liquor Arsenicalis three times a day in paroxysmal sneezing, 
allied to asthma (R). Potassium Iodide, gr. x, several times a day (R). Iodine 
inhalations, in paroxysmal sneezing with itching of nose (R). Camphor, in incessant 
sneezing, with profuse running from eyes and nose; the powder should be snuffed, 
or the alcoholic solution inhaled (R). Chloroform 5j in Spirit of Camphor to 3j, of 
52 



802 SOMNAMBULISM — SPERMATORRHEA. 

which a few drops inhaled from a handkerchief, is efficient. Cocaine in 3 per cent, 
solution applied to the nasal mucosa in severe cases; but should never be intrusted 
to the patient. [Compare Catarrh, Hay-fever, Influenza.] 

Somnambulism. 

Potassium Bromide, will give decided relief in. the somnambulism of children 
allied to epilepsy, often with squinting, which may become permanent, generally the 
result of deranged digestion; the nightmare of adults will usually yield to the same drug 
(R). Hypnotics to cause quiet sleep, but any one hypnotic should not be continued 
long. Treatment is usually limited to regulating indiscretions in diet and correcting 
gastric disturbance, also securing the best hygienic surroundings to promote undisturbed 
sleep. [Compare Nightmare.] 

Spasmodic Affections. 

Aconite, externally and internally, for spasms not of severe type (P). Aconitine, 
as ointment in the most severe, as well as in the milder local spasmodic affections; in 
angina pectoris, spasmodic asthma, cough (P); is spasmodic laryngitis has good effect 
(R). Camphor is said to relieve in many forms, as strangury (R). Hyoscine, is 
used with advantage in various spasms (Erb). Belladonna, of value for spasms of 
sphincter muscles, especially those of pelvic organs (P); Atropine hypodermically in 
local spasm (R). Strychnine, of great value in spasmodic asthma (P); also in tetanus, 
chorea, and epilepsy (Pf, S). Veratrine, as solution, brushed over lids once a day in 
painful spasmodic contraction of the orbicularis (Wa). Opium, very useful as an 
antispasmodic, especially if given with a stimulant, as Alcohol, Ether, or Chloroform 
(R); is especially useful in painful spasm (W). Apomorphine has proved efficient 
in a severe case of spasmodic contractions with opisthotonos but no inflammatory or 
organic lesion (Shannon). Hydrated Chloral in tetanus, convulsions, strychnine- 
poisoning, chorea, cramps, and other spasmodic affections, is an efficient palliative 
(W). Sulphonal is effective for the spasm of fractures (Andrews); has been used with 
asserted good success in epilepsy, hiccough, chorea, and nocturnal cramps (W). Ipe- 
cacuanha, in spasms of respiratory organs, of great value (P). Chamomile Oil, 
in spasms of hysterical persons, in 4 to 6 minim doses a very excellent remedy; also 
useful in pseudo angina pectoris (P). Lobelia, a valuable antispasmodic in cautious 
hands (P). Lupulin, in gouty spasms (P). Tobacco, in spasmodic asthma, and for 
relaxation of muscular spasms (P). Sumbul, is of use in gastric spasms (P). Carda- 
mom, is usefully employed in gastric spasms (P). Ammonia, useful in children's 
colic (R). Chloroform, inhaled for intestinal spasm (P). Phenolsulphonates, in 
flatulent spasm of women, usually a neuralgia of the abdominal nerves, the pain being 
excited by flatulence; act by preventing the formation of wind, — sometimes Phosphorus 
better (R). Mustard Poultice, an excellent counter-irritant in spasmodic affections 
(P). [Compare Angina Pectoris, Asthma, Cholera, Chorea, Colic, Convulsions, 
Cough, Croup, Dysuria, Epilepsy, Gastrodynia, Hiccough, Hydrophobia, Hys- 
teria, Laryngismus, Pertussis, Poisoning by Strychnine, Stammering, Tet- 
anus, Torticollis, Trismus.] 

Spermatorrhea. 

Potassium Bromide, when due to plethora, erections normal, but persistent and 
teasing; is harmful in debilitated states, or daily losses (B); combined with cold spong- 
ing and the use of a hard bed (R). Digitalis, 3j or ij of the infusion twice or thrice 
daily; few remedies are more successful in arresting spermatorrhea (R, P); when 
feeble erections, frequent emissions, cold hands and feet (B); is a true temporary 
anaphrodisiac (Gaunot). Camphor Bromide has an especial reputation, but is 
taken with difficulty being apt to irritate the stomach (W). Cantharis, deficient tone 
of seminal vesicles, erections feeble, sexual feeling torpid; the tincture, gtt. ij-iij ter die 
(R); with Iron internally in emissions (R). Phosphorus, for the induced physical 






SPINA BIFIDA SPINA] IRRITATION. So} 

and mental debility; also, Hypophosphites of Lime and Soda (R), Gelsemiuin, 
as anaphrodisiac, may be combined with Belladonna or Cunidfu Nux Vomica, 

for relaxation and atony (B). Strychnine, in large doses, especial!) when impoti 
(R). Quinine, has been recommended (R). Belladonna, p 
jss of Zinc Sulphate, three or four times a day, often successful in no, turnal emiflsi 
(R). Atropine, relaxed genitalia, no dream or orgasm (B). Hyoscine is useful in 
all cases of sexual excitement, through its influence on die spinal centres, and is the 
most certain remedy in ordinary eases of over-frequent seminal emissions | \\ i Lupulin, 
is a good anaphrodisiac; with Camphor, when a genital sedative is required i B). Iron) 
the Iodide, is useful in anemic cases (B). Ergot, beneficial in relax, B). Hy- 

drastis, is a useful injection, gtt. x of the fluidextract through a urethral tube to the 
prostatic portion of the urethra (B). Cimicifuga, useful in weak, relaxed conditions 
(B); when hypochondriasis exists it is beneficial (P). Sulphonal has been commended 
as a sexual sedative (W). Silver Nitrate, a vesicating solution applied to perineum, 
generally useful and without danger (B); in solution, gr. xxx to the ?>, applied by ure- 
thral syringe to the prostatic portion of the urethra, is Lallemand's treatment, and still 
finds favor with many surgeons (Whitla). Arsenic, when from weak and relaxed 
seminal vesicles. Kind Advice, frequently the best treatment, as this affection is 
often due to the phantasms of a morbid imagination. Bladder, should be emptied 
after the first sleep. [Compare Emissions, Hypochondriasis, Impotence.] 

B- Tinct. Cantharidis, 3 i j - i R. Lupulini, gr. x. 

Tinct. Ferri Chloridi, ovj. Camphorae, gr- v. 

M. Sig. — 20 drops in water thrice daily. Ext. Belladonnae Fol. gr. ij. 

In impotence with spermatorrhea, of great M. ft. pil. no. xij. Sig. — One pill thrice 

utility. (H. C. Wood.) j daily. (B.) 

Spina Bifida. 

Iodine, injected into the sac, 3ss of tincture, or gr. ss, with Potassium Iodide gr. v, 
aquae oj, has cured numerous cases (B); Iodi gr. f, Pot. Iod. gr. § ad aquae 5j (Wa). 
Collodion, as a means of compression (B). Bayer's Operation, treats the tumor as 
if it were a hernia; he dissects out two lateral flaps from the skin covering it and removes 
the sac, leaving only two lateral flaps of the dura, which he sews together, afterwards 
bringing the skin and muscles together separately. 

Spinal Concussion. 
Lead-water and Opium, as lotion over the seat of injury (A). Leeches, if pain 
persistent (A). During the early stage the treatment of shock must be instituted, 
stimulants and restoratives being freely administered; traumatic neurosis may be 
treated with electricity, massage, hydropathy and the rest-cure; inflammatory symp- 
toms require the treatment for acute or chronic myelitis (Lyman) . [Compare Myelitis.] 

Spinal Congestion. 
Ergot, gives excellent results (Brown-Sequard). Turpentine, as hot epithems, 
useful (Wa). Antiphlogistic measures, with rest and absolute diet; wet cups or leeches 
to the spinal region; cold affusion or ice-bags to the spine while the patient is in a hot 
half-bath (Ros); the prone position is often found beneficial. [Compare Mentxcitis, 
Myelitis.] 

Spinal Irritation. 
Aconite, as ointment locally (R). Belladonna preparations, locally, generally 
are better than Aconite (B). Ignatia, in small doses diminishes irritability of cerebro- J 

spinal axis (Pf). Strychnine, persistently, will ameliorate wandering neuralgic pains ^ 

due to irritability of nervous system (B). Ergot, large doses for congestion (Hammond). 



( 



804 SPINAL PARALYSIS — SPRAINS. 

Conium, in functional derangement of the cord, with excessive irritability of the reflex 
function (Wa). Firing, sometimes very beneficial (B). Electricity, the inverse 
galvanic current gives much relief (Hammond). Blisters, with hot-water bag to spine, 
large doses of Strychnine, Phosphorus, Phosphoric Acid and Opium, are the methods 
based upon the anemic theory of the disease; out of 156 cases so treated 133 were 
thoroughly cured (Hammond). [Compare Meningitis, Myelitis, Neuritis, Neu- 
rasthenia.] 

Spinal Paralysis and Softening. 

Ergot, to starve the inflammation by occluding the spinal arteries (Hammond). 
Electricity, best; galvanic current from spine to nerves and muscles (Ros). Mercury 
and Potassium Iodide, a thorough course, in spastic paraplegia when syphilis is sus- 
pected (O). Phosphorus is often serviceable in myelitic paraplegia from excessive 
venery (W). Silver Nitrate is employed in chronic inflammation of the cord affecting 
the anterior columns, and giving rise to paraplegia, but is of doubtful value (W). Mas- 
sage with forcible flexion and extension and proper apparatus, to overcome rigidity 
and contracture in infantile spastic paraplegia, have often enabled a patient to get 
around comfortably (O). Baths, warm, of every description, are useful in spastic 
spinal paralysis (Lyman). Suspension, has been tried with some degree of success 
(Id). In softening the treatment must be palliative and supporting only (H). [Com- 
pare Locomotor Ataxia, Myelitis, Paralysis.] 

Spinal Sclerosis. 

Mercury with Potassium Iodide, when syphihs is suspected as the causative factor. 
Strychnine Nitrate in amyotrophic lateral sclerosis, injected into the wasting muscles 
in rapidly increasing doses (Gowers); should be avoided in primary lateral sclerosis 
(Taylor). Silver Nitrate is the only remedy of value in idiopathic anterior and posterior 
sclerosis, but often fails. Arsenic as Fowler's solution by the mouth, is useful in 
various spinal scleroses and in disseminated sclerosis. Gold and Sodium Chloride is 
used with alleged benefit in the various spinal and cerebral scleroses (W). Cod-liver 
Oil and other general tonics, may be serviceable. Massage and passive movements 
of the wasting muscles, are said to be serviceable in lateral sclerosis. Rest prolonged, 
in bed, gives the best results in primary lateral sclerosis (Taylor). Electricity, a weak 
galvanic current is sometimes of benefit, but as a rule electricity is disappointing in 
central nervous diseases; should not be used in lateral sclerosis. [Compare Loco- 
motor Ataxia, Paralysis.] 

Splenic Affections. 
Mercury Biniodide, gr. j to 3j of ointment, rubbed in before a hot fire, has given 
excellent results in chronic malarial enlargement of the spleen (Wa). Quinine, in 
simple malarial enlargement (B) ; gr. xv or xx or more daily, one of the most effectual 
remedies (Wa). Ergot, the most effectual remedy for enlarged spleen (Da C). Potas- 
sium Bromide in doses of gr. xx-xlv daily, removes malarial enlargement with marvel- 
lous quickness (Bernard). Hemogallol increased the red corpuscles and decreased 
the white, in a case of leukemic splenitis (Billig). Ammonium Iodide, effective in 
chronic splenitis, with Unguent. Hydrarg. Iod. Rubri externally; also small doses 
frequently repeated in all splenic derangements from malaria (B). Iodine, locally in 
chronic forms (B). Cold Water as douche to the abdomen for 2 or 3 minutes at a 
time, contracts the spleen and sensibly affects the enlarged spleen of malaria or typhoid 
fever (Mosler). [Compare Leucocythemia.] 

Sprains. 

Arnica, is very useful; the infusion internally and externally (P); the tincture 
diluted as lotion is effectual (Wa). Aconite, the liniment to painful sprains, often 
affords relief (Wa). Turpentine, as a liniment (P). Ammonium Chloride, in 



SPR1 i STAINS. 

solution, as lotion, or with bread as poultice, to remove discoloration due to BD1 
\\ |. Rhus Toxicodendron, the tincture r>ssi ( ,t)joi waterisa good application. Oil 
of Bay, as a stimulating liniment (P). Ichthyol with g] with 

alcohol and ether as a liniment, relieves the pain and rei Cam- 

phor in liniments as a stimulating application, is much us< 1 (W). Vinegar is often 
I useful as a topical application (W). Lead Subacetate, the strong solution Bj iv 
to a pint oi water, is a favorite application (W). Cold Douche, salt may be added; 
the force must bo regulated by the condition of the tissues (R). Heat, by fomentations 
alternated with cold allusions (D). Rest, is the most essential in- i.. I should 

he perfect; a roller bandage with splints may be required to secure the rest of the i 
Massage is of great value after subsidence of the acute inflammation (\\). Strapping 
the foot and ankle in sprain of the latter, by strips of strong rubber adhesive plaster open 
behind, involves no loss of time, requires no crutches, and is not attended with any 
impairment of function (Gibney). [Compare Brutses.] 

Sprue. 

Simaruba, the Ailanthus glandulosa, in large doses of a stronger decoction than 
usually prepared, has given satisfaction in some cases of dysenteric origin (Mn). San- 
tonin, the yellow form, gr. v in 5j of olive oil, once or twice daily for a week, has given 
good results (Begg); tried without benefit (Mn). Calcium Carbonate, as powdered 
cuttle-fish bone or powdered crabs' eyes, two teaspoonsful at a time, after purgation 
by castor oil, also an aromatic tincture containing probably Simaruba and Opium; the 
method of a successful but irregular "sprue doctor" of Shanghai, who said that the 
object of his treatment was to remove the slime which coats the bowel (Mn). Castor 
Oil, as an aperient before commencing the milk-cure (Id). Rhubarb, the compound 
powder as an aperient occasionally, when relapses of diarrhea, sore mouth and flatulent 
dyspepsia (Id). Silver Nitrate, in solution by enema, for cases of dysenteric origin 
(Id). Cocaine, in solution, gr. v to the §, brushed over the painful mouth before taking 
food, relieves suffering (Id). Borax, a weak solution as mouth -wash after taking milk 
(Id). Fruit-cure, has given good results in Java; the diet must consist entirely of such 
fruits as are pulpy and free from coarse seeds, fibres, and excessive acidity, except pine- 
apple, which is interdicted (Van der Burg). Milk-cure, is by far the most successful 
treatment; at first not more than 60 ounces in the 24 hours, sipped through a glass tube 
in small quantities hourly; \ pint may be added daily after a few days, until 100 ounces 
are reached, and after 10 days more this may be increased gradually to a daily maxi- 
mum of 6 or 7 pints: for 6 weeks after the stools become solid, and the mouth free from 
irritation, no other food should be permitted (Mn). Kumyss, sometimes agrees 
for a time when milk fails to give satisfaction (Id). Diet, after the above-mentioned 
six weeks, may be varied by a raw egg added to the milk; later, some artificial malted 
food, arrowroot or other digestible starch; still later, fish or chicken (Mn). Meat- 
juice, obtained by squeezing a pound of good beef-steak, cleared of fat and under- 
done, every 2 hours for 7 or 8 days daily, in those cases where milk does not agree 
(Macleod). Hygiene, the patient must never feel cold, and hence must dress warmly. 
He should not return to the tropics (Mn). [Compare Dysentery.] 

Stains. 
Silver Nitrate Stains may be removed by washing with Potassium Cyanide oijss, 
Iodine, gr. xv, Water, oiij; or, after moistening the spots, drop on them a few drops 
of Tinct. Iodine, and wash out with a solution of Sodium Thiosulphate, oss to 5j (B). 
Potassium Permanganate Stains are removed by washing with a saturated solution 
of Oxalic Acid, which should be washed off with warm sterilized water, as in Kelly's 
method of disinfecting the surgeon's hands. Blood-stains on dark-colored material 
are best seen by artificial light. After a few hours they become of a rusty, reddish- 
brown color, which they maintain for years. The microscope shows the characteristic 
corpuscles. These stains when on iron are difficult to distinguish from rust; the latter 



i 



806 STAMMERING — STERILITY — STINGS. 

is not soluble in water, while blood is extremely so. Heat applied to the metal will cause 
the blood to peel off, unless the stain has been exposed long enough to have rust mingled 
with the blood. A solution of blood in water, heated, forms a coagulum which is solu- 
ble in hot caustic potash, the solution thus formed is green by transmitted light, and red 
by reflected light. Menstrual blood cannot be distinguished from that resulting from 
a wound (Husband). 

Stammering. 

Vocal Training, the rhythmical method, the most successful, the chief end in view 
being to regulate the precipitate, irregular form of respiration; but long continuance 
necessary, six months, a year, or more, in special institutions (Ros). The patient must 
be taught the use of language anew, treated with especial kindness, and never subjected 
to mockery or punishment. [See Potter on Speech and its Dejects, Lea Prize Essay, 
Philadelphia, 1882.] 

Sterility. 

Aurum, cures sterility when dependent on chronic metritis or amenorrhea, or 
coldness, more certainly than any other remedy; the Chloride, gr. -jV (B). Potassium 
Iodide, when due to syphilis (R). Dilatation of os and cervix carefully when sterility 
depending on obstruction, with dysmenorrhea (H). Sterility is frequently associated 
with uterine displacement (Meadows); less often with atresia. In persons of good 
health it may be caused by an acid discharge from the uterus, which kills the sperma- 
tozoa; for this Vichy water internally and per vaginam, also alkaline baths (Charrier). 
Is due to aspermatism of the husband in more cases than generally believed (Gross). 
Many cases are due to blocking of the cervical canal with a morbid discharge from 
the cervical glands, and such may be relieved simply by repeated cleansing of the canal 
with a cotton-wrapped probe or forceps. 

Stings and Bites. 

Ammonia or other alkali in weak solution, locally for stings of insects to neutralize 
the formic acid (R); Ammonia internally as a nervine stimulant in snake-bites, more 
useful than brandy or any other stimulant; ttrx-xx of Aqua Ammoniae in water or 
wine, every half hour or oftener; also externally or hypodermically, 1 in 2 of water into 
a vein (Wa). Ammonium Carbonate, gr. v hypodermically, is used for wounds by 
poisoned arrows. [See under Wounds.] Salicylic Acid, 1 to 19 of flexible collodion, 
locally for bites of insects; allays pain at once, and only in rare cases is the neighboring 
tissue swollen. Mercury, the Bichloride, 1 to 1000 of flexible collodion, is equally 
effective. Potassium Permanganate, in strong solution, 1 to 6 locally, is promptly 
efficient for all reptile-bites and insect -stings; if wound is small, make incision to enlarge 
it, and insert lint soaked in the solution; if a rattlesnake-bite, inject the solution hypo- 
dermically above the wound (Dupon) ; the crystals rubbed into an incision, after placing 
a ligature above, the most effective antidote for serpent-venom (Br). Viola Cucullata, 
the common violet, is used as an internal remedy in Pennsylvania for rattlesnake-bite, 
and is successful in a remarkable degree; the leaves are eaten, and a poultice of Indigo 
and salt is at the same time applied to the wound. Arsenic, 1 part to 5 of black pepper, 
is the Tanjore pill, highly esteemed in India for bites of venomous snakes (Wa). Cal- 
cium Chloride, a filtered solution injected into wound from snake-bite, successful in 
seventeen cases (Binz). Silver Nitrate, the sharpened stick applied to every sinuosity 
of the wound; excision safer (Wa). Sugar, applied to stings of wasps, said to relieve 
almost instantly (Wa). Ipecacuanha, as poultice or paste, allays pain or irritation; 
is regarded by some as almost specific (Wa). Ichthyol pure, or as a 50 per cent, paste 
with lanolin or vaselin, locally over the part, is effective in relieving the pain, burning, 
itching and swelling due to insect stings or bites, and is greatly preferred to Ammonia 
(Ottinger). Antivenene is an effective antitoxin against the venom of several serpent 
species (Fraser). Bile of the biter serpent is an effective antidote to its poison (Id). 



STOMATITIS STRABISMUS SUPPURATION. X07 

Alcohol freely in snake-bites, as a stimulant is mosl important; Ammonia is b 
(Wa). Sting if left in the wound should be removed; pressing with the barrel of a 

small key will expose it. 

Used against fleas and insects are:— Phenol in weak solution sponged over tin- 
exposed parts of the body, to keep off mosquitoes (R). Hedeoma, the oil is very 
repulsive to insects, especially fleas and mosquitoes. Erigeron is popularly known 
as fleabane, its oil may be used against fleas. Pyrethrum, the powdered Qowei 
several species of this plant are known as buhach, and are used as insecth ides. Qua 
a strong infusion is used as a wash in Java on mat-covered ted with fleas, 

which vanish as by magic under its influence (Nealc). [Compare POISONING BY Ser- 
pent-venom, Wounds.] 

1$. Ol. Picis Liquidae, Ol. Oilvae, R. Carbonis Vegetab Ibj. 

01. Hedeomae, aa 3j. Potassii Nitratis 5ij. 

Spt. Camphorae, Phenolis, ojsa. 

Glycerini, aa oss. Persian Insect Powder, Sviij. 

Phenolis oij- Mucil. Tragacanth., q s. 

M. Sig. — Shake well. Lotion against | To make fumigating pastilles for use 

mosquitoes, for fishermen and hunters. I against mosquitoes. 

Stomatitis. 
Potassium Chlorate, locally and internally; large doses necessary, gr. x-xx; in 
ulcerative stomatitis of nursing women and aphthae, of no value in mercurial form (R). 
Hydrastis, the fluidextract locally in mercurial and aphthous stomatitis (B). Gly- 
cozone, frequently applied, is of benefit in ulcerative stomatitis (Edson). Hydrogen 
Dioxide acts favorably (Godet). Boric Acid and Borax are of excellent service in 
aphthous ulceration and other inflammations of the mouth (W). Phenol, as a 
concentrated solution in glycerin carefully, as a mild caustic in aphthous stomatitis 
(Wa). Alcohol, Brandy -and-water an excellent lotion (B). Mineral Acids, pure 
Hydrochloric applied on pine wood to ulcers (B). Eucalyptus, a decoction of the 
leaves, locally (B). Glycerite of Tannin, in ulcerative stomatitis (R). Copper 
Sulphate, solution painted over edges of gums in ulcerative stomatitis; generally dry 
Alum better (R). Alum, in ulcerative form, applied dry with the finger several times 
a day, especially when disease affects one-half the jaw (R). Salicylic Acid, to ease 
the pain of catarrhal stomatitis; one part, dissolved in sufficient Alcohol, to 250 parts 
of water (R). [Compare Aphtha, Cancrtjm Oris, Sprue.] 

Strabismus. 
Belladonna, for the strabismus of encephalitis (P). Atropine, with strong convex 
glasses, to suspend accommodation for months, or years if necessary; may cure con- 
vergent strabismus in its earlier stages, in children of 3 years of age and younger (Green 
in C). Operation, required in most cases, especially when of congenital origin. 
Glasses, properly adjusted to sight, serve to strengthen the weak muscles in children, 
and to pull the axes right (Gould). 

Strophulus. 

Zinc Oxide, dusted freely over the part. Magnesia, or some other mild alkali, 
with improved feeding and aperients, to which measures this affection generally yields 
in infants. Nitric Acid, the dilute acid 3j to oviij of Rose-water, as lotion applied 
frequently to the affected parts (Wa). Lancing the gums is proper (H). Strophulus 
in a form of miliaria occurring in infants, generally as a result of too much wrapping 
up. [Compare Miliaria, Lichen.] 

Suppuration. 

Sulphides, small doses gr. ss-j, frequently repeated, are very serviceable (B). 
Calcium Sulphide, when ichor secreted instead of pus; also arrests suppuration, or 



8o8 SURGICAL FEVER — SYCOSIS — SYNCOPE. 






if that is impossible will hasten maturation (R). Quinine, recommended in profuse 
suppuration (R); to sustain system when suppuration prolonged (B). Phosphates, 
the compound syrup is efficient to repair waste from suppuration (B). Iron and 
Manganese Iodide, the syrup in cachectic states resulting from suppuration (B). 
Hydrogen Dioxide, is a most energetic pus-destroyer; the solution may be applied 
in full strength, or diluted with an equal part of water. Glycozone, acts similarly 
but more slowly; after cleansing by Hydrogen Dioxide solution, the application of 
Glycozone stimulates healthy action and hastens the cure; for which purpose it has no 
superior in the entire range of therapeutics (Edson). Bismuth Subiodide, dusted 
over a suppurating surface after cleansing, is highly efficient as an antiseptic and a 
stimulant of healthy granulation. Acetanilide, is effective for 2 or 3 days, but ultimately 
fails to prevent suppuration (Foote); the following combination, used as a dressing, 
absolutely inhibits suppuration where it can reach the wound surface, and checks and 
quickly abolishes suppuration if that be already present, — Acetanilide, powdered, 48; 
Boric Acid, powdered, 15; Starch, powdered and finely sifted, 35; Phenol, the 
liquid, 2. It should be changed twice daily as long as there is discharge to moisten it, 
when the wound becomes dry the dressing may be left on for days (Fallas). Nuclein, 
has been used successfully in suppurative disorders (Vaughn). [Compare Abscess, 
Boils, Carbuncle, Empyema, Septicemia.] 



Surgical Fever. 

Aconite, quickly and repeatedly administered in early stages, during chill or soon 
after, the safest treatment (P); is used with benefit in urethral fever, also to prevent 
chill after passage of sounds (Pf). Strophanthus, the tincture in doses of njv, effi- 
ciently prevents rigors after instrumentation on the urethra (Fenwick). Quinine or 
Antipyrine, may be used as antipyretics (Caird) . Salicylic Acid, or Sodium Salicylate, 
especially useful as an antipyretic (B). Chloral, gr. xv-xxx every 2 hours; there is 
no better treatment (Wa). Alcohol for stimulation, also strong cardiac tonics, are desi- 
rable in wound-fever, which is a preventable affection being caused by septic absorption 
(Caird). Hot-pack when pyrexia with scanty urine after operation (Id). Irrigation 
with bichloride solution to moderate the inflammation, with free drainage and pure air 
(Id). [Compare Inflammation, Septicemia, Urethritis, Wounds.] 



Sycosis. 

Nitric Acid, 5j to Oj aquas, as wash, used frequently (R). Boracic Acid, 3jss 
finely powdered and incorporated with § j of Vaselin, is found most useful (Wa). Salol, 
as an antiseptic powder, has done good service. Mercury, Citrine Ointment has been 
extensively employed, also the Oleate of Mercury, both with good results (W); the 
Bichloride, gr. ij to the o of water, as lotion after each epilation (R). Sodium Sul- 
phite in solution with glycerin and water locally, when of parasitic origin (Wa). Ich- 
thyol is a very useful application (Hodara); especially so when introduced by cata- 
phoresis, a 10 per cent, solution at the cathode (Ehrmann). Sulphurous Acid, with 
an equal part of glycerin, an efficient application (Jenner). Arsenic, has powerful influ- 
ence, used internally in doses of ttjjv of Liquor Arsenicalis thrice daily (Wa) ; the Oleate 
of Arsenic is an efficient local application. Sulphur Iodide, as ointment, 5j to ojss, 
is efficient, with Donovan's solution internally (Sir E. Wilson). Copper Sulphate, 
as lotion, 3j to oxvj of water, with oss of Zinc Sulphate, and ojss of Aqua Laurocerasi 
(B). [Compare Condylomata, Tinea Sycosis.] 

Syncope. 

Nux Vomica, in drop doses of the tincture every 5 minutes, to restore the cardiac 
action in extreme cases of syncope approaching heart -failure, especially when of neurotic 
origin; is promptly efficient (Macfarlan). Cinnamon, the Oil, as a powerful stimu- 



SYNOVITIS SYPHILIS. 

lant, is sometimes employed i P). Alcohol, as brandy or wine, when heart suddenly 
enfeebled from fright, etc. (R). Amyl Nitrite, in sum, ially in an 

subjects, its inhalation speedily restores consciousness (O'Neill). Atropine, 

subcutaneously, the best means of resuscitation, there being no medicine whi< 
promptly exalts the force and rapidity of the heart's action II rley) Dutol 
may be used instead oi Atropine. Ammonia, internally, or breathed into thi 

ssages (R); the Carbonate as smelling salts (Wa); efficient in sudden and functional 
failure of the heart's action (W). Quinine Salicylate rendered good service in i 
of repeated syncope due to anemia iSir J. Lavandula, the compound tint 

ture is used with benefit (Wa). Chloroform internally as a cardial stimulant in the 
syncope of hysterical subjects (R). Digitalis in large doses, in>w \w ,,i ih. 
hypodcrmieally, or a grain of Digitalin, is a valuable cardiac stimulant in syncop \\ I 
Ether by the mouth, as a powerful and rapid stimulant, is often indicated in sudden 
sinking-spells (W). Position should be leaning forward, with the head as low as 
possible (R); raising the head is a dangerous procedure. Cold water over tin 
(B); cold allusion always (R); is best made by dashing cold water from tin- hand on 
to the face and neck. Galvanization of the pneumogastric (B). Artificial Respira- 
tion by Sylvester's method, and rhythmical traction of the tongue, should always be 
employed in the first instance in syncope from chloroform (Boureau). Compression 
of the Heart has been done in 12 cases, but never with final success (Id); successfully 
performed in a laparotomy case by squeezing the heart through the diaphragm (Lane). 
[Compare Collapse, Heart Affections, Shock.] 

Synovitis. 
Potassium Iodide, with Iron and Quinine, in syphilitic patients with constitution 
broken down (D). Iodine, in chronic synovitis, painted around joint; the solution 
injected into white swelling (R). Quinine, and free stimulation in all cases of pyemic 
synovitis, such as occurs in acute rheumatism of gonorrheal causation, occasionally in 
typhoid fever, and may result from a trifling injury in strumous subjects. Mercury, 
and Morphine, the Oleate locally (R); an elegant and efficient application (B); in 
syphilitic cases Mercury internally when acute symptoms have subsided (D). Aconite, 
for pains in inflamed joints (R). Silver Nitrate, locally to vesication almost, often 
very beneficial (Wa). Phenol, in a 2 per cent, solution injected into the joint 
once in 2 or 3 days, in chronic synovitis (W). Picratol as paste, is efficient to reduce 
swelling and relieve pain in synovitis of the knee (Yale). Alcohol, and water, equal 
parts, an excellent evaporating lotion (B). Blisters, a flying blister every night in 
chronic synovitis (R). Cod-liver Oil, in strumous cases (B). Surgical Treatment, 
splints to keep the limb motionless in all cases arising from injury; during acute stage 
splint should be fastened at some distance above and below the joint, not touching the 
joint itself; straight position, leeches to the joint, or cupping near it; ice, evaporating 
lotions or hot fomentations; blisters inapplicable until the acute stage subsides (U): 
if suppuration occurs the joint must be dealt with as any other abscess cavity (Mac- 
Cormac). Heat, as fomentations or poultices in the acute form. The results of dry 
heat, applied by the Tallerman apparatus seem almost marvelous in traumatic syno- 
vitis, whether in base-ball men or other persons; its effects are more prompt and marked 
in small joints than in large ones (W). Bandage, or Strapping, to cause absorption 
of fluid; bandage with cold water after alternate bathing with hot and cold water, in 
chronic synovitis. [Compare Coxalgla, Joint Affections.] 

Syphilis. 
Mercury is believed to be a true vital antidote against the virus (R); used for at 
least two years will eradicate syphilis (Keyes); its internal administration is best because 
the most practicable, and the two most efficient preparations are the Bichloride and 
the Protiodide (Foumier); by intramuscular injection, a method which offers many 
advantages and has given the very best results (Lambkin); the Protiodide in pills 



SlO SYPHILIS. 

of gr. £ each, one after each meal increased by one even- third day, until teeth get sore 
or bowels disordered, then drop two pills from each dose (Keyes); the best remedy 
for primary and secondary forms, not in tertiary; small doses are best, stopping short 
of ptyalism (B); Blackwash, Calomel, or Citrine Oint. very useful in mucous sores, 
tubercles, and elevated indurations; in syphilitic ozena, psoriasis, rashes, condylomata; 
the Bichloride, gr. ij-v in 5j of Alcohol, painted over syphilitic mouth lesions daily 
(Keyes); the Salicylate is the best salt for hypodermic use, gr. jss in itjxx of sterilized 
liquid petrolatum injected deeply into the buttock (Fuller) : Mercurials should not be 
given until the diagnosis is confirmed by the appearance of the secondary symptoms 
(Clark). Potassium Iodide is of inestimable value in tertian- syphilis and is useful 
whenever the dyscrasia has existed for any length of time (W); is approached by no 
remedy in constitutional syphilis; also for mercurial cachexia, syphiloma of nen-ous 
system, and many disorders of syphilitic origin; will certainly arrest ulceration of 
nares, palate, etc., if given in large doses, gr. xx-3j even 4 hours (R); is of little 
value in early stages; in the later should be combined with Mercury (St). Rubidium 
Iodide, is more pleasant than Potassium Iodide, having a milder taste, and is borne 
far better, especially by the stomach and in regard to the production of iodism and 
cardiac difficulties (Neisser). Iodipin is fully as efficient as potassium iodide (Sessous); 
proved curative in the most malignant cases, also in the relapsing and cerebral forms 
(Feibes). Iodine, as gargle for ptyalism; the tincture applied to syphilitic sores of 
the throat (R); or 5ss of tincture to oiv Syr. Fusci, a teaspoonful well diluted ter die, 
after meals, when Potassium Iodide can not be borne (St). Iodoform, powdered and 
dusted over ulcers (B). Nitric* Acid, in secondary forms (R); holds high place as 
an internal remedy (Wa); when sponginess of gums excessive, 3iv of the dilute acid, 
to 5ij aquae, teasp. 4 times daily; also use locally (St); as cautery for the initial lesion, 
the fuming acid, if used at all, should be applied early and thoroughly, followed by 
Blackwash locally on lint (Bulkley). 

Aurum, after Mercury and the Iodides, in old cases of secondary and tertiary, 
ulceration of the throat, ozena, phthisis, syphilitic bone-diseases (B); its beneficial 
action incontestable (Tr); the Bromide of Gold and Arsenic has rendered good senice 
in trifacial neuralgia diagnosed as due to syphilis (E. A. Wood); Gold is unquestion- 
ably useful in the later stages, its best effects being obtained with very small doses (Pf): 
the Bromide of Gold, Arsenic and Mercury (Mercauro) is highly praised in the late 
manifestations of syphilis, especially in those affecting the nenous system. Stillingia, 
with Nitric Acid in chronic cases of broken-dow-n constitutions from abuse of Mercury 
and Iodides has been most satisfactory (B). Cascara Amarga, is said to have remark- 
able powers as an alterative in syphilis, but to be useless if alcohol and tobacco are used 
at the same time. Sanguinaria, in secondary and tertiary forms is held to be very 
useful (P). Sarsaparilla, a most important remedy, as adjunct to, and in abuse of 
Mercury (P); with Guaiac and Mezereon, as the Compound Decoction of Sarsaparilla, 
in tertiaiy form (B). [See Guaiac, below.] Belladonna, with Mercurial Ointment, 
for secondary ulcerations of rectum (P); the tincture 3iv ad oij aquae, a teaspoonful 
4 times a day in water, instead of mercurials (St). Iron, the Iodide in constitutional 
syphilis, to promote constructive metamorphosis (B); where anemia exists (R); the . 
Potassio-Tartrate, gr. xv-xx, even 4 hours, especially in the gangrenous form (Otis). 
Guaiacum, in tertiary syphilis only, or as vehicle for Potassium Iodide and Mercuric 
Chloride (B). Phenol and Salicylic Acid, locally to syphilitic abscesses, Phenol is 
best (B). Ichthalbin in doses of gr. xv-xxx thrice daily, has been highly praised (W). 
Sulphur, the natural sulphur waters are of very great value in chronic syphilis (Doit). 
Antitoxin, the blood-serum of animals having a natural insusceptibility to the disease, 
has been used with good results. Zinc Chloride, also the Iodide and Nitrate, locally 
to syphilitic ulcers (R). Calcium Phosphate is useful in syphilitic gummata (Beneke). 
Denutrition, the Arabic "hunger-cure" efficient, but unpopular (B). Turkish Baths, 
or wet packing, ameliorate and aid the cure of constitutional syphilis (B). Hygiene, 
is of the greatest importance in syphilis (Bulkley). Cod-liver Oil, remarkably improves 
condition resulting from prolonged use of Mercury and Iodides, the syphilodermata, 
and squamae; internally and by inunction (R). [Compare Chancre, Condylomata, 
Ptyalism, Ulcers.] 



rABES Mi'M\ lERICA umi i i i in. Si i 

K Hydrarg. Iodidi Rubri gr.iij. i;. Hydrarg. Iodidi Rubri gr.ij. 

Potassii Iodidi oiij-vj. 

Tinct. Aurantii Cort., Potassii [odidi 

Syrup. Aurantii Cort aa 5j. Tinct.GenU 

Aqua q. s. ad Sviij. M. Sig. A teaap. in water aftei 

M. Sig.— A teasp. thrice daily after meal. {Fox, for the Mixed TrtatmotU.) 

meals. {Otis, for the Mixed Treatment.) 



IV Hydrargyri Chloridi Corros. , R<. Potassii [odidi oij. 

Ammonii Chloridi aa gr. iij. Ammonii Curb .~ss. 

Tinct. Cinchona? Comp., Tinct. Cinchona- Comp., . . . T)iv. 

Aquae, aa S iij - Glycerini, 5j- 

M. Sig.— A teasp. thrice daily. Each 5 Syr. Aurantii Gorl 3jss. 

contains gr. .'■,. of Corrosive Sublimate. M. Sig. -A teasp. in plenty of water 

(Bumstead.) after each meal. yes.) 



Tabes Mesenterica. 
Calcium, the Chloride and Phosphate (R); the former is a powerful remedy if 
kept up (Wa). [See under Scrofulosis.] Iodine, with Cod-liver Oil by inunction 
(El); locally over glands; carefully, lest inflammation be increased (R). Potassium 
Iodide in small repeated doses, valuable (Wa). Mercury, Corrosive Sublimate with 
bark; gr. .',, ad 5ij Tinct. Cinchonas, after meals, for chronic glandular disease (D). 
Phosphates, for malnutrition (B); the Hypophosphites act slowly but surely (Wa). 
Iron and Iodine, in various forms are the most useful remedies in scrofulosis, but 
medicine is powerless without strict hygienic measures (A); the Iodide or Phosphate 
of Iron and Cod-liver Oil, as for tubercle elsewhere (El). Fel Bovinum, is worthy of 
trial, though at best a palliative (Wa). Cod-liver Oil, is the best remedy to promote 
assimilation (B); of great service (R). Chaulmoogra Oil, is of benefit, used by 
inunction (Wa). Aliment, raw meat, cream, chocolate, and cocoa, are valuable 
nutriments in these cases (El); peptonized foods are of inestimable value (Wa). Hy- 
giene, change of air, especially to sea-air, is all-important (El). [Compare Scrofulosis.] 



Taste, Disordered. 

Mercury or Podophyllin, as purgative for cankery taste unconnected with alco- 
holism; or half-glass of pure cold water daily half an hour before breakfast (R); £ gr. 
of Gray Powder 3 or 4 times a day will generally remove the disagreeable taste in the 
mouth due to dyspepsia, in the course of chronic disease or in early convalescence from 
acute illness (R). Electricity, faradization as a stimulant of the nerves in the tongue, 
may aid the recovery of function when loss of taste is due to nerve disease (Gowers). 



Teeth. 
Potassium Iodide, in doses of gr. x, thrice daily, often cures looseness of teeth 
from periostitis of alveolar processes (Wa). Iodine, the tincture painted over gums 
close to the teeth when the gums begin to recede; also to remove tartar (R). Cin- 
chona, powdered bark often used in tooth-powders (R). Collodion, on cotton, as 
filling for carious teeth (P). Liquor Sodse Chlorinatse, 3vj ad o xi j aqua-, a highly 
useful application in fetid discharges from carious teeth (Wa). Cotarnine, the Hy- 
drochloride locally will promptly stop a dental hemorrhage after extraction (Jahl); 
arrests the flow of blood promptly (Marcus). Ichthyol in 25 per cent, solution on 
cotton as a tampon, effectually checks hemorrhage after extraction (Floris). Mastiche 
is used as a temporary filling' for carious teeth. Alum should not be used as a mouth- 
wash, as it acts destructively on the teeth (W). Salicylates are very efficient in certain 
teeth troubles occurring in gouty subjects, as periostitis or other inflammation of the 
pulp or surroundings of a tooth (Haig.) [Compare Dentition, Gums, Odontalgia.] 



( 



8l2 TEMPERATURE. 



Temperature in Disease. 
Average Normal Temperature, of adults, 98.6 F.; of children, 99 ; of the aged, 
98.8 . Diumal variation i° to 1.5 F., highest from 9 A. M. to 2 p. M. Above 108 F. is 
a fatal sign, which issue may be averted by cold baths, reduced by ice from 96 to about 
6o° F. (A). The clinical thermometer placed in the mouth, axilla or rectum, and 
retained in situ for five minutes, should go hand in hand with Aconite in the treatment 
of inflammations (R). [For Antipyretics see the articles on Fever and Inflammation".] 

Clinical Thermometry is one of the principal means of positive diagnosis. The 
thermometer should be self-registering, certified, and accurately marked according to 
the Fahrenheit scale, to which scale all the temperatures mentioned in this article refer. 
The most reliable temperature is that in the rectum or vagina; less so in the axilla and 
folds of skin, and still less reliable in the mouth. A correct reading of the ordinary 
thermometer cannot be obtained in less time than five to seven minutes (Da Costa); but 
quicker-reading instruments may be obtained from the trade. 

The Average Normal Temperature of the body is 98.6 , and, like the pulse, will 
vary somewhat in individual cases; as a general practical result it is agreed that in 
temperate regions the normal temperature at completely sheltered parts of the surface 
of the human body amounts to 98. 4 Fahr., or a few tenths more or less; and a rising 
above 99.5°, or a depression below 97. 3 F., is a sure indication of some kind of disease, 
if the increase or depression is persistent. The temperature is increased at the prime 
of life, is raised and depressed temporarily by the influence of diet, stimulants, exercise, 
etc. The minimum diurnal temperature is observed at 2 a. m., the maximum at 4 to 6 
P. M. The greatest recorded range of temperature in disease is 50.4 ; the minimum is 
71. 6° in a case of sclerema neonatorum (Quain's Diet.), the maximum 122 . In severe 
and fatal cases it rarely exceeds 107 , and rarely falls below 92° even in fatal collapse. 
It may rise 3 to 4 after death, as observed in a case of typhoid fever in which death 
occurred with a temperature of 107 , which increased shortly afterwards to 110.5 . 
A temperature of 107 indicates malignancy, and when met with for two consecutive 
days in typhus, scarlatina, measles, pneumonia, pyemia, meningitis or rheumatism, 
death may be expected shortly. In relapsing, remittent and intermittent fevers, and 
in the initial chill of an abortion, the temperature may reach 107 without indicating 
great danger. During the last hours of life in many diseases, the temperature rises to 
io9°-iii°; for example in tetanus, sunstroke, and typhus. With a temperature of 
96 collapse is imminent. 

Abnormally High Temperatures reported in the British Medical Journal, by 
Dr. Donkin, include those of eight cases, all but one in females, and none proved fatal. 
Pain was a prominent symptom in all. (1) in. 6°; convalescing from enteric fever. 
(2) 108 ; no organic lesions; ovarian pain. (3) 115. 8°; great abdominal pain and 
excitement. (4) in°; convalescing from enteric fever. (5) 113 ; enteric fever and 
double pneumonia. (6) 112 ; synovitis; this was the only male. (7) 112°; painful 
stump, with necrosis. (8) 117 ; pyonephrosis. Dr. Jacobi of New York reported a 
case of injury in which the temperature taken in the mouth, axillae, rectum and urethra, 
before many witnesses and with many thermometers, was 148 F. and yet the patient 
did not die. Dr. Welch mentioned as a well-known case, one Galbraith of Omaha, in 
whom the temperature went to 171 F. for some hours. 

High Average Temperature (above 104 ), is found in severe pneumonia, scarla- 
tina, remittent, typhus, typhoid and relapsing fevers, pyemia, etc. Moderate High 
Temperature (102 and above), is seen in peritonitis, acute rheumatism, pericarditis, 
pleurisy, dysentery, cerebro -spinal meningitis, catarrhs, etc. A temperature of ioo° 
and above is found in chronic affections, incipient inflammations and mild fevers. 
When, in effervescence, the heat increases rapidly, it will in defervescence decline pro- 
portionately fast and vice versa. Look for a grave affection when high temperature 
is continuous. A distinct interval between the morning and evening temperature is a 
favorable sign. A slow and gradual increase indicates typhoid fever; in rheumatism 
and anomalous fevers the increase is more rapid, and still more so in acute inflamma- 



I III IS. 

torv disease, as pneumonia, pleurisy, typhus, scarlatina, rubeola, etc ["hi rise is 
usually rapid in intermittent fever, febricula, and ephemeral fevers. A rapid i 
rescence ami slow defervescence indicates some complication of disease; the reverse 
order indicates great danger. When the temperature begins ' n the even 

to the morning, it is an indication of improvement; while a rise oi temperature 
the evening to the morning is a sure indication that the patient is worse. Stabilit 
temperature from morning to evening is a good sign, but from evening to the mom 
is unfavorable. 

Decrease of Temperature below the normal point is rare. It occurs sometimes 
transitorily, announcing a favorable erisis, and preceding return to the normal tern 
perature. It is also met with occasionally during the morning remission of remittent 
fever; also during the apyrexia of intermittents; in acute collapse, pre not 

by fever; in chronic wasting diseases, and sometimes also on the approach of death, 
especially in typhus fever. 

In Phthisis, the temperature is higher in the evening than in the morning; later, 
higher at early bedtime than at noon, and high again at dusk. This is a valuable and 
delicate test of the progress of tuberculization. 

In Typhoid Fever, the accession is by a rise of one degree each day, with the diurnal 
variation. If the evening temperature does not exceed 103. 5 , the disease will probably 
be mild; but a temperature of 105° in the evening indicates a severe type and much 
danger. A sudden reduction to 95 in the third week denotes intestinal hemorrhage; 
a lingering temperature of ioi°-io2° in the fourth and fifth weeks indicates non-cica- 
trization of the intestinal ulceration. 

In Scarlatina, the rise of temperature is rapid, 104.7 may be reached in a few 
hours and 105 by the second day. It seldom rises above 105 and almost never above 
106 ; is continuous until the eruption begins to fade, when remissions take place unless 
complications arise. 

In Measles, 103° is the usual temperature, with daily -variations, increasing with 
the eruption and catarrhal symptoms. A high temperature lasting beyond the tenth 
day denotes complications. 

In Diphtheria, the temperature by the end of the third day will, in uncomplicated 
cases, not exceed io3°-io4°. It falls temporarily when the exudation appears. Defer- 
vescence occurs in the severe but favorable cases, from the twelfth to the fourteenth 
day; in the milder cases not before the sixth. In some fatal cases it occurs early, from 
the third to the fourth day. In asthenic cases the temperature of the surface falls, 
while that of the interior remains high, ioo° in the axilla and 103 in the rectum. Dur- 
ing convalescence, the temperature is low and readily depressed, but may be raised by 
intercurrent maladies. Any increase after the first five days, or a continuous high 
temperature after the first ten days, is unfavorable. A sudden rise may indicate com- 
plications. 

Co-Relation of Pulse and Temperature. — As a general rule the co-relation of 
pulse and temperature may be stated as follows, namely: — an increase of temperature 
of one degree above 08 F. corresponds with an increase of ten beats of the pulse per 
minute. 

Testicles. 
Mercury, the ointment, locally in indurations and enlargements of testes (Wa); 
Corrosive Sublimate, with Cinchona or Sarsaparilla in sarcocele (D). Camphorated 
Naphthol, used hypodermically in tuberculosis of the testis with very gratifying results 
(Reboul). Aurum, is highly recommended in hypochondriasis accompanying testi- 
cular disease, and as a tonic for low-spirited, pining boys with undeveloped testes. 
Water, cold applications in neuralgia of testes with tonics and neuralgic treatment 
generally (D). Suspensory Bandage, with rest, in many affections of the testes (D). 
[Compare Hydrocele, Orchitis, Varicocele.] 



8l4 TETANUS — THIRST. 



Tetanus. 

Antitoxin used in more than ioo cases with a mortality of about 30 per cent. (W). 
[This treatment is discussed under the title Sera in Part I.] Phenol used by parenchy- 
matous injection, is fully as efficient as the serum treatment (Babes); used in 40 cases 
with one death (Bacelli) ; in 33 cases with one death (Ascoli); in 42 cases with 16 deaths 
(Symmers). Creosote in large doses hypodermically, gave good results in a traumatic 
case, after antitoxin and phenol had failed (Higginson). Potassium Bromide 
is one of the best suited remedies, as indicated by its physiological action, not less than 
5ss should be given in the day and Chloral at night as a hypnotic; used in 34 cases 
with but 4 deaths (W); in large doses, 5j every 3 or 4 hours has given better results 
than any other remedy (B). Chloral, in full doses, gr. xx, no remedy more effectual (B); 
has sometimes cured (R); best used in combination with Potassium Bromide (W). 
Chloroform, in small and frequently repeated inhalations, also by friction, has been 
useful in many instances (Wa); anesthetics give temporary relief (B); four cases of 
acute tetanus treated successfully by chloroform inhalations, the daily dose varying 
from 3ij to iv (Preobrajensky). Paraldehyde, promises well, in full doses, 3ij-ijss; 
does not depress the heart, as chloral and the bromides do (B). Strychnine, of decided 
service (P) ; cured 8 cases of traumatic form in doses of gr. T V to J (S) ; the evidence as 
to its curative power is of doubtful credence, but it is most successful in spontaneous 
and chronic cases rather than in the traumatic form (B). Aconite, has benefitted 
many cases (P); its success warrants further trial (W). Belladonna, successfully 
used in many cases; the extract internally, and locally to wound (Wa); Atropine, gr. 
T ? z injected into muscle (B); bleeding, vapor-baths, and large doses of Belladonna 
have cured tetanus (Tr). Hyoscyamine, also Duboisine, in gradually increasing 
doses, have proved very efficient (Oulmont). Morphine, hypodermically, deeply into 
tetanized muscles, and if possible to the point of entrance of the nerves, used with 
successful results (Demarquay); as ordinarily used is of no value (Wa). Apomor- 
phine may prove antagonistic (P). Cocaine and Morphine, of each a 5 per cent, 
solution, 3 syringesful hypodermically, immediately relieved and finally cured a bad 
case of idiopathic tetanus unrelieved for 3 days by chloral, morphine, etc. (Lopez). 
Gelsemium, has cured several cases (P) ; its spinal action is opposed to that of tetanus 
(B). Camphor is strongly indicated, as it causes both nervous sedation and cardiac 
stimulation (Bacelli). Physostigma has been used with excellent results (P); the 
fluid extract by mouth if possible, at the very beginning, and must be pushed until just 
short of arresting breathing (B); evidence is discrepant (W). Curare, hypodermically, 
has much evidence for its power (P). Cannabis Indica, used with marked success in 
traumatic form (P) ; should be used to intoxication, which is not dangerous (W). Anti- 
pyrine is worthy of trial, especially when hyperpyrexia (W) ; it antagonizes excitability 
of the motor nerve centres, and has been used with benefit. Amyl Nitrite, used 
in 3 cases with marked benefit as spinal sedative (W); has been used with success (R). 
Nicotine, by rectum or hypodermically, appears to be useful in many cases (R); much 
evidence for it as the best remedy (P) ; effective but dangerous (B) ; Physostigma better 
(Wa). Conium is indicated but has not proved successful (B). Oxygen is deadly 
to the bacillus, and should be freely admitted to the wound (Symmers). Water as 
warm baths, also cold applications as ice, afford temporary amelioration (B); the 
spinal ice-bag is very useful (R). Cold by placing the patient in a cold-storage room 
at freezing-point for several days, cured a severe case in a boy of 10 years (McGrann). 
Division, or stretching of any nerve-trunk connecting the wound with the spinal cord. 
[Compare Spasmodic Affections, Trismus.] 

Thirst. 

Acid Drinks, allay thirst by promoting the secretion of the alkaline saliva; but 
excessively used will derange the stomach (R); Citric Acid with Sodium Bicarbonate 
and flavoring substances, form the thirst tabloids of certain English druggists. Bitters, 
in drinks with acids slake thirst most effectually (R) ; a weak infusion of Cascarilla or 



THROAT n< DOl LOl EU ( \. 

Orange-peel, acidulated slightly with HC1 acid, an efficienl thirst-quelling drink fcr 
fever patients (Graves). Ice, sucked, is very grateful, and allays thii 
Tepid Drinks, are useful in the thirst of d'i : rout). Fruit Juices, or these 

made into drinks, but the most harmless agents must be used in moderation, and their 

consumption has to be cheeked, otherwise patients will take them to I » ess and mav thus 
do themselves considerable injury (Fenwick). 

Throat, Sore. 

Aconite, when temperature high, half-drop doses of the tincture, every ', hour for 
2 hours, then every hour, will almost certainly prove efficacious (R); valu dinar? 

sore throat (P). Belladonna, is admirably adapted to the treatment of ordinal 
throat; when much fever combine with Aconite (R). Potassium Nitrate di 
in the mouth, to abort a sore throat (Wa). Tannic Acid, as powder, gargle, spray (P); 
the Glycerite of Tannin, after acute inflammation; in ulceration of aphthous sore 
throat daily when tendency to catarrh (R). Ipecacuanha, the wine as spray, in non- 
inflammatory sore throats and hoarseness from congestion of vocal cords (R). Capsi- 
cum, 5j of tincture to Oi aquae as gargle, in some sore and malignant sore throats 
(R, P). Potassium Chlorate, in grain doses every half-hour (Smith); is valuable 
locally in sore throat (Mastin). Alum dry or in solution (R); should not be used in 
the mouth as it is destructive to the teeth (W). Myrrh the tincture as a gargle for 
ulcerated sore throat (P). Salicylates do good in rheumatic angina and quinsy (Wi. 
Ichthyol in 2 or 3 per cent, solution as a gargle for inflammations of the throat (Herz); 
in 40 cases of ordinary sore throat removed symptoms in 24 hours (Sonnenberg). Hy- 
drogen Dioxide as a disinfectant and deodorant gargle in various affections of the 
throat and mouth (Courtin). Guaiac, the compound guaiac gargle is often very effi- 
cient in simple sore throat and commencing tonsillitis. Chloral, internally and locally, 
is an excellent remedy for ulcerated sore throat (Brodnax). Cimicifuga, in simple 
sore throat (P); also in malignant forms when the mucous membrane is dry and spotted 
with inspissated mucus (R). Mercury, in acute tonsillitis, which see (R); the Bichlor- 
ide as a gargle [formula below], in ulcerated forms of syphilitic sore throat (Sir Chas. Bell). 
Rhus Glabra, a decoction, oj to Oj boiled to OJ, with Potassium Chlorate oss, is a 
very efficient gargle (W). Arsenic, in medicinal doses, for sloughing of throat or 
malignant sores (R): the Iodide is an excellent remedy for the so-called diphtheritic 
sore throat, gr. iij triturated with gr. xx of sugar of milk, one-half of which is dissolved 
in Biv of water, and a teasp. given every hour or so. Methylene Blue, in simple, 
non-diphtheritic ulceration of the throat, patients have expressed themselves with 
delight as being cured, after one or two applications of the solution (Rose). Iodine, 
the tincture, locally to sores, whether syphilitic or not (R). Nitric Acid, undiluted, 
to sloughs (R). Silver Nitrate, locally, in early stage of inflammation, may cut it short 
(R). Sulphurous Acid, by inhalation, spray, or fumigations for malignant sore 
throat, scarlatinal or otherwise (R). Water, cold compress nightly, to harden the 
throat when tendency to catarrh (R). Ice, constantly sucked (R). [Compare Diph- 
theria, Pharyngitis, Tonsillitis.] 

^. Tinct. Guaiaci Ammon., R. Hydrarg. Chlor. Corro* g r .-. iv - 

Liq. Potassii Hydroxidi, aa o iij - Alcoholis, 3'j- 

Tinct. Opii, 3ij- Solve, et adde — 

Aq. Cinnamomi, q.s. ad oviij. Decocti Cinchonae, Mollis Rosae, 

M. ft. gargarisma. Tinct. Myrrhs aa 5 ij . 

Sig. — To be used as a gargle, every hour, M. ft. gargarisma. Sig. — Gargle, to be 

in clergyman's sore throat. (Garner.) diluted if too severe. (Sir Chas. Bell.) 

Tic Douloureux. 

Croton-Chloral, has special effect on the 5th nerve (B); is palliative in doses of 

gr. v every \ hour till gr. xxx are taken (W). Salicylates, in large doses, cured a case 

of 12 years' standing. Stramonium, gr. \ to * of the extract every 3 or 4 hours lor 

4 or 5 doses, often affords decided relief; stop if narcotic symptoms appear (P). Arsenic, 



8l6 TINEA. 

cures by influencing nutrition (B). Phosphorus, is useful in doses of gr. , ,',,-, to gr.^ 
every 3 hours (R). Morphine, with Atropine, hypodermically, gives relief (B). Aconi- 
tine, has lately been given with good results (B). Antipyrine, and Acetanilide, are 
sufficiently analgesic to relieve pain in many cases. Iodides, are promptly cura- 
tive when tic is due to syphiloma of the nervous system, the pain being nocturnal 
chiefly (B). Cimicifuga, is frequently very effective (B). Turpentine, when rheu- 
matic in origin or produced by fecal accumulations (B). Quinine, holds a foremost 
place in the list of remedies (Wa). Gelsemium has strong evidence in favor of its 
value (W). Ammonium Chloride, in doses of 30 grains 4 times daily, is of great 
service in numerous cases, especially when the pain partakes more of a rheumatic than 
of a neuralgic character (Sir Thos. Watson). Cannabis Indica, gr. \ to $ rarely gr. j, 
of a good extract, is very effective and ranks in value next to morphine and atropine 
(Reynolds). Physostigma, a few drops of a solution of the extract, 1 in 30, or one 
or more gelatine discs of Physostigmine introduced within the eyelids of the affected side, 
effectively relieved or cured several cases (Munro). Chloroform, the liniment applied 
with friction is sometimes serviceable (Wa); a few drops by deep injection in the vicinity 
of the nerve trunk (B). Galvanization of the fifth nerve, gives decided relief to the 
pain, and frequently results in permanent cures in cases which belong to the category 
of the so-called essential neuralgia; (B). [Compare Hemicrania, Neuralgia, Neuri- 
tis, Odontalgia.] 

Tinea Circinata — Ringworm of the Body. 

Mercury, the Bichloride, 1 part in 250 of water, as parasiticide application after 
depilation (A); Calomel, as ointment, 3] to the 5, is useful (B); strong Citrine oint- 
ment rubbed in twice daily is often effectual ( Wa) ; the ointment of the red Oxide often 
cures ringworm on the body or limbs when other remedies fail (Wa). Phenol pure, 
5j to the o of glycerin, or equal parts of each, is a very efficient application (B). Boric 
Acid, is an excellent topical application, especially in that form affecting the scrotum 
and inner side of the thigh (Watson). Copper Acetate, in ointment, gr. x to the 3, 
is a very effective application (B). Sulphites, are used in parasitic skin diseases to 
destroy the parasites (B). Sulphurous Acid, is better than Phenol and safer (A); 
must be fresh to be of use (Bulkley). Cocculus Indicus, the decoction locally, after 
washing the skin well (P). Oil of Cade, the best depilatory known (A). Arsenic 
will not cure, but may do service as a nerve tonic or an improver of nutrition, in con- 
nection with other remedies (Bulkley). Iodine, as liniment once applied (R); with 
Oil of Tar, 1 to 4, is excellent (Wa). Kamala, used locally by the Hindoos (P). Tar 
Ointment, is used with good effect (P). Acetic Acid, strong, applied to ringworm 
of any part of the body except the scalp; no treatment easier, more speedy or certain in 
its action (R). Sodium Chloride, in ointment is a very effective remedy [see under 
Tinea Tonsurans]. Cod-liver Oil, is a powerful auxiliary in weakly and cachectic 
subjects (Wa). Diet and Hygiene, are important; the food should be nutritive and 
abundant, especially animal fats; daily baths, out-of-door exercise. Fungus, the 
Trichophyton tonsurans (A). [Compare Dhobie Itch.] 

Tinea Decalvans — Alopecia Areata. 
Parasiticide Lotions, must be used after epilation and washing of head daily 
with soft or black soap. Collodion, with Cantharidal Ether, equal parts, as a stimu- 
lant after the fungus is destroyed (A). Oxygen, locally applied to the scalp by a close- 
fitting rubber bag, to restore the hair [see under Alopecia]. Tonics, are necessary, 
especially for the nervous system (Bulkley). Fungus — the Micros poron Audouini (A); 
but I have never seen it, though having made repeated and thorough searches (Bulkley). 
[Compare Alopecia.] 

Tinea Favosa — Favus. 

Mercury, is efficient when used early; the Bichloride, gr. xx to Bj of simple cerate 
(B); or gr. ij to the 5 of water applied after each epilation (R). Myrtol, is curative 



IIMV. 8l? 

of favus (B). Phenol pure, in glycerin or cod-liver oil, as a local application (hi 
Sulphurous Acid, as a parasiticide; \n.li Sulphurosi Dil. Sss, Sodii Thiosulphatis 
*,iij, Aquae >| s. ad 3xvj (Startin); is useful in favus, but when cases are unusually 
obstinate us action should be assisted by epilation (R). Simple Oils, to soften and 
facilitate the removal of scabs I R). Poultices, are useful preparatory to epilation (R) 
Iron, the tincture of the Chloride, internally in doses of iu'\ thrice daily for a child ten 
years old; combined with cod liver oil if the disease is assoeialed with Scrofula 'Sir K 
Wilson). Sulphur Iodide, in weak ointment, gr. x\ to the 5, well nibbed in alter 
removal of crusts, is the most reliable preparation of its class fWhitia). Epilation, 
must be resorted to and carried out with eare and patience (Id) Ml the remedies 
useful for ringworm of the scalp may be used against favus, and success depends rathei 
upon the judicious way in which these agents are used one after the other than on the 
persistent use of any one of them (Id). It is clearly demonstrated that the disease is 
conveyed from the mouse to the cat and then to the children who play with the affected 
cat (Id). Fungus— the Achorion Schonleinii (A); a very rare affection in this coun 
try (Bulkley). 

Tinea Imbricata— Tokelau Ringworm. 

Iodine, the double strength liniment, freely applied, is the best treatment for natives 
(Mn). Chrysarobin, as ointment, gr. xx to the :> of vaselin, for limited pat. 
[see under Dhobie Itch]. Cassia Alata, the bruised leaves well rubber! in over the 
affected area (Id). Sulphur, as fumes or ointment, acts very slowly and unsatisfac- 
torily (Id). Oiling the Body, is believed to be a preventive (Daniel's). Cleanliness 
of the skin and boiling or destruction of the clothing worn next it, to prevent recurrence 
(Mn). The disease is a form of body ringworm peculiar to certain eastern tropical 
climates, is produced by a trichophyton, and is characterized by a concentric arrange- 
ment of closely set rings of scaling epidermis (Mn). [Compare Dhobie Itch.] 

Tinea Sycosis — Ringworm of the Beard. 

Mercury Bichloride gr. j to the 5 of water, locally after each epilation. Sulphur, 
oj to the 5 of Petrolatum, as a parasiticide application, after epilation. Sodium 
Thiosulphate 3j to the o of water, applied 3 or 4 times a day. Sodium Sulphite 
oj, Glycerin oj, water 5iij, applied locally (Wa). Bland Oils to soften the crusts 
which should be removed with soap and warm water, then the part should be shaved 
and a parasiticide application made every 6 to 8 hours; shaving and epilation of the dis- 
eased hairs should be done on alternate days. Fungus — the Trichophyton tonsurans. 
[Compare Sycosis, Tinea Tonsurans.] 

Tinea Tonsurans — Ringworm of the Scalp." 

Mercury, the Bichloride, gr. xx to the 5 of simple ointment, is an effective applica- 
tion when used early (B); must be used with caution. Phenol pure, 5j to the ."> 
of glycerin (B). Sulphurous Acid, the acid of the B. P. with an equal part of glycerin, 
is useful; must be assisted by epilation when the affection is obstinate (R); or Startin s 
formula (see under Tinea Favosa). Potassium Sulpho-cyanide, 5ss in glycerin 
oj and water ovij, as lotion applied on lint covered with oiled silk, after washing the 
patches twice daily with warm water and soap and drying (Gee). Sodium Chloride, 
in ointment, equal parts of common salt finely powdered and vaselin, thoroughly mixed, 
and well rubbed in night and morning after shaving the part, until the skin becomes 
very sore; is most efficient even in apparently intractable cases (Perkins). Iodine, 
oij to the o of the oil of wood tar, is an efficient application, producing no pain ami 
preventing the extension of the disease (R); 5j or more to the ."> of true ase, 

the latter being a bland and penetrating excipient, makes a most effective remedy (Jack- 
son). Oleum Tiglii 5ss-j to the o of Sulphur ointment, is effective in obstinate 
cases; it causes dermatitis and alopecia, but the hair grows again in time (Id). Aceto- 
zone cured a very obstinate case which had resisted all other treatment (MacDonald). 
53 



i 



< 



8l8 TINEA VERSICOLOR — TONGUE — TONSILLITIS. 

Copper Stearate is an excellent application. Limewater as a wash (W). Resorcinol 
said to be a valuable application for the various parasitic skin diseases especially 
tinea (W). Arsenous Iodide, is the best constitutional remedy; gr. T \ T increased to 
gr. J for an adult, gr. tjV to ^B f° r children, with alkaline lotions locally (Wa). Viola 
Tricolor, the leaves are employed in Italy for tinea capitis (P). Cocculus Indicus, 
a decoction locally applied after washing the part well, is efficient (P). Quinine, dis- 
solved in glycerin, or a mild mercurial pomade, as grease to the hair of the patient and 
uncontaminated members of the family, to prevent the sporules reaching unaffected 
parts (R). Oils, may be used to facilitate the removal of the scabs (R). Cleanliness, 
and free use of soap and water, is a sine qua non, and in some cases of tinea may be 
alone sufficient to produce curative results. Isolation of person, and brushes, towels, 
etc., necessary to prevent infection. Fungus — the Trichophyton tonsurans (A). 

Tinea Versicolor — Chromophytosis. 

Iodine locally, preceded by washing with soft soap and warm water (Morris). 
Sulphurous Acid, diluted to one-fourth with water, or a strong solution of Sodium 
Thiosulphate, as local applications (Id). Benzol and lavender water, equal parts of 
each (Id). Salicylic Acid gr. xx, Precipitated Sulphur 3j, Benzoinated Lard 5j, 
rubbed in twice daily. Mercury, the Bichloride, in solution, gr. j-iv to the 5, applied 
locally after washing with soft soap and water and a stiff brush. Chrysarobin and 
Salicylic Acid, dissolved in Traumaticin or Collodion (Morrow); [see under Dhobie 
Itch for formula]. Fungus— the Microsporon furfur. 

Tongue. 

Potassium Chlorate, gr. v internally and 3j-ij ad Oj aquae locally; in ulcers of 
tongue (Wa); also for rawness of tongue in advanced phthisis. Potassium Iodide, 
in syphilitic ulcers of tongue (D); and in hypertrophy (A). Potassium Bromide, 
3j to ovj water as wash, may soothe morbid sensibility of the tongue (A). Borax, 
Sodii Boratis gr. xl, Glycerini Sj, Aquae Biv, as application in cracked tongue (Wa). 
Iodine, the tincture locally by a fine brush, or as a gargle with 7 or 10 parts of water 
and some honey, has given uniform success in malignant ulcers (Wa). Aurum, 
internally and locally, has cured hypertrophy of the tongue with induration thereof 
in scrofulous subjects, also strumous ulceration of the tongue. Conium, is thought to 
act specifically with benefit in ulcer of the tongue (Wa). Cinnamon, the oil as a power- 
ful stimulant in paralysis of tongue (P). Ginger, Cochlearia, Pyrethrum, as gargles. 
Cloves, Mezereon, Pepper, as masticatories, in paralysis (P). Frenum, should 
be divided in tongue-tie; use blunt-pointed scissors, directing the points down close 
to the jaw, so as to avoid wounding the ranine artery (D); better to cut as little as 
possible, and directly backwards, as the artery of the frenum may proceed from the 
sublingual (Holmes). [Compare Glossitis.] 

Tonsillitis. 

Aconite, when high fever and elevated arterial tension, relieves greatly, gtt. ss-j 
of tincture every £-hour or hour (B) ; every J-hour for 2 hours, then every hour, will 
almost certainly prove efficacious (R). Belladonna, of surprising efficacy, gtt. v of 
tinct. every 3 hours in §ss aquae (P). Mercury, often speedily removes; Calomel, 
gr. tto, or Hydr. cum Creta, gr. \ every 2 hours; not in chronic forms (B); gr. £ of Gray 
Powder every hour when tonsils almost meet, has marked effect; the Oleate of Mercury 
and Morphine in obstinate and painful tonsillitis (R). Silver Nitrate, locally may 
abort, if applied early (R); the solid stick, once thoroughly applied in the first stage, 
rarely fails to prevent suppuration (Howard). Guaiac, disagreeable, but very effective 
(P); 5ss doses of tincture every 4 hours has remarkable power; should be given in 
emulsion with mucilage or yolk of an egg (B); makes an excellent gargle, the tincture 
of Guaiac and glycerin, equal parts, in 3 doses every hour or two, gives excellent results 
in acute tonsillitis. Opium, gr. v-x of Dover's powder at bedtime, is in many cases 
curative (Shoemaker). Salicylates often do good in rheumatic angina and in quinsy, 



roN 






which seems to have some relation to the rheumatic diathesis (W), Cocaine in 10 

(ht cent, solution, locally, at intervals of 15 minutes, removes pain 
motes resolution; a very efficient application in 5 or 10 per cent, solution, bi 
temporary paralysis of palatal muscles, so that liquids regurgitate through the n 
(Boeckel): a strong solution painted freel) over the affected tonsil in 
mence on one side of the fauces, will cut short the attack in . and prevent 

suppuration. Emetics, at the very onset of the disorder, will sometimes BUCceed in 
cutting it short (.Sir Thomas Watson). Potassium Chlorate internally is valuable 
(Kerley); in grain doses every half-hour is very efficient (Smith). Potassium Iodide 
in solution locally, gr. j-v to the 5, is useful (B). Picratol in 9 per cent, glycerin 
solution, applied In a swab, is very efficient (Yale). Ichthyol in 30 per cent, aqueous 
solution as a paint, applied twice daily after cleansing with an alkaline solution (k\ 
will abort abscess of the tonsil (Unna). Ammonium Benzoate, large doses in whisk, j 
every two hours, is the best treatment (Seiler); checking the disease within 24 to 
hours (Coston). Tannic Acid as an astringent gargle is useful (P). Hydrogen 
Dioxide, the solution is used as a gargle with great benefit. Quinine in a dose of gr. 
x-.w, will sometimes abort the disease (B). Capsicum in powder applied on a swab, 
or the diluted tincture in a gargle, is useful in severe tonsillitis, especially that accom- 
panying scarlet fever (W). Sodium Bicarbonate locally by a wet swab or finger to 
the surface of the tonsils every five minutes for half an hour, then every hour during 
the same day, will often prevent a tonsillar abscess. Water as ice and wet pack around 
the neck, extremely grateful (B); a cold wet compress covered with oiled silk and a dry 
bandage, to the neck at night, is very serviceable. Scarification of the tonsils gives 
immediate and marked relief in all cases, especially those which are not amenable to 
ordinary treatment. 

B- Tinct. Aconiti oss. M. Sig. — 3ss-ij every 2 hours, according 

Tinct. Guaiaci, to age. In severe cases, with high fever, 

Syr. Zingiberis, aa oss. bounding pulse, severe headache. 

Syr. Simplicis, 5 ij • (Shoemaker.) 



Tonsils, Enlarged. 

Ammonium Iodide, oss in §j of glycerin, applied every night by a camel's-hair 
brush, very efficacious (Wa). Barium Iodide, in hypertrophy of the tonsils, effects 
a rapid diminution in their size, even when indurated for years (Hale). Liquor Ferri 
Chloridi, diluted, oj-ij to the 5, painted over tonsils twice daily, is one of the most 
effective astringents (Mackenzie). Aluminum Sulphate, a saturated solution applied 
daily by a brush, as a mild caustic (W). Ergot or Ergotin, by injections into tonsils 
(Meigs). Zinc Chloride, as caustic, the most efficient and least annoying method; 
a saturated solution applied on a wire cotton-holder to each crypt and held there a few 
seconds; a few applications will shrink the gland in a week. Tannin, a strong solution 
touched daily to tonsils (H); a few sips of a saturated solution, 5ss in 3iij aqua;, slowly 
sipped, will stop bleeding, if profuse (A); gr. xx to 5j aquae, hypodermically, as in 
nasal polypus. Silver Nitrate, touched daily to tonsils, will sometimes make them 
shrink (H). Catechu, a serviceable astringent gargle; the infusion 5vj with tincture 
of Kino 5ij, as gargle (Wa). Oxgall, locally, is praised (Wa); is of real utility (Wa). 
Citric Acid, rubbed daily to the tonsils, is highly praised in enlargement thereof. Ex- 
cision of a part of the tonsil (H) : Mackenzie's double guillotine removes both tonsils 
at once; hemorrhage seldom happens, ice will generally check it (A). Surgical meas- 
ures should receive unprejudiced consideration, as the medical treatment is tedious in 
the extreme. 

Tonsils, Ulcerated. 
Coptis, the infusion as a gargle (B). Sulphurous Acid, dilute, locally by spray, 
or a solution of Sodium Sulphite 5j in water oj (B). Potassium Iodide, will arrest 
syphilitic ulcerations at once (B). Phenol, in a 5 per cent, wash with tincture 



820 TORTICOLLIS — TOXEMIA — TREMOR. 

of Myrrh, a good application by sponge to throat (Wa). Cimicifuga, a decoction 
of the root as a gargle (Wa). [Compare Ulcers.] 

Torticollis. 

Atropine relaxes spasm and has been especially useful in rheumatic torticollis (W); 
hypodermically into the affected muscle in increasing doses until the limit is reached, 
which is sometimes as much as gr. & (Leszynsky); used successfully in spasmodic torti- 
collis, up to gr. T V (Potts). Guaiacol, a few drops rubbed in gently, immediately 
relieves the pain (Brodnax). Cimicifuga, has curative efficacy (P). Capsicum, a 
handful of the crushed pods infused for 36 hours in a pint of hot or cold water, and 
applied on lint covered with gutta-percha (R); gives striking results (Wa). Opium, 
as liniment with friction, or in opium plaster, is often serviceable (Wa). Potassium 
Bromide, in large doses with Arsenic, may always be tried in the spasmodic form, 
which is sometimes one of the most obstinate complaints (Whitla). Gelsemium, 
some cases have been reported as cured by its hypodermic administration after tenotomy 
or myotomy had failed (Id); very large doses, TTjjiij of Wyeth's fluidextract thrice daily, 
increased until eight times this amount is taken, so as to produce very pronounced 
physiological symptoms, in spasmodic torticollis (Weir Mitchell). Surgical Treat- 
ment, by stretching or resection of a portion of the spinal accessory nerve, has succeeded 
sometimes in spasmodic torticollis, but it has also failed, and being so unsatisfactory 
should not be tried except as a last resort (Whitla). Electricity, galvanization of the 
affected muscles and faradization of the opposed ones, quickly relieves (B); has given 
excellent results in spasmodic torticollis, and if resorted to early may succeed, but must 
be persisted in for some time (Whitla). 

Toxemia. 

Alcohol as an arterial and nervous stimulant, may be used with signal advantage 
in threatened cardiac failure from poisoning by toxins or similarly acting toxic agents 
which are not so closely allied to alcohol that the latter becomes a reinforcing depressant 
(W). Hypodermoclysis aids the elimination of toxic products by the kidneys (Kemp); 
saline injections hypodermically and intravenously, are used successfully in various 
forms of toxemia. If the patient is robust and his condition sthenic, with venous 
infusion on one side may be conjoined venesection upon the other. The object is to 
hasten the dilution and elimination of the poison, both directly and through the skin 
and the kidneys particularly. The results are good in a certain proportion of cases and 
sometimes extraordinary, while the procedure is practically harmless. The normal 
salt solution injected into a vein and filling the rectum with a saturated solution of 
Magnesium Sulphate (McKeown). [Compare Septicemia, Shock, Uremia.] 

Tremor. 

Hyoscyamus, the tincture in full doses will palliate mercurial tremor; or Hyoscya- 
mine, gr. ^ gradually increased to T V (B). Hyoscine, is a useful drug in diseases 
having tremor as a marked symptom, as disseminated sclerosis, delirium tremens, and 
is usually safe (Weatherly); quiets the tremor of paralysis agitans and chorea, also 
senile trembling (Robin). Conium controls excessive tremor temporarily; has been 
used in chorea and paralysis agitans (W). Gelsemium in full doses; or a combination 
of Hyoscyamus, Conium and Gelsemium, the first to keep the brain quiet, the latter 
to quiet the nervous irritation at both the central and peripheral extremities (Lavers). 
Cocaine, influences alcoholic and senile tremor more favorably than any other remedy; 
large doses and frequent administration are unnecessary (B). Veratrine, has been 
used successfully in alcoholic tremor and that of disseminated sclerosis, also in the 
trembling weakness of typhoid fever (Ferris). Calcium Salts, were given by me in 
one case of tremor at the beginning of general paralysis, resulting in its cessation for 
several months (Br). Arsenic, ttjjIj— iij of Fowler's solution, diluted with two parts 



iku -mini VSIS rUBERCl L01 5 \i I I . riONS. 

o\ water and given hypodermically, was successful in several cases I Eulenberg), Pb 
phorus, in alcoholic and mercurial tremor (De Mussy). Silver Nitrate, gr. 1 iij d 
used in six cases of mercurial palsy with fairly rapid recovery (Sementini). Zinc Ph 
phide, is effective in the tremor of mercurial and arsenical poisoning (De M 
SO in the tremor of sclerosis (P). [Compare CHOREA, Di iii;h \i ikimi 

AGITANs ] 

Trichiniasis. 

Benzol, in doses of njx, every hour or two, up to 3jss daily, followed by a brisk 
laxative, was very successful in 27 cases, treated simultaneously 1 Putter). Purgatives, 
as Rhubarb and Senna, or an occasional dose oi Calomel, to thoroughly evacuate the 
gastro intestinal canal. Ammonium Picrate is said to be an efficient rerned] \\ I; 
experiments show that it has no effect on the trichina' (Erb). Glycerin in large doses, 
to destroy the worm by its hygroscopic qualities, has been recommended. The in i 
tions, in the stage of invasion, are to relieve the pains, to secure sleep, to combat the 
fever, and to support the patient's strength; there are no medicines which have any 
influence upon the embryos in their migration through the muscles (O). 

Trismus. 

Chloral is valuable in trismus neonatorum, gr. j-ij by the mouth or double that 
amount by the rectum, to a young babe (W). Physostigma has been used, but with 
no more encouraging results than in tetanus (W). Atropine hypodermically, has been 
used with benefit (R). Opium in doses of mh of the tincture, with castor oil and a 
warm bath, in infantile trismus. Cannabis Indica has been used successfully in 
trismus of the new-born (B). Turpentine locally to the cord, is highly esteemed in 
the southern states, for trismus neonatorum. Aseptic Dressing of the cord as a pro- 
phylactic, to prevent the entrance of Nicolaier's bacillus. Treatment of any kind is 
seldom effectual (D); is never effective (El). Trismus neonatorum, lock-jaw of the new- 
born infant, may be due to many causes; one of which is bathing in very hot water. 
A certain midwife, whose hands could not distinguish the differences in temperature 
of the bath, sent me over 100 cases (Weber). [Compare Tetanus.] 

Tuberculosis, Acute. 
Quinine, to subdue the fever, also Salicylic Acid for the same purpose, with re- 
peated blistering over different parts of the chest and many dry cuppings of the lower 
limbs and the trunk morning and evening; this, with wine and alcohol, broths, jellies, 
milk and peptonized foods, is my plan of treatment for acute miliary tuberculosis, by which 
one case was absolutely cured (Jaccoud). Arsenic, appears to reduce the tempera- 
ture gradually and is useful in many ways (R). Cold, to the surface of the abdomen, 
with ice sucked freely, the body sponged with iced vinegar and water, food and drinks 
to be iced, and even iced enemata sometimes; with Quinine, gr. x-xxx once in 48 
hours, or the pill of Quinine gr. j, Digitalis gr. ss, and Opium gr. }, every 4 hours, fluid 
food every hour or half hour day and night, in acute miliary tuberculosis, may bring 
about a cure if energetically followed from the beginning (McCall Anderson). Treat- 
ment of acute pulmonary tuberculosis, either the miliary form or acute pneumonic 
phthisis, is only palliative (Bruce). [Compare Phthisis.] 

Tuberculous Affections. 

Arsenic, children affected with tuberculosis involving the lungs, intestines and 
peritoneum, have steadily and slowly improved and finally recovered under Arsenic 
treatment (R). Salicylic Acid, Unna's strongest plaster, applied repeatedly for several 
days, to remove the horny covering in tuberculosis verrucosa cutis; this will remove 
much, and the rest is destroyed by the fuming Acid Mercuric Nitrate, applied to a small 



822 TUMORS — TYMPANITES. 

portion of the growth at a time, as it is painful (Crocker). Camphorated Naphthol, 
hypodermically in tuberculous adenitis, tuberculosis of the testis and of the bladder. 
Potassium Cantharidinate, gr. , : l,, to gr. ^\ h hypodermically, produces an exudation 
of serum throughout the body, and may cause a concentration at an affected spot of 
efficacious substances which would not ordinarily find their way there, but it should not 
be employed when kidney disease exists (Liebrich). Hydrargyrum Thymol-aceti- 
cum, in solution injected into the glutei muscles every eight days, followed after a few 
injections by Potassium Iodide, gr. iij thrice daily by the mouth, as a cure for tubercu- 
losis (Tranjen, Ewald). Zinc Chloride, in dilute solution, deeply injected into the 
tissues surrounding tubercular deposits, in order to induce a condition of sclerosis fatal 
to the growth or existence of the bacilli; in tuberculosis of the epididymis and in spina 
ventosa a i in 20 solution; for tuberculous disease of the joints, ribs and glands a 1 in 
10 solution, of which 20 drops to be injected in a number of places around the periphery 
of the diseased part (Lannelongue). Iodoform seems to have a specific influence on 
the bacillus, and its value as a local application in surgical tuberculosis seems to be 
firmly established (W) ; in 10 per cent, emulsion filled into the cavity after free opening 
and scraping, the cavity being then sewn up, gives excellent results in tuberculous 
abscesses (Billroth) ; a sterilized 10 per cent, emulsion made with glycerin or olive oil, 
injected every 14 days or oftener into tuberculous joints and abscesses after thorough 
aspiration, also in tuberculous empyema (Bruns); this may be well employed for all 
forms of local tuberculosis of soft parts, as the glands, testes and lungs (Trendelenburg). 
Guaiacol by inunction, is of great value in tuberculosis of infants and children (Rach- 
ford). Thiocol is serviceable in surgical tuberculosis, and has a decidedly effective 
influence on the process (Schnirer). Ferrisol in doses of gr. xv by the mouth, also in 
10 per cent, solution by intramuscular injection, is a useful remedy (Secreti). Ichthyol 
gr. xx increased to gr. lxx thrice daily internally, has given excellent results in tubercu- 
losis of the bladder and kidneys (Richter). Ichthoform proves satisfactory for the 
diarrhea and pain of intestinal tuberculosis (Schsefer); in 1 to 2,000 solution by irri- 
gation in that of the bladder (Lohnstein). Phenosalyl as a bactericide, used in 16 
cases of laryngeal tuberculosis with curative results (Stein). Cod-liver Oil is the 
remedy from which most good is to be expected in the tuberculous diathesis (Wa). 
Serum-treatment and the use of Tuberculin as a diagnostic agent are discussed under 
the title Sera in Part I. [Compare Laryngitis tuberculous, Lupus, Meningitis 

TUBERCULOUS, PERITONITIS TUBERCULOUS, PHTHISIS, SCROFULOSIS, TABES MESEN- 
TERICA.] 

Tumors. 

Mercuric Bromide, in \ grain doses, has benefited abdominal tumors (Wa). 
Chloroform, to aid in diagnosis of abdominal tumors when deep-seated, and when 
walls of the belly are hard and rigid; also in phantom tumors (R). Pepsin hypoder- 
mically into the substance of morbid growths which are homologous to the tissues, 
especially fatty tumors, to arrest their growth and cause their absorption. Hyoscya- 
mus, the leaves as cataplasm or fomentations to painful tumors, afford great relief 
(Wa). Iron, the Liquor Ferri Chloridi is found to be valuable as a curative application 
to fungous or hemorrhoidal tumors (Wa). Galbanum, as plaster to indolent, non- 
malignant tumors, to diminish or cause their absorption (Wa). Electrolysis, is em- 
ployed with more or less benefit in sebaceous tumors, lipoma, bronchocele, enlarged 
glands, etc. (Wa) : solid tumors, as goitre, enlarged glands and similar growths have 
been repeatedly cured by electrolysis (B). [Compare Cancer, Cysts, Glandular 

ENLARGEMENT, GOITRE, POLYPUS, UTERINE TUMORS, WEN.] 

Tympanites. 

Turpentine, often greatly benefits (P, Wa); 3j every 6 hours in tympanites of 
typhoid, with prostration but without diarrhea (R). Asafcetida, in hysterical tympan- 
ites, internally or as enema, beneficial (P); also in that of fever (Wa). Capsicum, 
gr. ss-ij, every 4 hours (P). Cocculus Indicus, a few doses of the tincture will often 






t\ I'm ms rYPHOiD 1 1 \ i k. 

succeed in the tympanites of peritonitis and enl i (P), Ginger, with di 

purgatives (P). Posture, relieves many bad cases promptly; inversion or pa 
inversion of the patient, as in the knee-chest position, Tor 10 or 15 minutes, to Cfl 
the gravitation of the bowels upwards, thus straightening out the rectum; or if thi 
not practicable, place the patient on one side and elevate the fool of the bed i\\ 
three feet (Sweetnam). Surgical Measures, by celiotomy and incision of the gut, 
should be done promptly, when cathartics, posture, enemata and the use of the rectal 
tube have failed to give relief (Porter). Puncture or Aspiration only in extn D 
and as a last resort, and then only in such eases which presenl DO other cause for celiotomy 
than the tympany itself, as typhoid fever without perforation, pneumonia (Id) 

pare PERITONITIS, TYPHOID FEVER.] 

Typhlitis. 

Opium has undoubted curative power (B); for great pain but not in doses suffii ient 
to mask the symptoms. Saline Purgatives to remove impacted feces, the cause of 
the trouble in most cases. Drastic purgatives should not be used (B). Enemata 
of soap and warm water to aid in the removal of impacted fecal matter. Lime-water 
with milk, also ice and champagne, for the vomiting. Leeches, should never be 
omitted when tenderness and fever begin (B). Ice-bag, over the swelling (H); has 
conquered many cases which the surgeons would operate on for appendicitis. [Com- 
pare Appendicitis, Intestinal Obstruction.] 



Typhoid. Fever. 

Acetozone, the solution may be given internally ad libitum; used early and regu- 
larly it shortens the course of the disease and ameliorates all the symptoms, used in 
128 cases with mortality of 8i per cent. (Harris); in 40 cases, no death (Westinghouse); 
in 24 cases, no death (Wasdin); in 40 cases with 2 deaths (Abt); in 53 cases with no 
death (Woods). Guaiacol irnij, or the Carbonate gr. iij, every 2 hours as an intestinal 
antiseptic, was used in 408 cases with a mortality of 5} per cent., against 13 per cent. 
in 199S cases treated otherwise (McCormick); m>x-.w painted over the skin where 
it is readily absorbed, is efficient in reducing the temperature (Montagnon); the Car- 
bonate gr. xxv-xxx twice daily, is highly efficient, used in 60 cases with no deaths (Hoel- 
scher). Thiocol is an ideal intestinal antiseptic in this disease (Johnston). Salol 
is of great value as an intestinal disinfectant, promoting healing and preventing rein- 
fection; given in 5 to 10 grain doses, according to age, ever}- 4 hours until the urine is 
tinged, then reducing the amount and frequency, but maintaining a faint coloration of 
the urine, has for ten years afforded me the most gratifying results (Bramwcll): it 
should not be given in the compressed tablet form for many reasons. Salophen has 
proved equally efficient. Copper Arsenite, in divided daily doses of gr. , ,',,,, commenced 
early and continuously used, will maintain a moderately low temperature, a good pulse 
rate, comparative freedom from great abdominal pain and tympanites, and will lessen ma- 
terially the number of stools, while it greatly improves their character and consistence 
(Aulde); used in 90 cases with but one death; leaves an excellent condition of the ali- 
mentary tract after the fever is over (Thomas). Phenol pure, ~>i with tincture of 
Iodine oij, of which mixture 1 to 3 drops even' two or three hours, is a very good plan 
of treatment (Da C); all cases during an entire year were treated with a mixture of 
Phenol and Chloroform, without the loss of a single case, by Dr. Quill of the 
Indian army. Chloroform, the spirit in mixture with Phenol, as above; a i per 
cent, solution of Chloroform will kill the bacillus of enteric fever (Werner). Mercury 
as Calomel in small doses at the onset (R); to move the bowels at firs! 1 M< Cormick); 
gr. x in one dose the first day, then gr. iij daily for 3 or 4 days, the German specific 
treatment (B); with Guaiacol etc., the two chief agents in a specific treatment which 
aims at aborting the disease by intestinal antisepsis and elimination (Woodbridge). 
Potassium Bromide is as much of a specific for this disease as quinine is for ague, 
aborting the fever in 8 or 10 days (Hawkins). Cinnamon, the ( >il as an internal germi- 



824 TYPHOID FEVER. 

cide, has given good results. Collargol by inunction, gave excellent results in several 
severe cases (Netter). Mineral Acids, Hydrochloric is given in very large quantities 
in the so-called Swedish plan of treatment (W); Nitro-hydrochloric in doses of gtt. xx 
in simple elixir, and Sulphuric for intestinal hemorrhage, preferred over all other plans 
of treatment (Da C). Tartar Emetic, with Opium, when wakefulness and delirium; 
minute doses gr. T V frequently, are of great service (B); Antimony cuts the disease 
short with such certainty that it is almost doubtful whether the lesion of typhoid is 
specific or is not rather incidental or adventitious (Lawrie); should be given with 
cardiac tonics. Digitalis, of value in many cases as a sustainer of heart power, but 
may be dangerous in the later stages (Anstie, Murrell); used by the Germans when there 
is no cardiac weakness; gr. x-xx as antipyretic, over a period of 36 hours (P). Quinine, 
may have efficacy in typho-malarial fever, is less effective as the typhoid element pre- 
dominates, useless in purely continued fevers (B); is justly abandoned, but may be 
used to maintain the circulation, in tonic doses, gr. vj-x in the 24 hours (Da C). Qui- 
nine Salicylate, not in antipyretic doses, has given the happiest results, being superior 
to salol or any other intestinal disinfectant (Sir J. Moore). Saloquinine in dose of 
gr. xxx given in the evening shortly before the bath, so as to develop its antipyretic 
action when the effect of the bath is declining (Overlach). 

Antipyrine and Acetphenetidin, as antipyretics, ,but all such agents of energetic 
action cannot be too emphatically condemned in this disease (Sir J. Moore). Lacto- 
phenin gr. xv for adults thrice daily, reduced the temperature from 2 to 4 F. in 450 
cases, where water treatment could not be obtained (Schuler). Thermol is valuable 
as a safe antipyretic and internal antiseptic (Miller). Phenocoll, the Hydrochloride 
is used as an antipyretic with marked success. Veratrum Viride to reduce tem- 
perature (R); for delirium ferox (B); is irrational and dangerous (W). Arnica is 
highly extolled; its "picture" shows definite powers in this disease (P); small doses 
in asthenic conditions (B); when vital powers are greatly depressed (Wa). Baptisia 
is very useful in the early stage (W). Turpentine, invaluable when hemorrhage and 
extreme tympanites (P, R); njxxx-lx in Starch mucilage and nj>x of Tinct. Opii (P); 
njv-x frequently for hemorrhage or tijx every 2 hours in advanced stage, with dry 
tongue (R); when coma, stupor, it often arouses the vital powers (Wa); njvij with 
gr. 4^ of Morphine; of especial value when marked fever and congested lungs, as well 
as for the tympany (Da C). Chloral, is the best drug for nervous symptoms, but must 
not be used when the heart is weak (Da C). Opium, small doses at night, for insomnia 
with delirium; also as injection for the diarrhea (R); in one case when vital powers 
seemed hopelessly depressed, gr. \ caused improvement (Wa); for spreading tender- 
ness (peritonitis), give 10-minim doses of the deodorized tincture, also gr. j in supposi- 
tory every four hours (Da C). Belladonna, when contracted pupils, low, muttering 
delirium (B); is thought to counteract the poison of typhoid (Wa). Bismuth, gr. 
x-xxv of the Subnitrate with gr. J— j of Opium every 3 hours for the severe diarrhea 
(Da C). Ergot, for intestinal hemorrhage, hypodermically if the symptoms are urgent 
(R); Ergotin, gr. ij-vj hypodermically, or 5j of the fluidextract of Ergot, for intestinal 
hemorrhage (Da C). Sulphur gr. xv every 2 hours, is valuable for cases with consti- 
pation, and has a beneficial action on the intestinal mucous membrane (Caramano). 
Sulphurous Acid deserves high praise (Dewar) ; iTgij-xx according to age ever)' 2 hours 
for a week or ten days, if diarrhea present add Sulphuric Acid and Opium (Wilks). 
Thymol as an intestinal antiseptic is valuable (Henry); gr. ss-ij in solution (Da C). 
Eucalyptus Oil, not Eucalyptol, ttjjx-xxx in whiskey, a very efficient intestinal anti- 
septic, also antipyretic and abortive to the disease, gives greater relief to all the general 
symptoms than any other drug (Kesteven). Camphor as an arterial stimulant, espe- 
cially when nervous symptoms are prominent and there is a tendency to insomnia 
(McCormick); gr. j-ij in iroxv of sterilized olive oil hypodermically, is unequalled in 
extreme cases (Stengel). Tannalbin to control excessive diarrhea, is very efficient 
(Moore). Ichthoform as an intestinal disinfectant and for excessive diarrhea, gr. 
xlv-oj daily, used in 20 cases with entire satisfaction (Polacco). Calcium Chloride 
gr. xv-xxx every 2 or 4 hours in hemorrhage, to increase the coagulability of the blood 
(Butler). Gelatin in 10 per cent, solution, a pint in 24 hours, for the same purpose 
(Id). Suprarenals dessicated, gr. v every 4 hours to constrict the vessels (Id). Sodium 



T\IM10ll> 






Citrate gr. xx xl to the pinl of milk used as diet, to secure partial decalcifi 

the excess lime salts and prevent thrombosis (Wright). Trional 

Serpentaria, useful when much depression exists, cautiously if intestines at all irril 

Hydrastine, when copious sweats (P). Lead Acetate, with Opium, for the 
purging (R); also Alum (R). Lime-water, as an astringent and antacid, is efficient, 
Sodium Chloride, should not be withdrawn from the loud (Wa). Aromatic Spit it 
of Ammonia, for great accumulation of mucus in the throat (Da C Copper Sul- 
phate, gr. ,'. : , with Opium, gr. ' ; , for the diarrhe Strychnine, is the remedy 
for the functional palsies (Da C). Purgatives, only the very mildest, and they with 
the greatest caution (Wa). Medicine, will never abort a case <-<i true typhoid; its 
natural duration is from 28 to 30 clays (Jenner); medicines should not be given in 
pills or tablets, which are liable to irritate the intestinal lesions. Serum Treatment, 
both antitoxic and prophylactic, has been successfully employed (Chantemesse). Bath 
at -o° V. gradually lowered by ice to 65 F., whenever the temperature reaches 103 I 
(Loomis); a most important agent in this disease (B); in mild eases, cold wet com- 
presses or wet sheets; or washing with cold water; in severe eases, affusion, shower, 
or general cold bath, 50° to 55 F., or better 95° cooled gradually to 6o° (R); this, the 
Brand (more justly Currie's) method, increases the flow of urine and its toxicity, restor- 
ing the latter to normal and sometimes to double the normal, thereby clearing the sys 
tern of a large quantity of toxins (Ausset). Stimulants, Whiskey in doses of Sss, as 
indicated by the pulse, heart action and general condition (Loomis); alcohol is necessary 
to sustain the heart (Da C); Coffee is a better stimulant than alcohol (P); Strychnine 
only to reinforce alcohol, when the latter proves insufficient (Loomis); Digitalin hypo- 
dermically for impending failure of the right heart, shown by cvanosed extremities, 
pulmonary edema, etc. (Id); Alcoholic stimulants freely, with Quinine, for pyemic cases 
showing joint complications. Diet should be milk alone, with lime-water, peptonized 
or prepared, during the whole course (Loomis); Milk must be used with great caution; 
if the curd be undigested great evils arise; give essence of meat alone (Sir Wm. Jenner); 
avoid the extremes; an absolute milk diet required if intestinal symptoms are grave; 
no solid food until health is restored fully; a scalded-milk diet exclusively may be 
depended on. Adjuvants, water as a drink freely, as much as possible; water locally 
by abdominal compress, great cleanliness, good ventilation, absolute rest and quiet. 
Disinfection of the discharges by Formaldehyde 1 to 40; of linen and bed-clothing 
by Phenol 1 to 20; of the nurse's hands by Mercuric Chloride solution 1 to 1,000. 
[Compare Hemorrhage ixtestixal, Rectal Ulceration, Tympanites.] 

I!- Resin. Podophylli gr. tjIt- I ^■ Mentholis gr. ss. 

Hydrarg. Chloridi Mitis, Thymolis gr. j. 

Guaiacolis Carbonatis, Eucalvptolis njjv. 

Mentholis, aa gr. jV Guaiacolis Carbonat gr. iij. 

Eucalvptolis, q. s. Ft. capsula no. j. Sig. — One capsule 

Ft. tabella no. j. Sig. — One or more of every 3 or 4 hours, alternating with the 
these tablets even- \ hour during the first 3 tablets, after the fourth or fifth day of treat- 
days, to secure 5 or 6 free evacuations daily. : ment. All the medi lown 
{Woodbridge Xo. 1.) ' with large draughts of distilled or sterilized 
water. (Woodbridge No. 3.) 



R. Resin. Podophylli, gr. 555- 

Hydrarg. Chloridi Mitis, - 

Mentholis, 

Thymolis, aa gr. T V R- Quininae Sulpharis gr. x. 

Guaiacolis Carbonat., gr. \. Acidi Hy : Mil., 

Eucalvptolis, q. s. Vel Ac. Sulphurici Dil., 3 

Ft. tabel'la no. j. Sig.— One tablet every Syr. Aurantii |j. 

hour or two, after third or fourth dav, re- ' Aquae Cari q.s.ad 5vj. 

duced so as to gradually lessen frequency of M. Sig.— A tablesp. in an equal quantity 

evacuations, until the temperature returns to of water, every three or tour hours. 
normal. (Woodbridge Xo. 2.) (Murchts 



826 TYPHUS FEVER — ULCERS AND SORES. 



I 
f 






Typhus Fever. 

Antipyrine for hyperpyrexia (W) ; Antipyrine or Quinine as antipyretic, it being 
more necessary to keep the temperature within safe limits in typhus than in typhoid 
(B). Acetphenetidin, a safe and efficient antipyretic. Baptisia, is said to have proved 
very useful (W). Belladonna, to cleanse and moisten the tongue; controls the delirium, 
slows and strengthens the pulse, reduces the temperature, shortens course of disease 
(R, P); in the early stages, relieves severity of symptoms (P); give when the pupils are 
contracted (Graves). Arnica is highly praised as a remedy in typhus (P, Wa). Po- 
dophyllin, gr. $-J as mild laxative at onset, when constipation, congestive headache, 
biliary derangement (P). Digitalis, in large doses, a favorite remedy in Germany (P). 
Rhatany, as tonic, in advanced stages (P). Hyoscyamus, for mild brain symptoms 
(P). Opium, fulfils many important indications; never give when pupils are con- 
tracted (Wa). Mineral Acids, their use recommended in all countries (Wa). Tar- 
tar Emetic, with Opium in the delirium with insomnia (R). [See under Typhoid.] 
Chloral, to produce sleep and allay violent delirium (R, Wa); its use has often been 
followed by amelioration of the symptoms (Wa); is highly efficient in the wild delirium 
of the earlier stages (Russell). Serpentaria, in low stage, delirium, watchfulness, 
tongue dry and brown, or black; combine it with Ammonium Carbonate (P); is 
given occasionally to excite diaphoresis and support the vital powers (Wa). Camphor, 
a remedy of considerable value, but contraindicated when flesh-red tongue, tender 
abdomen, diarrhea (Wa). Purgatives, mild salines may be used if required, but not 
drastics (Wa). Alcohol as milk-punch, is useful in all stages (W); stimulants are 
needed sooner than in typhoid, the adynamia being more profound in typhus and appear- 
ing sooner (B) ; Coffee is better than alcohol for the adynamia (P). Cold Baths for hy- 
perpyrexia, have been employed on a large scale (W). Diet, nutritious persistently, 
beef-tea, egg-nog, nutrient enemata. Isolation, imperative, as the disease is eminently 
contagious (B). [Compare Delirium, Tythoid Fever.] 

Ulcers and Sores. 

Arsenic, improves rodent ulcer (B). Belladonna, has a remarkable influence 
over various ulcerative processes (P). Chloral, as lotion for sluggish sores, 5 to 20 
grains to the § of water (Keyes); is highly efficient in ulcerated sore throat or ulceration 
from any cause (Brodnax). Chloretone in 1 per cent, solution as an anesthetic to 
irritable ulcers (W). Mercury, Calomel finely levigated and dusted on, is highly 
efficient in ulcer of the conjunctiva; Calomel Ointment or Black Wash in scrofulous or 
tuberculous lupus, and in open scrofulous sores (R); Corrosive Sublimate, in 1 per 
cent, solution, as application to syphilitic ulcers (Fox); the Ung. Hydrarg. Xitratis, 
diluted one-half, for serpiginous ulceration; or the Iodide, gr. xx-xl to the o of vaselin, 
in syphilitic ulcerations (Keyes). Lime, as the Carbonate or Lime-water to check 
discharge; the Sulphide when thin ichorous discharge; the Phosphate has influence 
on scrofulous sores (R). Opium or Morphine, with glycerin, as an application to 
relieve pain (R); gr. j-ij, daily, also locally, has a decidedly curative value in phagedenic 
and indolent ulcers; not so useful in so-called irritable ulcers (Pf, P). Ichthyol, pure as 
oint. or with Lanolin, has done excellent sen-ice in ulcers of the leg; a 10 per cent, 
ointment is very efficient in old leg ulcers (Bulkley); a 30 per cent, solution applied 
after a 1 per cent, solution of Holocaine, gave phenomenal results in corneal ulcers 
(Travis). Ichthargan in 1 and 5 per cent, dusting powders made with Talcum, 
is extremely efficient in old leg ulcers (Unna). Thiol, the dry form, as dusting powder, 
has been of great benefit. Piperazin, in 1 per cent, solution, locally to gouty sores, 
relieves the pain and reduces the inflammation. Resorcinol, in strong or supersaturated 
solution, locally applied to tuberculous and other ulcerations of the larynx, is efficient 
and painless (Tymowski); locally in rodent ulcer (Williams). Tannic Acid locally to 
check excessive secretion in chronic ulcers (W); the Glycerite to coat over discharging 
sores (R). Tannoform is efficient in fetid ulcers of the leg (Von Mering). Camphor 
dusted over indolent sores (R); gives the best results in ulcers of the leg (Schulze). 
Hydrogen Dioxide is particularly useful in ulcers of the leg with an atonic base, 






I'l CERS \\n SOR] 

also in soft ulcer and tertiary phagedena (Ravasini). Conium, locally, by means of a 
poultice, will ease pain and improve the sore (R). Chlorine, in 
(toughing and indolent sores (R); the gas as a local stimulant to promote healing in 
old ulcers is found to be highly efficient; Chlorine water properly diluted 
excellent stimulant, disinfectant and detergent wash for foul ulcei \\ i, Hydj 
internally and externally is employed with good results in rodent ulcer, and ul 
legs, rectum, and uterus (R). Sa'nguinaria, locally, to repress fungous granulations 
of indolent ulcers, i part to So of Glycerin (P). Phenol and Salicylic Acid 
(B); the Glycerite of Phenol is a good application to fetid sores (R); Phenol 
pure, freely applied under chloroform anesthesia, as a powerful 
caustic to destroy the diseased surface, in tropical sloughing phagedena I Mil). Pheno- 
salyl in 10 to 30 per cent, solution, is very effective in varicose ulcers and ul, 
rummata, even in cases resisting other medication for several years (Tshitsherin). 
Picric Acid in 1 per cent, solution locally for chronic ulcers (Maddock). Pyrogallic 
Acid is an excellent application for venereal ulcers (Vidal). Iodoform for venereal 
ulcers, dusted over surface (B); prevents granulation in all ulcers, and does no good 
except to relieve pain (Gross). Thymol Iodide is praised; an excellent substitute For 
Iodoform, being quite as efficient, and odorless; has given excellent results in treatment 
of indolent soft ulcers and syphilitic ulcerative processes. Silver Nitrate, as caustic, 
quickly rubbed over surface (B); applied to unhealthy ulcers, also ulcers of the mouth 
JR). Copper Sulphate, to indolent ulcers: touch with a crystal, or frequently apply 
a solution, gr. ij-x to the 5 (R). Nitric Acid, as escharotic, applied with a glass rod, 
Oil to protect the surrounding tissues, arrest its action by alkaline wash; 5j to Oj is a 
good acid lotion for washing (B); the lotion for indolent and painful ulcers (R). Potas- 
sium Chlorate, in solution as a wash to clean and stimulate foul ulcers (R); in impal- 
pable powder, a better application than Iodoform (B). Cinchona, powdered Bark 
dusted over foul, indolent, sloughing and gangrenous ulcers, promotes healing (R). 
Alcohol, locally to cover sores with thin protecting layer of coagulated albumin (R). 
Alum, dry or in solution, applied to relaxed and abundantly-secreting sores (R). Tur- 
pentine, internally for ulceration of bowels (P). Collodion, as protective covering 
P). Capsicum, a weak solution useful as a stimulant in scrofulous or fistulous sores 
(P). Savin, as acrid (not chemical) caustic (P). Potassa Fusa, or the milder 
Vienna paste, as escharotic; to arrest its action use a dilute acid (B). Zinc Chloride, 
the most efficient escharotic consistent with safety (B). Zinc Sulphate, dried, dusted 
over sores (R). Zinc Stearate with Thymol Iodide, is an excellent application for ulcers 
(Hellman); and for obstinate ulceration of the uterus (Hale). Acetanilide in fine 
powder dusted on, an excellent agent for ulcers, sores, mucous patches and rectal ulcer. 
Lead, the soluble salts as lotions to unhealthy, over-secreting sores (R). Balsams 
of Peru and Tolu, are excellent applications (P). Charcoal finely powdered, locally 
to sloughing sores (R). Hamamelis is used with satisfaction as an application to 
varicose ulcers (Pf). Glycerin as the official Cataplasm of Kaolin, is an excellent 
application. Potassium Permanganate in solution, affords an excellent disinfectant 
and germicidal wash (W). Oxygen, to atonic and painful ulcers (R); locally is highly 
efficient (Stoker). Nuclein locally, cured an ulcer of 20 years' standing in 4 months 
'Vaughn); or Yeast poultices (R), their value probably due to the nuclein in them. 
Section of exposed nerve-filament, in irritable ulcer, by bistoury passed beneath the 
sore 1 Hilton). Cod-liver Oil, especially for ulcerations of the glands, or indolent 
ulcers with excoriated edges, and lupus. Water, is sufficient as dressing in the majority 
of cases. Hot Water, applied by the continuous immersion therein of the affected 
limb, is perhaps the most efficient treatment of indolent ulcers of the leg or foot, resist- 
ing other applications; proved very successful in my Philippine experience for tropical 
ulcer and gangrenous sores of the leg, fissures and sores of the feet, and similar affections. 
Radium Rays are of value in rodent ulcer, especially when the ulcer is smaller than a 
shilling, in which case they act like a charm (MacLeod). Rest and support of great 
value; cleanliness, bandaging and recumbent position in ulcer of legs, facilitate recov- 
ery; also daily washing to restore the lost vitality of parts; elastic stockings, and the 
Esmarch bandage in chronic cases. [Compare Bedsores, Chancre, Chancroid, 
Throat; Gastric and Uterine Ulceration; Syphilis, Tonsils, ulcerated.] 



828 UREMIA — URETHRAL STRICTURE. 

B- Iodoformi, 5ij- i I}- Hydrarg. Chlor. Cor., gr. xv. 

Mucil. Acacias, njxv. Phenolis, njjxs . 






Ol. Mentha Pip., Ttjjij. 

Glycerini, irjfxx. 

M. Sig. — For unhealthy ulcers. 

(Bronson.) 



Aquae q. s. ad oiv. 

M. Sig. — For syphilitic ulcers, pack on 
cotton, and renew daily. (Fox.) 






Uremia. 

Pilocarpine, as an active diaphoretic, on the first appearance of uremic symptoms, 
as headache, drowsiness, convulsions; also free purgation by salines or Elaterium (Y); 
a weak or fatty heart is a positive contraindication for this drug (B); it must not be 
used if edema of the lungs exists, as further edema and death will result (Whitla). 
Digitalis, the infusion internally, or a poultice of the leaves to the back and abdomen, 
to procure free action of the kidneys (B). Morphine, hypodermically, is most effi- 
cient in the uremic convulsions of acute parenchymatous nephritis (Loomis); is dan- 
gerous in chronic interstitial nephritis (Ty); when the kidneys are seriously diseased 
the free use of opiates is attended by much danger, because the chief channel through 
which its alkaloids escape is choked up (W). Chloroform rather than morphine, for 
the convulsions (White). Oxygen by inhalation, 10 litres thrice daily, is used with 
success (Jaccoud); is as useful in practice as it is rational in theory (Carter); used with 
remarkable success in a very bad case of uremic coma (Macalister). Sodium Ben- 
zoate, 15 grains 4 times daily, has been found very serviceable in threatening uremia 
(Whitla). Sodium Bromide with Chloral, in full doses, by the bowel, for uremic 
convulsions (Id). Potassium Salts given in Bright's Disease increase the danger 
of uremia, hence Sodium salts are preferred (Id). Naphthalene, also Iodoform and 
Charcoal, as intestinal disinfectants, as much of the toxic material in the blood is 
reabsorbed from the bowel (Bouchard). Amyl Nitrite or Nitroglycerin, and brisk 
purgation, to relieve the dyspnea. Ether, in doses of 5ij by the mouth or 3ss hypo- 
dermically deep into the muscles (painful), for uremic dyspnea; must be pushed to 
oij or iij in 24 hours before good results can be expected (Gallois); being rapidly elim- 
inated it can be given in fairly large doses without causing intoxication. Colchicum, 
is an excellent derivative in these cases and acts best when combined with other purga- 
tives (B). Elaterium, gr. iVto i> to procure free watery evacuations — cautiously! (B); 
the compound powder of Elaterin, gr. 5 to iij, may be thrown on the tongue and washed 
down with a teaspoonful or two of water (Y); clinical experience has demonstrated 
its value in uremia (W). Quebracho is a valuable respirator)' stimulant in uremic 
dyspnea (W). Saline or Hydragogue Cathartics, are of great importance to secure 
elimination by the intestinal canal and to relieve the blood-pressure (B); purgation by 
salines on the first appearance of uremic symptoms (Y). Transfusion, in uremic 
convulsions (B). Hypodermoclysis is diuretic, and promotes elimination of the toxic 
products (Kemp); hot saline injections into the cellular tissue have given good results 
in chronic nephritis with uremia ; used in 2 cases with recovery, the patients having been 
bled before administering the injections (Richardiere) ; is worthy of a wide trial and 
seems to offer a chance of recovery in many cases which otherwise would prove fatal. 
Hot-pack or vapor bath, to induce powerful diaphoresis (B); the hot wet-pack or hot 
air bath, may be given daily or oftener when uremia is threatening. Milk is the only 
admissible food. Venesection, 10 to 20 ounces of blood from the arm gives striking 
relief in acute forms of uremia in the robust ( Y) ; leeches to the temples for the head- 
ache (Id). Lumbar Puncture temporarily relieves the convulsions, and may save 
life (Willson). [Compare Bright's Disease, Coma, Convulsions, Dyspnea, Scarlet 
Fever.] 

Urethral Stricture. 

Aconite, is of great service in spasmodic stricture (P). Cocaine, locally by catheter 
(Smith). Buchu, in irritable urethra, spasmodic stricture, and gleet (P). Opium, 
in full dose or an opiate suppository, with fomentations and a warm bath, will often 
suffice in spasmodic stricture (CI). Atropine as ointment rubbed in along the canal, 
in spasm of the urethra (W). Adrenalin Chloride 1 part with 5 of Chloretone, in 
normal saline solution 1,000, of which a few drops instilled into the urethra, will permit 



URETHRITIS i K 1 \ \kv DISORDERS. 

the passage of small instruments through a stricture previously impen rtrina) 

Catheterization, under an anesthetic in spasmodic stricture if other measures fail to 
relieve; also for gradual dilatation in organic stricture, the safesl and mosl general!) 
applicable treatment (CI). Oil, injected before dilatation (Wa). Thorough Divi ton, 
by a dilating urethrotome, the best operation for a radical cure; (>oo cases thus I 
Without a death or permanent disability (Otis). Electricity, a weak galvanic < urreru, 
with negative pole to the stricture, wili destroy it in 2 or ? sittings by electrolyai 
f carefully done, is the most etlicient and least painful method of treatment 
cure. 

Urethritis. 
Aconite, is used to advantage in urethral fever; also for prevention of chill aftei 
passage oi sound (Pf, W), Strophanthus, efficient in preventing rigors after instru 

mentation on the urethra, the tincture in doses of 5 minims (Fenwick). Urotropin 
internally, is said to effectually prevent urethral chill and fever following the 
sound or catheter. Acetanilide in mixture with gum-arabic water, %v. xx xl to the 5, 
may be injected in urethritis (W). Lysoform as an injection, is used with s 
(Simons'). Ichthyol in warm 2 per cent, solution as an injection, gives greal satisfaction 
in chronic posterior urethritis (Mueller). Ichthoform in solution, 1 in 2,000 to 1 in 
1,000. has marked siccative and antiphlogistic effects, and is a very efficient injection 
in chronic urethritis (Lohnstein). Silver Nitrate, locally, very efficient in chronic 
urethritis in females (W). Tannin, on bougies, once a week for 15 minutes, most 
efficient for urethritis in the female (Wa). Zinc Sulphate, cast in sticks, for intro- 
duction into the urethra (Wa). Myrtol, internally, in chronic inflammation of the 
bladder and urethra (Br). Terebene internally, may be used in chronic or subacute 
inflammations of the genito-urinary tract (W). Potassium Bicarbonate, with 
Potassium Acetate, aa gr. x in a large cup of flaxseed tea or a glass of Vichy water, every 
4 to 6 hours; with absolute rest in bed, a calomel pur^e, and urination under hot water, 
sufficient for most cases of urethritis, which may arise from lithiasis, leucorrhea in 
females, etc.: many cases of so-called aborted gonorrhea were really simple urethritis 
(Otis). [Compare Gonorrhea.] 

Urinary Disorders. 

Aconite, of great service in sub-inflammatory retention from chill (P). Turpen- 
tine, in hematuria and chronic catarrh of the bladder, and incontinence from atony (B). 
Strychnine, sometimes employed with marked benefit in retention or incontinence of 
the old (P). Cantharis, frequent or involuntary- micturition, especially when cough- 
ing, in women from weakness of sphincter; one or two drop doses (R). Cannabis 
Indica, in retention from spinal diseases (R); Diuretin, a remarkably efficient diuretic 
in cardiac and renal dropsy, 15 grains several times daily will increase the urine three 
and fourfold. Digitalis, holds high rank as a diuretic, 5j or ij of the infusion night 
and morning, or oftener if necessary; in sudden depression from cold or damp, or after 
scarlatina if danger threatens (P). Benzoic Acid, or Sodium Benzoate, in 10 to 15- 
grain doses, to render alkaline urine acid, and check the formation of phosphates (B); 
will not do so (Hutchinson). Sodium Phosphate is efficient to acidify an alkaline- 
urine (Id). Salicylic Acid also Salol are said to render acid an alkaline urine, especially 
the latter. Potassium Bitartrate in full doses, will acidify an alkaline urine. Uro- 
tropin as a urinary antiseptic, gives the best bactericidal results (Sachs); very efficient 
in ammoniacal fermentation of the urine, which it renders acid; is useful in phospha- 
turia. Helmitol is claimed to be even more efficient than urotropin in all respects. 
Nitrohydrochloric Acid, dilute, gtt. x-xv thrice daily in water, for phosphatic deposits 
f Mears). Ammonium Carbonate, in 6-grain doses, 3 or 4 times a day, to render 
acid urine alkaline. Triticum, in pint doses daily of its infusion or decoction, for 
strangury, cystitis, and many other complaints connected with the urinary apparatus. 
Alkalies, to neutralize acid urine, and control chronic cystitis; the Liquor Potassii 
Hydroxidi preferable to the bicarbonates, which have diuretic action and increase 
frequency of micturition; Liquor Potassii Hydroxidi mixed with the tincture of 
Hyoscyamus may undergo chemical changes, but the combination materially controls 



8 3 o 



URINE. 



painful and frequent micturition in bladder troubles (Thompson). Calcium Sulphate 
in daily dosage of gr. xx-xxx, is particularly efficient in phosphaturia (Etterlen). Buchu 
renders more help than any other drug in retention or incontinence of urine from catarrh 
of bladder implicating the ureters and even the kidneys (P). Water, copious injec- 
tions are beneficial in some cases of suppression (R). Diet, a vegetable diet has a 
powerful influence to alkalinize an acid urine; also fruit, milk and fish. [Compare 
Bladder irritable, Bladder paralysis of, Chyluria, Cystitis, Diabetes insipi- 
dus, Dropsy, Dysuria, Enuresis, Hematuria, Lithiasis, Oxaluria, Uremia, 
Urethral Stricture, Urethritis.] 



B- Scillse, 

Digitalis, 

Hydrarg. Chlor. Mitis, . . .aa gr. xij. 
M. ft. pil. no. xij. Sig. — One pill as 
diuretic twice daily. (Sir A. Clark.) 



B- Potassii Citratis, 5j- 

Sodii Bicarbonat., 3 v. 

Syr. Limonis, § j . 

Aquae, q. s. ad 5 iv. 

M. Sig. — A teasp. every 2 hours, to 

render the urine alkaline. (Roberts.) 



B- Tinct. Digitalis, 5ss-j. 

Spt. .Etheris Nitrosi, 5iij- 

Liq. Ammon. Acetat., 5ss. 

Aquas, q. s. ad §vj. 

M. Sig. — One-sixth every 3 hours, to re- 
establish the renal secretion. (Goodeve.) 



B- Potassii Bicarb., niijss. 

Acidi Acetici 5vj. 

Aquae, 5iij. 

M. Sig. — Teasp. doses as required, as a 
diuretic. Each dose contains about gr. x of 
Potassium Acetate. 



Urine, Clinical Examination. 

Urine for examination should be about four ounces of that passed in the morning 
before breakfast, or a sample taken from all passed during the 24 hours. 

Quantity. The amount passed normally during 24 hours varies between 40 and 
50 fluid ounces (1,200 and 1,500 cc), the quantity depending on the blood pressure 
and the condition of the renal epithelium. It is decreased below the normal during hot 
weather when the perspiration is increased, also in fevers and exhausting diseases. 
It is increased during cold weather when the perspiration is lessened, in both forms of 
diabetes, in contracted kidney, after acute infectious diseases and hysteric or epileptic 
attacks, also in some other morbid conditions. It may be entirely suppressed (ischemia) 
in cholera, acute nephritis, scarlet fever, diphtheria, severe dysentery, hysteria and 
shock, also by obstruction, as calculus or new growths affecting both ureters. 

Composition. The average composition of normal human urine, and the amount 
of each ingredient voided daily, are as follows: — 



Parts in iooo. 



Urea 28.00 

Uric Acid 0.60 

Hippuric Acid 0.35 

Creatinin 0.65 

Extractives 8.00 

Sodium Chloride 8.00 

Phosphoric Acid 2.00 

Sulphuric Acid 1.25 

Lime 0.25 

Magnesia 0.30 

Potassa and Soda 0.60 

Water 950.00 



Organic 
matter, 
37.60 



Voided Daily. 
Grains. Grammes. 

520.80 35.00 

ir.16 0.75 

6.51 0.44 

12.09 0.81 

148.80 10.00 

148.80 10.00 

Inorganic 37-2o 2.50 

matter, 23.45 1.56 

12.40 4-65 0.31 

5-58 o-37 

11. 16 0.75 



930.20 



62.49 



Organic Matter 37-6o. 

Inorganic Matter 12.40. 

Water 950.00 



.699.36. 
.230.64. 



.47.00 
•15-49 



Solids in Urine. The last two figures of the specific gravity nearly represent the number 
of grains of solid matter in the ounce of urine (Bird). The same two figures multiplied by 2 
(Trapp), or by 2.33 (Haeser), give the number of parts of solid matter in 1000 of urine. 



I RINE. 






Odor should be faintly aromatic; a fragrant smell indi< i r, the 

smell o\ violets points to turpentine, al odor indicates alkalin 

decomposition; a fetid smell points to the presence of blood. ' ..-)», 

copaiba, oil of santal, impart their characti lors to the urine 

them. 

Specific Gravity is determined by the urinometer, or by 9pei 

glass, and should be taken with a sample of the urine passed during :.\ houi I 
of normal urine varies from 1.015 to 1.025, and averages about 1.018, having [8 gi 
of solid matter to the fluid-ounce. If the sp. gr. is above 1.030, I 
below 1. 010, suspect albumin. 

Color. Normal urine has a pale yellow or amber color. When ps 
of sp. gr. 1.030 and above, it indicates the presence of glucose. Pale and copious, sp 
gr. below 1.018, is seen in hysteria, convulsions, nervous diseases. Color high, urine 
scanty, sp. gr. above normal,— in fevers and the uric acid diathesis. Color high, urine 
scanty, sp. gr. below normal, — in Bright's disease. Urine is colored -eery yellow or green- 
ish-yellow, by bile and by rhubarb; dark, with odor of violets, by turpentine; dark, 
muddy, smoky, by blood and strong coffee; black, by disintegrated blood, putridity of 
the urine, tar, creosote; olive-green or smoky, by phenol and by salol; brown, by 
arbutin; green, by indigo and salicylic acid; dark-green, by kairin and thymol; dark- 
blue, by methylene blue; bluish-znolet, by resorcinol; violet, by juniper; greenish-yellow, 
reaction acid, or reddish-purple, reaction alkaline, by santonin; blood-red, by hematow - 
Ion; magenta, by fuchsin; reddish-brown, by sulphonal. A milky color is due to fat 
globules and indicates chyluria, or to pus corpuscles from purulent disease of the urinarv 
tract. 

Reaction. Normal urine has a slightly acid reaction, chiefly due to acid sodium 
phosphate, also to uric and hippuric acids, and free acids, as lactic, acetic and oxalic. 
If excessively acid examine for crystals of uric acid. Hyperacidity occurs in fevers 
and in the uric acid diathesis; it is of slight diagnostic importance. On standing for 
some time, the urine undergoes ammoniacal decomposition and becomes alkaline. 
Alkalinity of the urine occurs temporarily soon after a meal, and permanently from the 
presence of alkaline phosphates in large quantity, as in anemia and nervous depression, 
or from the use of a vegetable diet, the ingestion of alkalies (except ammonia) and 
alkaline salts of the vegetable acids, from cold bathing, in gastrectasis, from free blood 
in the urine, and from fermentation of the urine in the bladder. 

Test by litmus paper. If acid, the urine will turn blue litmus red; if alkaline it 
will not do so, and will turn red litmus blue, or yellow turmeric brown. If the reaction 
is alkaline, dry the test-paper by gentle heat, in order to ascertain by the permanency 
or otherwise of the reaction whether the alkali is fixed or volatile; in the latter case 
the ammoniacal condition points to decomposition in the bladder, as in cystitis an^ 1 
atony of that organ. Fixed alkalinity is due to increased alkalinity of the blood, as 
in cases mentioned above, also when exudates and transudates are absorbed, and in 
stomach disorders when hydrochloric acid is diminished. 

Acetone and Diacetic Acid. For Acetone add to the urine in a test-tube a drop 
of an aqueous solution of Magenta decolorized by sulphurous acid. If Acetone is 
present a violet color is produced, the intensity of which is proportional to the amount 
of acetone. In dilute solutions the coloration does not appear until after four or five 
minutes. If the amount of acetone be very minute the urine may be distilled, the first 
portion coming over being examined. In this way a very minute proportion of acetone 
may be detected (Chautard). Or, to 3j of urine in a test-tube add enough solution 
of potassium hydroxide to render it alkaline. Then add a few drops of a freshly 
prepared saturated aqueous solution of Sodium Nitro-prusside, and if acetone be 
present, a purple or violet-red color will be formed on the addition of chemically pure 
Acetic Acid. Acetone precedes the occurrence of diacetic acid in certain cases of 
diabetes, and is said to occur in cancer and in cerebral disease. 

For Diacetic Acid, add to freshly voided urine a few drops of a strong aqueous solu- 
tion of Chloride of Iron. If a precipitate occur the mixture should be filtered. Heat 



832 URINE. 

the filtrate to boiling, and to a small quantity again add the solution of Chloride of Iron. 
If a red color is produced, add Sulphuric Acid, and extract with ether by distillation. 
Diacetic Acid is never found in normal urine. It may occur in the acute exanthemata, 
typhoid fever, pneumonia, phthisis, pleurisy, and pericarditis. When it occurs in 
diabetes, a fatal termination may be expected. 

Albumin may occur in the urine in one of four forms, viz. — serum-albumin, nucleo- 
albumin, albumoses, and peptone; each of which has its special clinical significance. 
Serum-albumin is one of the chief constituents of the blood, and is the form of albumin 
which appears permanently in the urine in acute nephritis and in the various forms 
of Bright's disease. Nucleo-albumin is one of the constituents of bile, and a product 
of desquamated epithelium; it occurs in the urine in jaundice, and in catarrhal condi- 
tions of the urinary passages. Albumoses are intermediate products of the digestion 
of albuminoids, and are present in the urine in scarlatina, leukemia, and gastric and 
hepatic disorders. Their presence does not indicate renal disease. Peptone occurs 
in the urine whenever there is absorption of destroyed tissue, as in phosphorous poison- 
ing, ulcerating carcinoma, and acute suppurations. The tests for albumin in general 
use are as follows, the urine having been previously filtered: — 

(1) Heat and Acid Test. Place a drachm or two of urine in a test-tube, and if alka- 
line add a few drops of acetic acid. Boil the upper layer slowly. If a cloudy opales- 
cence appears in the boiled portion, which does not disappear on the addition of a few 
drops of Nitric or Acetic Acid, it is albumin; if the acid causes it to disappear, it is 
phosphates. The chief disadvantage of this test is that it produces the reaction with 
all four forms of albumin. 

(2) Nitric Acid Test. Place in a test-tube about a drachm of pure nitric acid, and 
carefully overlay it with an equal quantity of urine. If albumin is present a cloudy 
ring of coagulated albumin appears at the junction of the two liquids. Bile causes a 
similar reaction, hence this test is not accurate for serum-albumin as against nucleo- 
albumin. 

(3) Potassium Ferrocyanide Test. Dilute the urine one-third with water, and put a 
small quantity in each of two test-tubes. To one tube add a few drops of Acetic Acid, 
mix the contents of the two several times, and divide again, having some acidulated 
urine in each tube. To the urine in one tube add a few drops of a 10 per cent, solution 
of Potassium Ferrocyanide, and compare with the urine in the other tube. If upon the 
addition of acetic acid a grayish cloud appears, which is not increased by the addition of 
ferrocyanide, nucleo-albumin alone is present, but if it increases serum-albumin is also 
present. This test is accurate and delicate, and is sufficient for general office work. 
If it is negative, all forms of albumin are excluded except peptone, for which the 4th 
test is required. If positive, only albumoses could be confounded with serum-albumin, 
and by the 5th test the presence or absence of the former is ascertained (Monroe). 

(4) Test for Peptone. If the urine contains serum-albumin, it should be removed 
by heat and filtration. Then add to the urine one-third its volume of a 10 per cent, 
solution of Sodium Hydrate, and follow with a few drops of a 2 per cent, solution of 
Copper Sulphate. If a purple color appears peptone is present; normal urine showing 
a bluish green color. 

(5) Test for Albumoses. Add to a small quantity of urine twice its volume of a 
solution composed of equal parts of diluted Hydrochloric Acid and 30 per cent, solution 
of Sodium Chloride. If albumoses are present a cloudiness appears which is dissipated 
on heating the mixture, but reappears when cooled. 

Other Tests for albumin are those by Picric Acid, Potassio-mercuric Iodide, and 
Sodium Tungstate. The great majority of physicians rely on the tests by heat and 
by nitric acid, which are unreliable and unscientific (Monroe). The presence in the 
urine of many substances interfere with the tests for albumin; among them are alka- 
loids, analgen, antipyrine, chloroform, copaiba, hypnone, piperazin, oil of santal, ben- 
zosol, and benzoic acid (contained in benzoin, benzoates, cranberries, plums, styrax, 
balsams of Peru and tolu). 

Bile Pigment. Gmelin's Test, as follows: Place on a white plate near each other 
a drop or two of urine and the same quantity of fuming Nitric Acid, and by manipula- 



URINE. 






tion bring the two together slowly. If bile is present b play of colors resYdta in this 
order,— green, blue, violet, yellow. Marechal's Test, as follows: Put a drachm of 
urine in a test-tube, and let 2 or 3 drops of tincture of fodine trickle down along the 
side of the tube, held nearly horizontally, so that the fluids may touch but not mix. 
If bile pigment is present, a fine green color will be developed below the iodine layer. 
Other tests are Vogel's color-table, Noel's test, Pettenkofer's test, and the Silver Oxide 
test. Bile pigment is present in the urine in the acute stage of catarrhal jaundice, 
and in cases of cholelithiasis. 

Chloride of Sodium in the urine should be normally from ] to 1 per cent. The 
quantity is increased in intermittent fever, and is decreased (hiring other 1. 
particularly in croupous pneumonia during the stage of consolidation, also in 
and in wasting diseases. Add to urine an equal quantity of a solution of Silver Nib 
1 in S, which will precipitate both the chloride and the ph Then add a few 

drops of Nitric Acid, which dissolves the phosphates. Leaving the chloride as a dense, 
white precipitate of silver chloride, its hulk serving to estimate the proportion of chloride 
present. 

Cryoscopy is the study of the freezing point of the urine and blood of those supposed 
to be suffering from renal insufficiency, and is an elaborate procedure requiring a large 
quantity of blood. It may be replaced by the Phloridzin Test, as follows: I'hloridzin, 
gr. I'.-i, with an equal quantity of sodium carbonate to hold it in solution, is given 
hypodermically, the bladder being emptied immediately before the injection. If the 
kidneys are healthy, elimination of sugar will occur in half an hour, hut if none is then 
found in the urine serious renal disease may be suspected; while if the sugar is below 
0.3 per cent, renal insufficiency may be diagnosed. 

Diazo-reaction. This reaction is obtained in certain morbid conditions, particu- 
larly typhoid fever, acute tuberculosis, and measles. The reagents should be freshly 
prepared, and are (1) Hydrochloric Acid 50 parts, Sulphanilic Acid 5, Distilled Water 
1000. (2) Sodium Nitrite in 5 per cent, solution. Fifty minims of the first reagent 
and one drop of the second are placed in a test-tube, and an equal quantity of urine is 
added, then mixed carefully, and Aqua Ammonia; in the proportion of about $ the 
volume is added. If a red color develops on shaking the mixture, the diazo-reaction is 
present. Salol, indican, urochrome, codeine, resorcinol, quinine, digilalin, creosote, 
ingested by the normal individual, produce a similar reaction (Jung); and the use of 
preparations containing tannin, iodine, or iodides inhibit it (Burghardt). 

Glucose. Urine containing glucose is usually light in color, has a high specific 
gravity, and froths readily when poured from one vessel to another. Before testing it 
should be freed from albumin. Fehling's Test, as follows: Add to the boiling urine a 
few drops of Fehling's alkaline cupric tartrate solution. If sugar is present a yellow, 
orange, or red precipitate of cuprous oxide will form; 10 cc. of the solution being reducei 1 
by 0.05 gramme of diabetic sugar (anhydrous glucose). More convenient is Piffard's 
cupro-potassic paste, or Pavy's cupric test pellets, or YVyeth's tablets for preparing 
Fehling's solution; the latter having been used by the writer for several years with entire 
satisfaction. Pavy's Solution is a modification of Fehling's, is intended for those who 
prefer the apothecaries' weights and measures to the metric, and is equally efficient for 
qualitative and quantitative'testing. To make it, dissolve 252 grains of pure Copper 
Sulphate in distilled water to 8 fluid-ounces; and dissolve 1260 grains of Sodium and 
Potassium Tartrate, also 480 grains of Sodium Hydroxide in distilled water to 8 fluid- 
ounces. Keep the two solutions separate in glass-stoppered bottles, in a cool, dark 
place. For use, mix equal volumes of the two by pouring the copper solution into tin- 
alkaline one. Of the mixed solution 210 minims correspond to 1 grain of diabetic 
sugar. On diluting a small quantity of the mixed reagent with 3 volumes of distilled 
water and boiling, it should remain clear, without any trace of discoloration or precipi- 
tation, otherwise it has deteriorated and is worthless. 

Other Tests for glucose are— Trommer's and Haines', which are similar to Fehling's; 
Boucher's bismuth test, Moore's by sodium hydroxide, and the Picric Acid test, which 
54 



834 URINE. 

are subject to fallacious results; that by Indigo-carmine, which is unreliable; the 
Polarization test,' the Fermentation test by yeast, and the Phenyl-hydrazin test. 

Interference with tests for glucose occurs by the presence in the urine of the following 
substances: — acetanilide, antipyrine, ammonium salts, arbutin (contained in epigea, 
kalmia, uva ursi, etc.), benzoates, betol, bromides, camphor, some carbohydrates (e. g. 
animal gum), chloral, chloroform, copaiba, creatinine, cubeb, glycerin, glycosuric acid, 
iodides, morphine, acetphenetidin, pyrocatechin, rhubarb, rumex, salicylic acid, 
(in salicylates, oil of wintergreen, oil of betula, salol), senna, serum-globulin, sulphonal, 
turpentine, urethan, uric acid and urates. Of the foregoing, those which actually 
reduce Fehling's solution are acetanilide, antipyrine, chloral, chloroform, copaiba, 
glycerin, morphine, rhubarb and salicylic acid. 

Temporary Glycosuria may be produced by poisoning with alcohol, amyl nitrite, 
carbonic oxide, chloral, hydrocyanic acid, morphine, sulphuric acid. 

Indican. Jaffe's Test, as follows: Mix 10 Cc. of urine with an equal volume of 
strong Hydrochloric Acid, and about 3 Cc. of Chloroform. Then add, drop by drop, 
several Cc. of a strong solution of Chlorinated Lime, previously filtered, and shake 
after each addition. Allow the mixture to stand for a few minutes, when the chloroform 
will collect at the bottom in a layer which will be more or less deeply blue in color in 
proportion to the amount of indican present. Indicanuria has been considered a symp- 
tom of albuminous putrefactive change in the intestinal canal, but in typhoid fever it is 
often absent, and it occurs sometimes in simple constipation. It is said to be increased 
after a meat diet, and in intestinal obstruction, but not invariably. 

Mucus and Pus resemble each other so closely under the microscope, that it is 
almost impossible for any one, except an expert, to distinguish between them thereby. 
Mucus is more cloudy and flocculent to the naked eye than pus, which is generally of 
a stringy consistence and thickish yellow appearance at the bottom of the vessel. The 
supernatant liquid being poured off, and an equal bulk of Liquor Potassii Hydroxidi 
added, the deposit, if containing much pus, becomes gelatinized, and so tough that it 
cannot be poured out. If mucus, Acetic Acid added coagulates it, forming delicate 
molecular fibres. 

Phosphates. Deposits of phosphates are usually white and bulky. They are 
distinguished from urates by remaining undissolved on boiling the urine, and from 
albumin by dissolving on the addition of a few drops of Nitric Acid. Most samples 
of urine give a precipitate of calcium phosphate on boiling, but on adding a few drops 
of any strong acid the precipitate is redissolved. A deposit of phosphates may occur 
from alkalinity or deficient acidity of the urine, or from actual excess of the phosphates 
excreted; the clinical significance being different in each case. Phosphates have no 
significance when found in urine which has become stale after being voided, and has 
thereby acquired an alkaline reaction. Phosphaturia is the constant elimination in 
excess of the ammonio-magnesian or triple phosphates, or of calcium phosphate; and 
occurs in dyspepsia, cystitis, and alkaline fermentation of the urine in the bladder. 
Magnesium phosphate has no special significance. 

Urates. Urine containing the amorphous Urates of sodium, potassium, and cal- 
cium in excess, has a high color, is strongly acid, and deposits on cooling a brick-dust 
sediment, which disappears promptly when the urine is heated. This condition occurs 
in fevers, renal congestion, dyspepsia, hepatic affections, the lithemic and rheumatic 
diatheses, and after severe exercise causing perspiration. Ammonium Urate, the so- 
called "hedge-hog crystals," occurs in acid urine undergoing the alkaline fermenta- 
tion, and is dissolved by hydrochloric and acetic acids. 

Urea. Remove albumin, if any, from the urine; place a drop on platinum-foil, add 
a drop of Nitric Acid, and leave it undisturbed in a cool place for a minute or two. If 
the urea is in excess, crystals of uric nitrate form immediately. For clinical purposes 
it is necessary to ascertain the proportion of urea present, which is obtained by any 
one of several ureameters sold in the shops. The most reliable depend upon the de- 
composition of the urea by a solution of Sodium Hypobromite or Sodium Hypochlorite, 
with evolution of nitrogen, the volume of which is the measure of the urea decomposed. 



URINE. 






Those instruments are simple in arrangement, and arc usually accurate en 
ordinary purposes. Bartley's urcameter is one of the most reliable and 

The normal quantity of urea eliminated in - 1 1 hours fluctuates between joo and 
600 grains, or 1 ;. to ■' per cent, of the urine. In cold weather ii may fall fa 
140 grains in persons who load sedentary lives; and it is decreased in those who fa 
lived long in the tropics. It is increased in acute fevers, diabetes mellitus, dyspi • 
nervousness, by the excessive use of nitrogenous foods, and alter the copious 
of water. It is decreased in nephritis and starvation, by the use 1 
by the excessive use of tea or coffee, and alter prolonged rest. 

Uric Acid. Chemical qualitative tests are usually unnecessai add may 

often be detected by the naked eye as small, red crystals, in a urinary sediment, or de- 
posited on the sides of a test-tube in which urine has stood for some time; and the 

itals may be recognized with a low power under the microscope. The abseno 
uric acid or its compounds may be determined by the Murexzde Test, as follows: 
On a watch-glass or the cover of a porcelain crucible treat the sediment with a drop 
or two of Nitric Acid, to dissolve it, and carefully evaporate to dryness. Then add a 
drop of Ammonium Hydroxide, the stronger ammonia water, and if uric add or urates 
are present a purple color will be produced, due to murexide (ammonium purpura te). 
The quantitative test is best made by Maisch's modification of the Hopkins method, 
by precipitation with ammonia and hydrochloric acid, but the process is tedious and 
suited only to the laboratory. 

The normal excretion of uric acid varies from 7 to 10 or more grains daily. When 
not eliminated by the kidneys it becomes stored in the body and causes the uric or lithic 
diathesis, the manifestations of which are often serious. Its origin is believed to be 
from the disintegration of leucocytes and nuclein, not from the nitrogenous elements 
of the food, as was formerly held. It is diminished in nephritis, diabetes, chlorosis, 
chronic rheumatism, and before the paroxysms of gout; and is increased in acute fevers, 
indigestion, leukemia, functional affections, heart and lung diseases with much dyspnea, 
and after attacks of gout. 

Other Deposits are best examined with the microscope, and compared with good 
plates, rather than with printed descriptions. The plates in Hoffmann and Ultzmann 
on Analysis of the Urine, will answer the wants of most general practitioners, but the 
text follows the metric system. The urinary deposits may be classified thus: — 



In Alkaline Urine 
only. 


In Alkaline or Acid 
Urine. 


Organized \ Deposits. 


Calcium Phosphate 
Ammonium Urate 
Ammoniaco- 
magnesian, or 
Triple Phosphates. 


Uric Acid 

Urates 

Phosphates 

Oxalates 

Cystine. 


Mucus Torulre 
Pus Sarcinae 
Blood Vibriones 
Tube-casts Bacteria 
Spermatozoa, etc. 



Necessary Apparatus. A dozen Test-tubes. Alcohol lamp. A small porcelain 
dish. 2 watch-glasses. A sheet of platinum foil, f inch square. 3 pipettes of different 
sizes, to be used only for urine. A 2 oz. graduate. Urinometer (Squibb's). Urea- 
meter. Litmus paper, blue and red. Reagents mentioned in this article. Grape- 
sugar, for use in testing the Fehling's solution. A centrifuge apparatus is convenient 
but not essential. Oliver's test-papers or test-pellets, with a color scale, specific gravity 
beads, test-tubes, pipette, and directions for use, are sold under the name Physicians' 
Pocket Reagent Case, and are useful for the examination of urine at the bedside. 

The foregoing includes the tests which a physician will ordinarily employ in the 
examination of urine. For complete instruction concerning quantitative urinalysis the 
reader is referred to one of the numerous manuals on the subject, among which may- 
be mentioned Da Costa on Medical Diagnosis, Tyson on the Practical hxamination 
of Urine, and Sir Henry Thompson's Clinical Lectures on Diseases of the Urinary 
Organs, Lecture xxiv. 



i 



< 



836 URTICARIA — UTERINE CANCER. 

Urticaria. 

Antipyrin, internally, is promptly efficient in urticaria, also in the urticaria-like 
eruptions of children. Chloroform, as ointment to allay itching (R). Ichthyol has 
been used with alleged remarkable results (W); in doses of ttjv thrice daily and also 
applied externally, is the most effective remedy for extensive urticaria (Unna); there 
is no remedy equal to it for chronic urticaria (Morris); a dose of tipiij caused the dis- 
appearance of a severe urticaria of alimentary origin within half an hour (Lanz). Men- 
thol in solution, gr. ij-x to the o, is said to be very effective (W). Potassium Cyanide 
as lotion, 5j to the pint, locally for the itching (R). Arsenic may occasionally be given 
with benefit in chronic urticaria (W). Cimicifuga has promptly cured urticaria of 
nervous origin after complete failure of the usual treatment (W). Nitric Acid, as 
dilute wash, controls itching and prevents wheals (R). Benzoin, the compound tinc- 
ture painted on the skin for itching (R). Benzoic Acid, gr. viij in oiv aquas, as a 
lotion (Squire). Sodium Phosphate, in doses of 60 to 80 grains every 3 hours, is a 
valuable agent in this affection (Wolff). Zinc Carbonate and Zinc Oxide, aa ^jss, 
Phenol pure 5ss, Lime-water oij, Rose-water to make oiv, as a lotion applied freely 
and frequently for the itching (Id). Sodium Salicylate, gr. ij ever)' J hour, is remark- 
ably efficient (Smith) ; gr. xx thrice daily is effective. Copaiba, in full doses will pro- 
duce urticaria, but drop-doses every h hour will sometimes control it (Smith). Strych- 
nine, with emetics and purgatives, when the affection is chronic (Guibout). Colchi- 
cum, in gouty persons (R). Lead, in lotions to ease itching (R). Alkalies, espe- 
cially Potassium Carbonate, in solution locally (R): alkaline baths are useful, and 
warm baths are employed with benefit. Emetics when urticaria is due to gastric 
irritation (W). [Compare Pruritus.] 



Uterine Affections. 

Cimicifuga, to prevent miscarriage in irritable uterus and prolapsus (R); promises 
to be a valuable remedy in uterine affections (Wa) ; is remarkably efficient in neuralgia 
and sympathetic pains arising from an irritable uterus, no matter what their precise 
character (P). Belladonna, with Tannin, as suppository in uterine neuralgia (R); 
as vaginal or rectal injections, in neuralgic or inflammatory pains (Tr). Arsenic, in 
irritable ulcers, of decided benefit; gr. ^ ter die, after meals (Wa). Carbonic Acid, 
injected up the vagina for neuralgia of the uterus (R). Opium, with Starch as injec- 
tion into the rectum, will subdue the pain of uterine diseases (R); gives more speedy 
relief than any other remedy in irritable uterus, but long-continued is one of the worst 
(Wa). Iodized Phenol, has proved the most generally efficient agent for intra -uterine 
use during eight years' experience, applied by hard rubber probes wound with cotton- 
wool; it removes cervical mucus, gives freedom from pain, softens and dilates the cer- 
vix, heals abrasions, removes induration and villosities, regulates the menses, improves 
appetite and digestion, acts as a general alterative, and overcomes barrenness, if used 
long enough, but rapid results are not attainable by any method of treatment (Battey). 
Lead, as plaster, for pain in the back due to uterine disease (R). Chloroform, spray, 
in uterine neuralgia (R). Aquapuncture, has had extraordinary success in uterine 
colic (B). Baths of warm salt water remarkably useful in nervous or inflammatory 
hysteralgia (Tr). [See Abortion, Amenorrhea, Climacteric, Dysmenorrhea, 
Endometritis, Hemorrhage post-partum, Leucorrhea, Menorrhagia, Men- 
strual Disorders, Metritis, Metrorrhagia, Prolapsus Uteri, Uterine Cancer.] 



Uterine Cancer. 
Conium, useful as a palliative, 3 iij— iv ad Oj aquae, as injection for the extreme 
pain of uterine cancer (Wa). Arsenic, small doses for a long time, with a strong solu- 
tion of Iodine and Glycerin locally (Atlee) ; is believed to retard the growth of uterine 
cancer (Br). Carbonic Acid, injected vaginally, to relieve the pain (R). Opium, 



l n RIN1 HON \\i> n\ i-i RTROPHY. S- 

stands first in the list of palliatives, quieting irritation, allaying pain (Wa), Morphine, 

the specific action thereof upon the uterine circulation should be utilized in hop 

eases of this disease (Lutaud). Cotarnine, gives good but transi! Its in the 

hemorrhages from uterine carcinoma (Nassaucr). Ichthyol undiluted, applied on 

tampons, is analgesic and disinfectant, removes fetor, checks secretion, and is rem 

ably palliative (Woyer). Phenol pme. a we.d. solution as injection, an excel] 

cleanser, healer, disinfector, and allayer of pain (R). Bromine, the b 

for destruction of the mass (E). Glycerite of Tannin, checks discharge and 

is still better if mixed with glycerite of Phenol (R). Iodoform, wit' 

fat as bolus inserted into excavation produced 1«\ earner (R); gr. v \ in each bolus 

\\'i. Iodine, the saturated tincture thoroughly applied to the entire surface of the 
mass, is frequently of great use in checking hemorrhage, and seems b oily 

check the extension of the disease (E). Chloral, as anodyne, will agree with most 
persons (E); relieves the pains (VV). Chloroform Spray, for some minute-, (R), 
Cannabis Indica, to allay the pain (W). Thyroid Extract, used internally with 
apparent curative results in three cases of carcinoma of the cervix (Bell). Surgical 
Measures, are to be advised, as medicines can only serve as palliatives. 



Uterine Congestion and Hypertrophy. 
Aurum Salts, often beneficial in chronic metritis with scanty menstruation (B). 
Ergotin, long continued, successful in chronic metritis; lessens congestion (B); long 
continued has produced remarkable results in fibroids and polypi and chronic metritis, 
large, spongy, subinvoluted uterus (P); by interstitial injection into the cervix, has 
been of great benefit (G). Phenol pure, undiluted, on cotton-wrapped probe, no 
better treatment for uterine catarrh (B). Iodine, has proved the most valuable of 
all remedies as a local stimulant and a reliable alterative and excitant of uterine con- 
traction; use a saturated tincture to any part not exposed to the air (E); may be in- 
jected into cervix (G). Iodo-tannin, or Iodoformi oj, Ac. Tannici 5j, a serviceable 
application in many inflammatory and hypertrophic conditions; Iodoform suppositories 
in chronic metritis (P). Potassium Bromide, our main stand-by in uterine troubles; 
aside from its soothing properties it seems to divert the blood from the womb, and to 
lessen uterine congestion (G); a specific cure for simple subinvolution, the benefit 
being derived from the potash (Tait). Digitalis, in subinvolution (B). Cotarnine is 
powerfully hemostatic and gives permanent results in pure subinvolution (Gottschalk); 
in both post-partum and post-abortum subinvolution, provided that no decidua or 
debris remain (Freund). Ichthyol with glycerin on vaginal tampons, has analgesic 
and resolvent action (Id). Picratol gr. j-ij in vaginal suppository, or the i per cent, 
aqueous solution as douche or intra-uterine irrigant after curettement, to relieve con- 
gestion and pain (Yale). Glycerin on cotton tampon to cervix as a local hydragogue 
(Thomas). Glycozone, as an application in tumefied conditions of the cervix and 
uterus, is better than pure glycerin (Edson). Potassium Hydroxide, Caustic Potassa 
and Potassa cum Cake, said to be effective in chronic metritis; used cautiously 
(B). Chromic Trioxide, a strong solution to interior of uterus, a useful application 
Ipecacuanha, in subacute metritis of the puerperal state (Tr). Iron, locally in uterine 
catarrh (R); as a tonic, Iron and other restoratives, a cardinal rule in the treatment 
of all uterine disorders; with Ergot, Quinine, Arsenic or Potassium Bromide, when- 
ever the womb as a whole is congested or hypertrophied; Syr. Ferri Iodidi, with Cod- 
liver Oil, wins half the battle (G). Zinc Valerate, in 2- to 4-grain doses thrice 
daily, is one of the best nervines in these cases (G). Mammary and Parotid Extracts, 
used with signal benefit as internal remedies in several cases of subinvolution and monor- 
rhagia (Bell). Scarification, after dry cupping, in chronic metritis (Thomas'). Elec- 
tricity, in chronic congestive enlargement, a galvanic current of moderate intensity, 
slowly interrupted (B). Water, hot injections or douche, also cold alternately, one of 
the most effective measures, a gallon very hot ter die (R); especially valuable in con- 
gestion, which is generally venous; elevated hips a necessary part of treatment (E); 
cold water is often better than hot (G). Rest, to the patient and the organ, is of prime 



838 UTERINE DISPLACEMENTS — UTERINE ULCERATION. 

importance, abdominal bandage, skirt-supporters, pessary if anteversion or retrover- 
sion, abstinence from sexual intercourse (Thomas). 



R;. Ext. Humuli 5 j. 

Elix. Ammon. Valerat., 

Syr. Lactucarii, aaoss. 

M. Sig. — A dessertsp. at bedtime, or dur- 
ing the day when needed, as an antispas- 
modic. (Goodell. ) 



R. Iodi, 

Potass. Bromidi aa gr. x.\. 

Tinct. Iodi, oj. 

Aqua Destillat q. s. adoiv. 

M. Sig. — ttjxxx to be injected into the 
cervix by 3 to 5 punctures. (Goodell.) 



Uterine Displacements. 
Anteversion, without prolapsus, is not a malposition (F). Ice, locally when parts 
inflamed (R). Hot-water injections, to give tone to the vessels, essential; also val- 
uable after reduction of malpositions (E). Mechanical Means, only reliable or safe 
in retroversion and prolapse; the sound, as a means to restore a retro verted uterus to 
position, cannot be regarded as free from risk, even in skillful hands (E). Pessaries, 
harmful unless expertly fitted; should be adjusted so as to restore the uterus to the 
normal line, where the circulation will be least obstructed, not too high; should never 
be employed where cellulitis exists (E). Cotton Roll, as a substitute for the orthodox 
pessary, is far better; use Borated Cotton in flat sheets, rolling it into a roll 2 inches 
long by 1 inch diameter, and saturating in Boroglyceridi oj, Alumini Acetatis 5j, 
Glycerini Pur. q. s. ad Oj; if an astringent is required, the Acetate may be replaced 
by Alumini Sulphas (Wylie). [Compare Prolapsus Uteri.] 

Uterine Tumors. 

Mercury, the Bichloride in small doses, long continued, of undoubted value in 
treatment of fibrous or polypoid growths; gr. ^ every 6 hours, sometimes restrains the 
hemorrhage when other remedies fail (Wa). Calcium Chloride, in 30-grain doses 
thrice daily, has by prolonged use cured uterine fibroids (Hewitt); calcifies uterine 
arteries, also those of the body generally, and is dangerous (Tilt, Wells). Ergotin, 
hypodermically for fibrous tumor (R); gr. ij-vj on alternate days, give excellent re- 
sults (B); nine cases of fibroid treated thus by Hildebrandt with good results (P); 
this method often causes great pain and severe local inflammation (W); one grain 
each of Ergotin and Ferri Sulphas Exsiccat., in pill thrice daily, persistently, for uterine 
fibroids, using for the hemorrhages a tampon saturated with tincture of Iodine or Mon- 
sel's solution (Parvin). Ammonium Chloride, in fibrous tumors, gives more bene- 
fit than any other remedy, gr. x, twice or thrice daily, for weeks and months consecu- 
tively (Atlee). Ferrous Subsulphate, injected to restrain bleeding, cautiously! (B). 
Saline Mineral Waters, especially those at St. Catherine's, Canada, are useful (B). 
Ichthyol with glycerin on vaginal tampons, also internally, is analgesic in pain due 
to fibrous tumors (Cheron). Opium has specific action on the uterine circulation, 
and in hemorrhage from fibroid tumors or hopeless cases of cancer should be used 
freely regardless of the opium habit. Cotarnine is powerfully hemostatic to the uterine 
circulation, and may be used instead of opium. Mammary Extract internally, was 
employed with signal benefit in two cases of uterine fibroid (Bell). Electrolysis by 
Apostoli's method for the dispersion of fibroid tumors; it will dissipate pain, improve 
nutrition, and diminish their size without danger to life (Bigelow); the treatment of 
fibroid tumors by the galvanic current has been universally recognized by the profes- 
sion (Massey). Diet regulated, animal food chiefly, with recumbent posture while 
flowing, and the long continued use of Ergot in small doses, may accomplish some- 
thing (E). 

Uterine Ulceration. 

Hydrastis, quickly improves; the fluidextract undiluted as a topical application 
in uterine and vaginal leucorrhea, ulcerations and erosion of cervix (B). Phenol 
pure, undiluted, over surface twice a week in simple ulceration (R). Silver Nitrate, 



UVULA VACCINA! ION VAGIN] CIS. 

a serviceable application, but is often abused (B)j the solid stick applied to 
liter cleansing and drying with cotton-wool I \\ .1 1, Alum, as hip bath, lb and 

vaginal injection, is of great utility in ulcerations of the os uteri, or of the uterine cavity 
(Recamier). Glycerin 25, Alcohol i.-l, and pure Creosote 1 part, an excellent appli- 
cation to ulcers of the neck. Glycozone, as an application to ulcerated cervix, is far 
superior to pure glycerin (Edson). Picratol gr. ij in supposifc laturated 

cerin solution applied on tampons, to relieve pain and promote healing i Bis- 

muth Subnitrate, with enough glycerin to make a thick cream, is the best of all appli 
cations for ulceration of the os and cervix uteri (Suesserott). Vegetable Astringents, 
infusions or decoctions of Galls, Oak hark, Hamamelis, ('.cranium, -1, etc.; 

the Glycerite of Tannin, or Iodoform and Tannin, pat 
[Compare Endometritis, Leucorrhea.] 

Uvula. 

Tannin, Rhatany or Zinc, as astringent lozenges, for relaxed uvula (A). Cocaine 
combined with extract of Krameria, in a pastille, is often very effectual as a local astrin- 
gent for elongated uvula (Hall); a 20 per cent, solution applied by the spray or brush, 
will often suffice to give relief in acute uvulitis (Id). Ammonium Bromide, gr. xx 
ad o] aquse, as gargle, is one of the best applications, being as soothing as it is astrin- 
gent (Muirhead). Amputation of the elongated part (A); after applying a 20 per 
cent, solution of cocaine, by Mackenzie's uvulatome, or the uvula may be seized with 
forceps and a portion cut off with scissors (Hall); the hemorrhage may be severe and 
may recur some hours after the operation, but will be arrested by slowly sipping a mix- 
ture of Tannin ovj, Gallic Acid 5ij and Water §j (Mackenzie). 

Vaccination. 

Mercury, the 1 to 1,000 bichloride solution as wash to the skin for preliminary 
asepsis; if not thoroughly removed by hot water it will destroy the vaccine virus and 
render the vaccination unsuccessful. Aconite, internally with Belladonna Ointment 
locally twice daily for erysipelatous redness after vaccination (R). Zinc Oxide, dusted 
over, to allay the subsequent local irritation (W); with Pulv. Amyli, equal parts, over 
the surface. Lead Acetate, 5j to Oj water, as lotion for irritable pock (Foster). 
Phenol, 5j to Oj water, as lotion for excessive redness, with burning and itch- 
ing. 

Vaginismus. 

Ether, by inhalation as anesthetic, to ascertain cause, usually a displacement, 
fissure, or cellulitis (E). Thiol j and Glycerol ij, in which soak a tampon and apply 
for vaginal irritation (Bloom). Iodoform, in suppository when redness and excoria- 
tion; but Belladonna, the extract 1 part with 8 or 9 of fresh lard, when pain alone 
(Gallard). Cocaine, in ointment with Morphine and Conium, smeared over the pain- 
ful spot with the finger; or in a pessary with Iodoform and extract of Belladonna, may 
give speedy relief (Whitla). Piperine, gr. £ hypodermically near the vaginal orifice, 
proved successful (Schiffer). Tents, to gradually dilate the vagina, may be impreg- 
nated with various sedatives. Hygiene, sun-baths, hot-water injections, fresh air, 
removal from husband (E). Operation, Sims', removal of hymen with scissors and 
insertion of glass plug till parts are healed, when the cicatrix is to be divided t E): Atthill 
removed a narrow strip of mucous membrane on each side of the vaginal orifice with 
marked success in a very severe case. 

Vaginitis. 
Silver Nitrate, in solution, gr. xl to the o, applied within the cervical canal and 
over the vaginal mucous lining (E). Pinus Canadensis, the concentrated, colorless 
extract, locally, has a very soothing effect in acute vaginitis. Tannin, the glycerite 



840 VARICELLA — VARICOCELE — VARIOLA. 

in chronic vaginitis of children (R). Argyrol in 10 to 50 per cent, solution, is an ex- 
tremely valuable application (Small). Lysoform as a vaginal injection, has been used 
with success (Simons). Acetanilide in mixture with gum-arabic water, gr. xx-xl to 
the 3, as a vaginal injection (W). Grindelia has been used locally with alleged good 
results (W). Hydrastis the fluid extract locally is considered valuable by various 
specialists (W). Ichthyol in 10 per cent, aqueous or glycerin solutions, is very ser- 
viceable (Bagot); quickly relieves the pain (Bloch); in gelatin and glycerin as pessary, 
to relieve vaginal congestion (Playfair). Zinc Stearate mixed with Thymol Iodide, 
used locally with satisfaction (Brown). Zinol in 3 to 1,000 aqueous solution, an 
excellent application for vaginal and cervical catarrh of gonorrheal origin (Gunther). 
Emollients with Opium, as injections (Goodell). [Compare Gonorrhea, Leucor- 
rhea.] 

Varicella. 
Ammonium Acetate, in diaphoretic and antifebrile mixture. [See under Fever, 
Simple, for formula.] Inunction, with Camphorated Oil, or thin starch, to relieve 
itching and allay inflammation (P). Aconite, is of great value (B). Water, hot and 
cold baths and packs are of great utility; cold, if hyperpyrexia; cold compress if sore 
throat; hot or warm pack when free diaphoresis required (B). Diet, no animal food, 
milk best, with careful attention to the bowels, patient to be kept cool with light cover- 
ing, and use of a mattress rather than a feather bed, is all the treatment required (A). 
Saline Mixture, if high fever. Quinine, during convalescence. Complications are 
to be treated symptomatically. 

Varicocele. 

Hamamelis, appears to have permanently cured one case (R). Ergot, gr. ij-vj 
of Ergotin hypodermically, the needle to be inserted among the affected veins, care 
being taken not to puncture a vein, is effective; severe pain follows for a few hours 
(R). Water, cold douche to the perineum and buttocks, with suspension of testicles 
in cold water (R). Radical Cure, consists in obliterating the veins by wire ligatures, 
etc. (CI). 

Varicosis. 

Hamamelis, is employed with satisfaction in varicose veins and ulcers (Pf). Dig- 
italis, by fomentation, in acute inflammation from varicose ulcers (R). Ergotin, 
injected alongside of vein, but not within it, has cured (B); acts simply as an irritant 
exciting local inflammation, and having no specific action (W). Bandage, or elastic 
stocking; with cold sponging and rubbing upwards, as palliatives (CI). [Compare 
Hemorrhoids, Ulcers.] 

Variola. 

Treatment, in no way differs from that of the other eruptive fevers. Stokes' three 
indications for treatment are accepted by other authorities and are: (1) exclusion of 
ais, (2) keeping the parts in a permanently moist state so as to prevent hardening of 
the scabs, (3) lessening of local irritation (Whitla). Quinine, small doses in adynamic 
states, larger doses when hyperpyrexia (B). Iron and Quinine, in large doses by 
the mouth, also Ergotin by deep parenchymatous injection, and Turpentine by the 
bowel, in the hemorrhagic form of the disease (Whitla) ; these two drugs are the most 
valuable antiseptics in variola (Moore). Opium, low, muttering delirium; not so 
much used now as formerly (B); Morphine in the insomnia of the advanced stage, 
once or twice only, but not when copious salivation or mucous expectoration (Wa); 
useful in the advanced stages to sustain the system against an irremediable irritation 
by blunting sensibility (W). Phenol pure, njjiij with gr. iij of Quinine Sulphate, 
every 4 hours, effectually aborts the disease in its various stages (Seymour); is used 
with advantage (Wa); has been used on theoretical grounds but not with success (B). 



\ IK I [GO. 






Salol gr. w every 2 hours, is very successful (Begg); is useful bul oi limited < 
(Muir). Ammonium Carbonate has been used successful!) fWa) Chloral 
the temperature is high, and there is much restlessness and deliri Cimici- 

fuga, is given internally by some, who assert that it prevents pittii R Mercury 
in ointment or plaster, to pa-vent pitting in semi-confluent, or barer) conflu 
(Wa); formerly used (R). Camphor is said to restore the eruption, it re: 
in confluent malignant smallpox, camphor alone, or with Opium, may be used 
great depression of the vital powers (Wa). Belladonna, successfully used both 
prophylactic and curative agent (Erasmus Wilson ,, fi houi 

dilatation of pupil and some stupor, found effectual (Wa). 'Vaccinia Antitoxin i 
in a few eases with much apparent success i I ! Antistreptococcic Serum used 

in a series of cases with great benefit and rapid convalescence I Smith I; used in aa i 
with mortality of 9 per cent., against 34 other cases not so treated with mortalii 
20* per cent. (Schoull). Diet as in other fevers, tea and dry toast, raw eggs beaten 
up with cold milk, beef-tea when stimulation is indicated, roasted apples, ripe fruit in 

ion, cold water drank freely. 

External Applications, as powdered starch, flour, or Zinc Carbonate 3 parts to 
1 of Zinc Oxide with Olive Oil; cold or tepid water with vinegar, sponged over b 
twice or thrice daily (Wa). Ichthyol has been recommended in the strongest terms 
for the prevention of pitting (W); in 12 to 20 per cent, ointment gives prompt relief, 
shortening the course and preventing pitting (Kamneff); gives good results when applied 
to the scars left by variola (Schmidt). Phenol undiluted, applied carefully to the 
rash over a certain area each day, first on the head and face, will arrest the eruption 
in any stage, cut short the disease, prevent secondary fever and pitting, and lessen the 
patient's infectiousness (Duhr); will arrest the disease in any stage (Neech). Guaiacol 
in olive oil, 1 to 80, as inunction every 4 hours, allays irritation, checks maturation, 
abolishes odor, reduces temperature, and prevents delirium (Ridge"). Carron Oil 
makes a good dressing for the face. Fats, bacon fat smeared over the face, to allay 
itching and prevent pitting. Silver Nitrate, on a sharp-pointed stick, inserted into 
each vesicle after rupture, to prevent pitting (B); or simply paint skin with a solution 
of gr. xx to the § (R). Iodine, the tincture to prevent pitting, is painted ten times 
over face if on first day of eruption, 12 if on the second day, 12-16 times if on third day 
(B). Collodion, or solutions of India-rubber or Gutta-percha in Chloroform, to pre- 
vent pitting; or cotton-wool dipped into Lime liniment, applied to face or neck (R). 
Salicylic Acid 5j in a quart of hot water, applied by sponging to the skin and by 
gargle to the throat ever}' 4 hours, also used internally if much diarrhea, is my treat- 
ment and I have not lost a case of variola since adopting it (Pope). Eucalyptus, the 
Oil as inunction from the very commencement of the disease, is to be strongly recom- 
mended as an antiseptic application to the skin (Whitla). Mercuric Chloride in 
solution 1 to 1,000 applied by scrubbing twice daily, gave excellent results in the Havana 
epidemic of 1898, reducing the secondary fever to a minimum, preventing the stench, 
and lowering mortality to ten per cent. (Woodson). Scrub Baths daily with toilet 
sand-soap, if begun before the primary papules develop prevent vesiculation; and 
combined with puncture of vesicles and Hydrogen Dioxide in full strength on compresses, 
followed by a wet mask saturated with Mercuric Chloride solution 1 to 1,500, will pre- 
vent pitting (Id). Daylight should be shut out absolutely or replaced by red light, 
in all serious cases in which suppuration may be expected (Finsen); red light treat- 
ment has failed to prevent pitting in many cases (Schamberg). Oxygen set free by 
dropping gr. x of Acetozone into boiling water, destroys the odor of variola (Kicffer). 
Water, as cold baths and cold pack, of great utility (B); packing especially on retro- 
cession of rash (R). [Compare Yaccixatiox.] 



Vertigo. 

Digitalis, in small doses, alternately with tincture of Larch, and a long course of 
Iron Citrate and Strychnine, in essential vertigo, without any other head symptoms, 
and with general depraved nutrition, the most effectual treatment (Wa). Potassium 



i 



( 



842 VOMITING. 

Bromide, oftens controls paroxysmal vertigo, without coexistent spasm, or organic 
brain -disease (Wa). Ammonium Bromide, in an effervescing form with Cascarilla, 
for vertigo from overwork, when there are usually restlessness, insomnia, depression 
of spirits, with a sense of impending evil (Wa). Alkalies and Bitter Tonics, give 
the best results in vertigo of gastric origin. Sodium Bicarbonate, after meals, tonics 
before meals. Strychnine, with Iron, thrice daily, gives good results. Corrosive 
Sublimate, in small doses, with attention to the bowels and diet. Cod-liver Oil, 
for giddiness of the aged, when no serious brain-disease (R). Aurum, in vertigo and 
vertiginous sensations connected with gastric disorders or due to cerebral anemia, are 
often removed by a course of the salts of gold (B). Quinine, in aural vertigo, Meniere's 
disease, 10 to 15 grains daily, continued with intervals for several weeks (Charcot). 
Electricity, the constant current daily, anode over cervical vertebrae, cathode over the 
ear, the current strength being gradually increased to toleration and continued from 
3 to 5 minutes at a sitting, is of great benefit in aural vertigo, ameliorating the condi- 
tion in most cases. Nitro-glycerin, gives good results in epileptic vertigo (Br). Ver- 
tigo, is usually symptomatic of disorder of the stomach, or of the liver (cholemia), 
sometimes of general debility, rarely of disease of the brain (H). 



Vomiting. 

Arsenic, in many forms of gastric vomiting, especially that of alcoholism and 
chronic ulcer (B), and the vomiting of cholera (R); gtt. ss of Fowler's solution, every 
I hour for 6 or 8 doses, often relieves vomiting after a debauch, the morning vomiting 
of drunkards, and that of pregnancy (Smith). Nux Vomica, stands next to Arsenic, 
is useful in many ways (B); may be given with Ipecac, especially when tongue coated 
(R). Ipecacuanha, in small doses, will arrest certain kinds — a curious fact; especially 
useful in certain forms, ttjjj of Vinum Ipecac, every h hour or more (B, R, P) ; in sick 
stomach of nervous origin, minute doses are of undoubted value (W). Cocaine, in 
doses of gr. J thrice daily, controlled the vomiting of gastric carcinoma, after all other 
means failed (Meigs); 10-minim doses of a 4 per cent, solution every hour, of inestim- 
able value in the vomiting of yellow fever (Jennings); in 2 per cent, solution sprayed 
high up the nasal passages [see under Nausea]. Potassium Nitrate, one of the surest 
remedies against vomiting and nausea, gr. \ in oss of cold water every 4 or 5 minutes 
until relieved, in all cases except reflex ones and those due to irritant poisons (Moore). 
Opium is one of the most reliable remedies in severe acute vomiting, and is best used 
in suppository containing gr. ss-j of the extract, or by enemata of laudanum with starch - 
water (W). Morphine hypodermically, will arrest many kinds, is best in that of renal 
or biliary calculi, dysmenorrhea, or sea-sickness (P). Codeine in dose of gr. \, usually 
answers well in vomiting from almost any cause (Braithwaite). Atropine has sedative 
action on the vagus, the gastro-enteric branches of which nerve are powerfully excited 
in choleraic vomiting (Harkin). Orexin Tannate is a reliable remedy for intractable 
vomiting, also when food excites vomiting (Limpert); and in severe uremic vomiting 
(Bodenstein). Bismuth, the insoluble salts to allay vomiting dependent on gastric 
irritation (W); for many forms in children, especially when due to gastric catarrh 
(R). Phenol pure, with or without Bismuth (B); doses of gr. j-ij every 15 minutes 
to 2 hours in nervous vomiting (W). Creosote as a nerve paralyzant, is frequently 
employed with great advantage (W); in that of gastric cancer and ulcer (R). Brom- 
ides, in cerebral vomiting only; not in the gastric form (B); Potassium Bromide in 
that of uterine disease (W); Strontium Bromide is excellent in vomiting due to various 
causes; gr. x-xv twice daily with meals. Phenocoll, with Piperazin, gr. xv of each 
daily in a pint or more of carbonated water, was of great service in a case of uncontrol- 
lable vomiting which had resisted every known remedy. Menthol, has successfully 
checked persistent vomiting after all the usual remedies had failed in the hands of 
many well-known observers; itjjx of a 20 per cent, solution in Olive Oil, dropped 
on powdered sugar, each dose being about 1 grain (Weil). Sulphurous Acid, njfv- 
3j, well diluted, or less effectively Sodium Sulphite; Sulphites often curative in vomit- 
ing of sarcinse and acid matter, due to acid fermentation of starchy elements (B). Coc- 



VOMITING OF PREGN VNCY. 

cuius Indicus, efficient in cephalic vomiting ( P), Iris, in vomiting with blinding right 
supraorbital pain, liver deranged (P). Mercury, gr. \ of Gray Powder every two 
hours, especially in children with clayey stools (R); Calomel, gr. i to Oj aquae, oral 
dissolved in 5j oi Lin a teasp. every ten minutes for the regurgitation 

in nursing children (Smith). Bryonia, for bilious vomiting and headai he (P). Ver- 
atrum Album, in vomiting and purging of summer diarrhea (R). Hydrocyanic 
Acid, often very serviceable in nervous vomiting, acts promptly if at all I R). Hydro- 
bromic Acid, oss in 5j of water, four times daily, useful for the vomiting due to gas- 
trie ulcer (R). Chloroform, tmij-v, on sugar, for non-inflammatory vomitix 
Cinnamon or Cloves, will check vomiting i P). Calumba, in vomiting from kidney 
disease and renal calculi; frequently allays that of pregnancy and dentition (P). Ser- 
pentaria, for bilious vomiting (P). Cerium Oxalate, in that of pregnancy and from 
cancer (B); gr. j every three hours (R). Ammonium Carbonate, may relieve' vomit- 
ing when the ejected matter is acid (B). Peptenzyme, is highly efficient. Pepsin, 
for vomiting of food after meals, gr. x-xv before or during meals. Lime-water, is 
a favorite remedy for vomiting, especially in children: Milk and Lime-water often 
relieve when other methods fail (B). Sodium Bicarbonate, 3ss-j to a pint of milk, for 
infants, especially if constipated (R); the effervescing soda powders in the vomiting 
of acute diseases and the exanthemata (B) ; the severe vomiting of acute disease is often 
controlled by 5 doses in plenty of hot water. Kumyss, proves effective when no other 
food will be retained. Carbonated Water, is an efficient remedy. Ice, sucked, with 
horizontal posture, also absolute rest and quiet (Wa); iced champagne, 3ss every \ 
hour (B). Alcohol, iced brandy or champagne in teaspoonful doses every J hour 
in vomiting of cholera, pregnancy, and delirium tremens (B). Counterirritation, at 
epigastrium (R); by mustard over the vagus, extending from below the right ear to 
the right sterno-clavicular articulation (Waugh). Nutrient Enemata may be re- 
quired. [Compare Cholera, Hehatemesis, Nausea, Sea-sickness, Vomiting of 
Pregnancy.] 

R. Mentholis, gr. xx. R. Cerii Oxalatis, gr. xxiv. 

Alcoholis ovjss. Ext. Hyoscyami, gr. xxxvj. 

Syr. Simplicis, q. s. ad o'\). M. Ft. pil. no. xjj. Sig. — One pill twice 

M, Sig. — 5j every hour. {Potter.) I daily. (Goodell.) 



Vomiting of Pregnancy. 
Ipecacuanha or Nux Vomica, either will generally succeed where the other fails 
(R); no other remedy of equal value to Ipecac (P); ttjjj of the wine in 5ij of water 
every 15 minutes, is often successful (W). Nux Vomica, is useful but often fails, gtt. 
ss-j every hour or two in water (R); in very minute doses (S); gtt. ij-iij of the tincture 
every two or three hours, or gtt. x before each meal, with very hot water as a drink, 
is the best treatment (Parvin). Arsenic, Fowler's solution, gtt. j before each meal, 
will often relieve, when vomiting of food, retching and straining, with blood and pain 
(B). Creosote, checks the vomiting (R); has been successfully used (W). Phenol 
pure, drop-doses of crystals, liquefied by heat, in mucilage ter die (Wa). Staphi- 
sagria, has subdued when other remedies failed (P). Cerium Oxalate, gr. j every 
three hours (R); ordinary doses far too small, give as high as 10 grains (B). Mor- 
phine, hypodermically, in severe vomiting (R). Atropine has sedative influence on 
the vagus and is frequently effective (R); never failed to give relief in my many years' 
experience (Boys). Chloretone gr. iij every i hour for 2 or 3 doses, then at longer 
intervals, is efficient in most cases (Hutton). Aconite in full doses, often advantageous, 
but onlv while its constitutional effects are decided and apparent (W). Hydrastin has 
received especial praise (W). Potassium Bromide, is often efficacious (W); oss 
doses thrice daily, exceedingly effective in the combined diarrhea and vomiting of preg- 
nancy; the first dose should be given an hour before rising. Strontium Bromide, 
proved entirely successful in severe cases; gr. xv in water with meals, twice daily, for 
a month. Hydrocyanic Acid, often the best remedy (P); Orexin Tannate is used 
with very satisfactory results (Pick); gives permanent relief in many cases (Frommel); 



I 



( 



8 4 4 



VULVA AND VULVITIS — WARTS. 



promptly cured a very severe case resisting all other medication (Rech). Iodine, 
tijv of the tincture in §ss of sweetened water repeated in £ hour, of magical effect in 
a bad case which had resisted every other treatment; is often useful (B). Menthol, 
has proven very successful in obstinate cases [formula above]. Cocaine, locally to 
cervix, cured a most intractable case of several months' duration, though it failed when 
used internally (Boys); has given excellent results when used internally in triturates 
of y\y grain each [or see formula below]: a 2 per cent, solution sprayed high up the 
nasal passages [see under Nausea]. Calumba, as tincture often useful, drop-doses 
every hour or two (B). Bismuth, with Phenol are often effective (B). Ether, 
sprayed over the epigastric region and the corresponding part of the spinal column, for 
3 to 5 minutes every 3 hours, gives immediate relief (Lubelsky). Pop-corn, is a 
god-send to this complaint, having acted marvelously in several cases in which I have 
used it (Sweringen). Peptenzyme, is said to be very efficient; so also is Pepsin; 
Ingluvin seems almost specific (B). Dilatation, of the cervical canal, by the index 
finger, is regarded as extremely efficient, and reasonably safe; it may bring on abor- 
tion, if too extensive, but from records of several cases it may be said that it is a safe and 
sure remedy (Copman). Ice-bag to spine, an efficient measure (R). Vesication, a 
single blister over the 4th and 5th dorsal vertebrae, never failed for many years to put 
an end at once to the sickness of pregnancy for the whole remaining period of gestation 
(Harkin). 



3$. Atropines Sulphatis, gr. j. 

Morphinae Sulphatis, gr. iv. 

Acidi Sulphurici Aromat.,. . 5iij. 
Aquae, 5 v. 

M. Sig. — Ten to twenty drops, thrice 
daily. (Boys.) 

R*. Bismuthi Subnitrat., gr. clx. 

Cerii Oxalatis, gr. xl. 

Morphinas Sulphatis, ........ gr. jss. 

Syrupi, et Acaciae,..q. s. ad §ij- 
M. ft. emulsum. Sig. — A teasp. every 
hour until vomiting ceases. (Van Valzah.) 



R<. Cerii Oxalatis, gr. xij . 

Ipecacuanhas, gr. xv. 

Creosoti, gr. xxiv. 

M. Ft. pil. no. xij. Sig. — One pill every 
hour. (Goodell.) 

R<. Cocainae Hydrochlor., gr xv. 

Phenolis, Ttjjx. 

Aq. Cinnamomi, oss. 

Syr. Zingib., q.s. ad oj- 

M. Sig. — 10 drops gradually increased to 
20, in a little water every hour until relieved, 
then every 2 or 3 hours. (Poller.) 



Vulva and Vulvitis. 
Sodium Hyposulphite, an unfailing remedy in lotion for aphthae of the vulva 
(R). Arsenic, much used for eczema (T). Lead Acetate, a concentrated solution 
in glycerin locally for eczema of vulva (T). Alum, as lotion in vulvitis of children; 
gr. lx to Oj aquse, or less strong if found to increase discharge (R). Lime-water 
as a wash (R). Zinc Stearate mixed with Aristol an excellent application in vulvitis 
(Brown). Boric Acid in weak solution, 5j to the pint, as frequent cleansing applica- 
tion. Silver Nitrate in 2 per cent, solution painted daily over the inflamed surface 
after the acute symptoms have subsided in vulvitis. Phenol undiluted, applied to 
inflamed glands of the vulva after puncturing them. Cleanliness and local treatment 
of the cause in pruritus of the vulva. [Compare Leucorrhea, Gonorrhea, Prurigo, 
Pruritus, Vaginitis.] 

Warts. 

Chrysarobin, a 10 per cent, solution in ether or liquor gutta-perchae, after having 
pared the wart down with fine glass-paper; is a specific application (Fitz). Thuja, 
is highly effective for the cure of warts having a narrow base and a pendulous body; 
the strong tincture applied locally thrice daily, also wv in a wineglassful of water in- 
ternally night and morning (P). Iron, the tincture of the Chloride and dilute HC1 
Acid, equal parts applied night and morning, very effective (Bulkley). Nitric Acid, 
5j-ij of the dilute acid to a pint of water, as wash to keep small syphilitic warts con- 
stantly moist (R); the strong acid as an escharotic in venereal and other warts (W). 
Papain with glycerin and water, equal parts of each, to dissolve the diseased tissue, but 






WEN WORMS. 

the commercial form is usually ineffective (W). Savin, as a caustii (P): i pari to 
Vlum Wa). Rue, the Oil, with honey, locallj (P). Arsenic Trioxide, as a caustic- 
enough to be used to excite active inflammation; or Liq. Arsenicalis painted over •■■ 
: may be taken internally (B). Mercurial Ointment, containing 5 per cenl ..1 
enic, or a plaster having in each 8 square inches i;. ( grains ,i„s 

of Mercury (Unna). Tannin, and Burnt Alum, equal parts, powdered over warts 
twice daily, gives good results. Chromic Trioxide, gr. c to 3j aqute, with -lass rod 
to saturate diseased growth; remove anv superfluous acid, dress with dry lint (F Wa) 
Mercuric Nitrate, locally (R). Silver Nitrate, as caustic, but is usually too si 
ficial . R). Caustic Alkalies, locally (R); a saturated solution of I 
fully applied by a brush or sponge fastened to the end of a stick, is to be preferred 
(Wilson). Dermal Curette, is much used in Vienna to remove warts by enucleation. 
Strangulation by tying a string tightly around the base, will cause them to drop off 
in a few days. Heat, is a most thorough measure for their radical removal; it may 
be best applied by touching the wart 3 or 4 limes daily with the hot end of a cigar; 
the first few applications only give pain. [Compare CONDYLOMATA.] 

Wen. 
Extirpation, the least troublesome and most speedily effective method. Run a 
scalpel through it, seize the cut edge of the cyst, and gentl'v tear it out with a touch or 
two from the knife. Dressing of lint and Phenolized Oil to cause suppuration and 
contraction (D). 

Worms. 
Santonin, the best anthelmintic, a laxative in the morning, fast all day, a dose of 
Santonin, gr. ss-v, and Calomel, or Troches of Santonin, j-x, at bedtime, a Senna 
draught next morning, lor ascarides (P); for round and thread-worms, give in Castor 
Oil by mouth, or as injection (R). Naphthalene, an excellent all-round anthelmintic, 
of high value for ascarides and teniae, thoroughly reliable for all kinds of intestinal 
worms, giving prompt and complete results invariably, with entire absence of all un- 
pleasant symptoms; a single dose of gr. xv removed tape-worms entire (Mirowicz); 
for adults a dose of Castor Oil should follow, but for children it is preferable to • 
both together. Potassium Iodide, gr. xxxvj, Iodine, gr. xij, Water §j, ten drops 
thrice daily in water, caused the expulsion of a tape-worm n yards long of which there 
were no previous symptoms, and proved successful in other cases (Newington). Aspi- 
dium, oss-j of the oleoresin repeated in 2 or 3 hours, after a milk diet for a day, against 
tapeworm (W); followed by a brisk cathartic (P). Pepo, gij as emulsion, taken 
fasting, one of the most efficient remedies against tenia? (B). Pelletierine, the 
alkaloid of Granatum, is by far the best vermifuge for a tapeworm, repeated after a 
week for a second worm, as many as 3 having been found in one patient (Da C); gr. 
xv-xx of the Tannate, followed in a few hours by Castor Oil (R). [A formula for a 
mixed treatment is given in Part I under the title Granatum.] Kamala (Rottlera), 
excellent for teniae, requires no purge (P); gr. cl-clxxx for an adult (Wa). Cusso, 
the fluidextract in dose of oij to oj, or the same quantity of the flowers infused in §iv 
of boiling water, for both varieties of the tape-worm. Myrtol, is efficient against 
ascarides and round worms (B). Thymol, is almost specific against the ankylostomum 
duodenale, given in doses of gr. x-xxx, well triturated and in capsules, repeated 3 or 
4 times; but no alcoholic drink afterwards lest the drug be absorbed and poisoning 
ensue (Mn); gr. xxx for an adult, repeated after 2 hours, for uncinariasis (Warfield). 
Thymotal is an efficient vermifuge, especially in ankylostomiasis (Pool). Spigelia 
5ss-j for a child of 2 years, oiv for an adult, of the fluidextract of Spigelia and Senna, 
is efficient against the round-worm, which it seems to narcotize (W). Chloroform, 
a very efficient teniafuge, oj in oj of mucilage, after 20 hours' fast, followed one hour 
later by oj of Castor Oil, this is an adult dose, 5j should never be exceeded (Wilde). 
Iron, the syrup of the Iodide internally and a solution of the tincture locally, for as- 
carides (B); the Tinct. Ferri Chlor. oss ad Oj aquae, a good injection for thread-worms, 



i 



i 



846 WOUNDS. 

coagulating their albumin (R). Quassia, the infusion an effectual injection, conjoined 
with simple bitters internally, for ascarides (R). Lime-water, as injection for thread- 
worms (R); 5iij-iv repeated, for ascarides (Wa). Sodium Chloride, in 5ss doses 
on empty stomach, expels ascarides and prevents their reproduction (Wa). Turpen- 
tine in doses of 5ss, is efficient against tape-worm and round-worm, but is liable to 
produce unpleasant effects, and should only be used when other remedies have failed, 
or cannot be obtained (W). Papain destroys tape-worms, ascarides, etc. which are 
discharged in a partly digested condition after purgation. Quinine, as a tonic, also 
cold sponging, out -door exercise and judicious diet; useful probably by preventing 
the production of the abundant mucus which favors the growth of worms (R); espe- 
cially useful for ascarides, also as injection for thread-worms and tenia: (Wa). Ignatia, 
for convulsive symptoms (P). Eucalyptus, as injection, for ascarides (B). Aloes, 
is efficacious for ascarides (P). Scammony, for thread-worms in rectum (R); with 
Calomel, effective (Wa). Tannin, as Catechu, Kino, Red-gum, Rhatany, Hema- 
toxylon in injections, to destroy thread-worms (R). Alum, as solution for injection 
(R). Ammonium Chloride, to prevent formation of thick mucus which serves as 
nidus for worms (R). Valerian, especially when convulsions (R). Azedarach in 
decoction is used in the South for round-worms (W). Ailanthus in decoction of 
the fresh bark, for tape-worm (B). Tonics, as Iron, Cod-liver Oil, etc., to restore 
the intestinal canal to a healthy condition (R). [Compare Chyluria.] 



R. Chloroformi, 

Oleores. Aspidii, aa. oj- 

Emulsi Ol. Ricini (50 per 
cent.), oiij • 

M. Sig. — One dose after 24 hours' fast- 



is Fluidextr. Spigelian, oj. 

Fluidextr. Sennae. 5s.s 

M. Sig. — A teasp. to a child of 3 to 5 
years. , (Smith.) 



R\ Fluidextr. Spigelise et Sennae, oj- 

ing. Acts just as well if the Male Fern be I Santonini, gr. viij. 

omitted. (Smith.) M. Sig. — A teasp. to a child of 5 years. 

Wounds. 

Arnica, as lotion, is very useful for external bruises and cuts, also for internal 
injuries; unites surfaces very rapidly after amputations; the infusion or decoction best 
(P); very effectual (Wa). Aconite, valuable in surgical fever (P). Bismuth Sub- 
iodide, dusted into a wound one of the most efficient antiseptics, non-irritant, and a 
prompt stimulant of granulation; an excellent dressing for wounds after approxima- 
tion of the edges, the powder to be dusted thickly over the edges and thoroughly covered 
with flexible collodion. Dermatol (Bismuth Subgallate), is an excellent non-irritant 
vulnerary, having great stability and valuable drying and bactericidal qualities. Euro- 
phen, is an ideal application to sores and wounds, also for the many protective require- 
ments of minor surgery; is used as a dusting powder, or as a 5 to 10 per cent, ointment, 
with Lanolin as a base. Thymol Iodide is very efficient, or a mixture of it and Europhen, 
equal parts of each; it is an excellent substitute for Iodoform, and odorless. Ace- 
tanilide, in fine powder dusted over the surface of wounds and other breaches of tissue; 
with an equal part of Boric Acid, in the treatment of minor infected wounds, but its 
free external use is not entirely devoid of danger (W). Boric Acid in lotion or oint- 
ment, or dry as a dusting powder, for antiseptic dressing of fresh wounds (W) ; Boro- 
glyceride in aqueous solution, 1 to 40, may be used as a lotion. Phenol pure, in 2 
per cent, solution injected into poisoned wounds (Hueter); is but little employed at 
present (W) ; is the one great agent to combat infection or to prevent it, a strong solu- 
tion, oj to the o to thoroughly swab an infected wound, or a 5 per cent, solution if 
the wound is not severe (Lathrop). Salicylic Acid is preferred to phenol (Thiersch); 
in fine powder applied to gangrenous and sloughing wounds (B). Iodoform is exten- 
sively used as an antiseptic dressing, but is dangerous when dusted freely into a large 
wound (W); powdered and dusted over sloughing wounds, irritable and iil-conditioned 
ulcers and sores (B); Iodoform 1, Collodion 9 parts, painted on a superficial wound 
while edges are held together (Gross); may be painted over edges when stitched to- 
gether; gives excellent results. Mercury, the Bichloride, gr. vijss to quart j of hot 
water, stirred with a stick, makes a solution of 1 to 2000; the best of all antiseptics for 



\ I I LOW M \ I R. 

washing a wound or cavity, and for saturating the drc ill Hydrogen Dioxide 

is especially adapted to the cleansing and disinfection of deep infected wound U , 
is very efficient for profusely suppurating wounds (Koslow one, the 

aqueous solution freely applied after incision, cured a bad case o I 
in both hands following wounds made by explosion of dynamite (Chisolm) Pol 
sium Permanganate in solution forms an elegant disini. \\ 

Formaldehyde is both irritant and painful to the tissues, but is used in i to J pel i 
solutions for infected wounds (W); in a 10 percent, soap, followed b; chloride 

solution and sterile water, for cleaning a lacerated wound (Lathrop), Al iimti n 
powerfully astringent, desiccant and antiseptic, and reai wounds, 

Ichthyol undiluted, is useful in open wounds, especially fissured one-, of the scalp 
^I'nna); by inunction in deep or superficial wounds, also in serious lesions, alleviates 
pain, reduces swelling, and gives good results (Lorenz); painted over a sutured wound 
will leave scarcely visible cicatrices (Unna). Ichthoform is an excellent vulnerary 
(Rochaz); rapidly promotes healthy granulation without irritant action (Goldmann), 
Aloes, pulverized fine, is an efficient dressing for wounds, closing them and favoring 
eieatrization, also relieving the pain at once, requires removal only at long intervals 
(Millet). Nitric Acid, as escharotic for gangrene (B). Turpentine, one of the most 
efficient applications in hospital gangrene (B). Balsam of Peru, excellent for closing 
recent wounds (P). Benzoin, the basis of all the healing balsams (P). Opium in- 
ternally, to quiet intestinal peristalsis in abdominal wounds (R); promotes the repar- 
ative process (P). Zinol, in ii per 1000 aqueous solution on dressings for suppurat- 
ing wounds (Gunther). Chloretone in 1 per cent, solution as anesthetic and germicide 
for infected wounds (W). Gum Tragacanth in thick aqueous solution applied to 
granulating surfaces to protect them from the air (Wa). Tannin, or Glycerite of 
Tannin, to coat over wounds (R). Collodion or Liquor Guttae-perchae, to secure 
primary union of incised wounds (B); as protective covering (P). Ammonium 
Carbonate, gr. v hypodermically in the vicinity of wounds caused by poisoned arrows, 
repeatedly used with success in saving life by Dr. Parke, the surgeon of Stanley's last 
expedition in Africa. Alcohol favors the cicatrization of open wounds (B); is suffi- 
ciently antiseptic to be used as a dressing for wounds by lint kept wet with spirits ( W). 
Galvanic Couplet to indolent wounds (B). Poultices of yeast or charcoal for foul 
wounds (B); the ordinary poultices of flaxseed, slippery elm, etc., are hotbeds for 
bacteria and have no place among the resources of the aseptic surgeon (Senn); their 
injudicious use is the cause of infection, abscesses, diffuse cellulitis and septicemia in 
many cases (Lathrop). Water, in universal use as dressing; cold water often abused, 
hot-water dressing as advocated by Hamilton, promises better results (B). Turkish 
Baths, for pain in the seat of old wounds (R). Ice and Salt, applied to wounds pre- 
vent inflammation (R). Drainage should be the rule in stab wounds of the abdomen, 
and is of value in punctured wounds and other forms (Lathrop). [Compare Bed- 
sores, Gangrene, Hemorrhage, Inflammation, Septicemia, Surgical Fever, 
Ulcers.1 



R . Acidi Tannici, 5 i j . 

Alcoholis Absolut., 5 ss. 

Athens oijss. 

Collodii, § xij . 

M. Sig. — Styptic Collodion. 



R. Collodii, gj. 

Olei Ricini, 

Phenolis, aa. oss. 

M. Sig. — Phenolized Collodion, for use 
on wounds. 



i 



Yellow Fever. 
Pilocarpine in dose of gr. \ hypodermically in the first stage, carried to the induc- 
tion of emesis and catharsis, also diaphoresis, is the most efficient treatment known, 
absolutely jugulating the paroxysm (Habersmith). Sodium Bicarbonate to counter- 
act the hyperacidity of the gastric and intestinal contents, with small doses of Mercuric 
Chloride (see formula below); of 301 white cases so treated only 7.3 per cent, died, 
and of 72 blacks all recovered (Sternberg); this plan of treatment promises well 1 Mm. 
Mercury, a Calomel purgative, gr. ss, 2 or £ times on hte first day, followed by a warm- 



( 



848 YELLOW FEVER. 

water enema, is good treatment (B); has many advocates, and many opponents (Wa); 
should generally be abstained from (S). Turpentine, when cardiac weakness, depres- 
sion of vaso-motor system, dissolved state of the blood, iujx-oss; small doses, with 
Tinctura Ferri Chloridi, in the hemorrhagic form (B). Quinine, has some strong 
evidence in its favor as an abortive agent, one large dose, gr. xxx-xl, with Opium at 
outset (Wa); is not a specific; may hasten recovery in mild cases (S); gr. xx per rec- 
tum, to reduce temperature (B). Lime-water, with milk, has been found efficient 
for the vomiting (Wa). Capsicum, to obviate the black vomit, is highly spoken of 
(Wa). Cocaine, for the vomiting, nothing equals it in efficiency, it also acting as a 
diuretic, 10-minim doses of a 4 per cent, solution, by mouth, every hour for two or three 
doses, acts like a charm (Jennings). Chloroform, for the vomiting, a few drops to pre- 
pare the stomach for reception and retention of food ; its effects transitory, has to be re- 
peated before each meal (Wa) ; the Ammoniated Chloroform in zymotic pyrexia, its action 
is sedative, analgesic and antipyretic (Richardson). Phenol by the stomach and 
hypodermically, remarkably efficacious, even after the ominous "coffee-grounds" vomit 
(Lecaille). Cotarnine as a powerful hemostatic, for the black vomit. Morphine is 
dangerous and must be avoided (Mn). Duboisine is the most efficient hypnotic and 
calmative (B). Veratrum Viride, gtt. j-x hourly, according to age, till pulse and tem- 
perature are subdued; successfully used in connection with Mercury, etc. (White). 
Antipyrine for high temperature (W). Treatment must all be done at the beginning, 
no time to be lost; cold sponging early and frequently repeated, Calomel, Quinine and 
Salines at the start, Potassium Acetate for the kidneys, Morphine for gastric irritation, 
the feet to be in mustard water (Da C). Diaphoretics and Diuretics, also Laxa- 
tives, are very important throughout the disease (Da C). Purgation, throughout 
the disease (Da C); is beneficial at the very onset, but must not be repeated nor used 
at all after the second day of the disease (Mn). Alcoholic Stimulants in the typhus 
form only (B); in the third stage should be given boldly, promptly and constantly 
(Da C); iced champagne, Sss every \ hour for the vomiting (B). Rest, as absolute 
as possible, is very important (Da C). Diet should be of the blandest description 
(A); Milk and Lime-water, half and half, in small quantities, is the best aliment; in 
convalescence, the utmost care is necessary in giving aliments (B); many practitioners 
of great experience in Cuba forbid all food until convalescence is well established, and 
then allow only the blandest. Blood-serum from convalescent patients, used in 5 
cases with 4 recoveries (Agramonte). [Compare Remittent Fever.] 

Ri. Cotarninae Hydrochlor., gr. xx. 

R*. Sodii Bicarb., 3ij- Antipyrinae, 3jss. 

Hydrarg. Chlor. Corros., . . gr. \. Syrupi Simplicis, 3iv. 

Aquae Destillatae, Oij. Aq. Aurantii Flor.. .q. s. ad 3ij- 

M. Sig. — Three tablespoonsful to be M. Sig. — 3] every 3 or 4 hours, for the 

taken every hour. {Sternberg.) black vomit. 



APPENDIX. 



LIST OF CONTRACTIONS AND LATIN PHRASES USED IX WRITING 
PRESCRIPTIONS, WITH THE CORRESPONDING ENGLISH 

EQUIVALENTS. 



Contraction. 



gust. 



aa. 

Abd. 

Abs. feb. 

Ace. 

Acerb. 

Acerbit. 

Ad 

Ad concil. 

Ad j vie. 

Ad sec. vie. 

Ad 3 tiam vie. 

Add. 

Add. 

Add. c. trit. 

Ad def. an. 

Ad grat. acid. 

Ad grat. gust. 

Adhib. 

Adjac. 

Ad lib. 

Admov. 

Ad part, dolent. 

Ad sat. 

Adst. feb. 

Adv. 

JEg. 

Aggr. feb. 

Agit. 

Agit. 

Agit. ante sum. 

Agit. vas. 

Alb. 

Aliq. 
Alt. 

Alt. hor. 
Alut. 
Alv. 

Alv. adst. 
Amp. 
Ampul. 
App. 
Aq. 

Aq. astr. 
Aq. bull. 



Word or Phrase. 

Ana 

Abdomen, gen, inis 

Absente febre 

Accurate 

Acerbus, a, urn 

Acerbitas, gen. atis 

Ad (l>rcp. gov. ace.) 

Ad conciliandum gustum 

Ad duas vices 

Ad secundum vicem 

Ad tertiam vicem 

Adde, Addantur 

Addendus, Addendo 

Adde cum tritu 

Ad defectionem animi 

Ad gratam aciditatem 

Ad gratum gustum 

Adhibendus 

Adjacens 

Ad libitum 

Admove, Admoveatur 

Ad partes dolentes 

Ad saturandum 

Adstante febre 

Adversum 

/Eger 

Aggrediente febre 

Agita 

Agitetur 

Agita ante sumendum 

Agitato vase 

Albus, a, urn 

Aliquot 

Alter 

Alternis horis 

Aluta 

Alvus 

Alvo adstricta 

Amplus 

Ampulla 

Appone, Applica 

Aqua, gen. ae 

Aqua astricta 

Aqua bulliens 



English Equivalent. 



Of each. 



The belly. 

Fever being absent. 

Accurately. 

Sharp, sour, harsh (to the 

Sourness. 

To, up to. 

To suit the taste. 

At twice taking. 

For the second time. 

Fot the third time. 

Add. Lei them be added. 

To be added, By adding. 

Add with trituration. 

To fainting. 

To an agreeable sourness. 

To an agreeable taste. 

To be administered. 

Adjacent. 

At pleasure. 

Apply, Let it be applied. 

To the painful (aching) parts. 

To saturation. 

The fever being on. 

Against. 

The sick one, the patient. 

While the fever is coming on. 

Shake, stir. 

Let it be shaken or stirred. 

Shake before taking. 

The vial being shaken. 

White. 

Some. 

The other. 

Every other hour. 

Leather. 

The belly, the bowels. 

The bowels being confined. 

Large. 

A large bottle. 

Apply, Lav or put on. 

Water. 

. D water. 
iter. 



i 



55 



( 



8 5 o 



LIST OF CONTRACTIONS AND LATIN PHRASES. 



Contraction. 


Word or Phrase. 


English Equivalent. 




Aq. com. 


Aqua communis 


Common water. 


Aq. ferv. vel calid. 


Aqua fervens vel calida 


Hot water. 


Aq. fluv. 


Aqua fluviatilis 


River water. 


Aq. font. 


Aqua fontana vel fontis 


Spring water. 




Aq. gelid. 


Aqua gelidus 


Cold water. 




Aq. mar. 


Aqua marina 


Sea water. 




Aq. niv. 


Aqua nivialis vel nivalis 


Snow water. 




Aq. phag. 


Aqua phagedamica 


Yellow wash. 




Aq. pluv. 


Aqua pluvialis 


Rain water. 




Aq. pot. 


Aqua potabilis 


Drinkable water. 




Aq. satur. 


Aqua saturni 


Lead-water. 




Aq. urb. 


Aqua urbis 


City water. 




Aqual. 


Aqualis 


Pertaining to water. 




Aquil. alb. 


Aquila alba 


Calomel. 




Aut 


Aut 


Or. 




B. A. vel Bal. ar. 


Balneum arenae 


Sand-bath. 




B. M. vel Bal. mar. 


Balneum maris 


Salt-water bath. 




B. V. vel Bal. vap. 


Balneum vaporis 


Vapor-bath. 




Bals. 


Balsamum 


Balsam. 


B. B. 


Barbaderisis 


Barbadoes. 




Bene 


Bene 


Well, good. 




Bib. 


Bibe vel Bibatur 


Drink (thou), Let it be drank. 




Bid. 


Biduum 


Two days. 




Bis 


Bis 


Twice. 




Bis die 


Bis in die vel dies 


Twice a day. 




Bol. 


Bolus 


A large pill. 




Bon. 


Bonus 


Good. 


Brach. 


Brachium 


The arm. 


Brev. 


B re vis 


Short. 


Bui. 


Bulliat vel Bulliant 


Let it (or them) boil. 




But. 


Butyrum 


Butter. 




C. 


Cum 


With. 


Caerul . 


Caeruleus, gen. i 


Blue. 




Calef 


Calef actus, gen. i 


Warmed. 




Calom. 


Calomel vel Calomelas 


Mild Chloride of Mercury, Calomel. 




Calor. 


Calor, gen. oris 


Heat, warmth. 




Cap. 


Cape, Capiat 


Take (thou), Let him take. 




Cap. quant, vis 


Capiat quantum vis 


Let him take as much as he will. 




Capil. 


Capillus, gen. i 


A hair. 


Capsul. 


Capsula, gen. ae 


A capsule. 


Caput 


Caput, gen. Capitis 


The head, Of the head 


Carbas. 


Carbasus, gen. i 


Linen, lint. 




Caute 


Caute 


Cautiously. 




Cc. 


Centimeter cubicum 


Cubic centimeter. 




Ccu. 


Cucurbita 


A cupping-glass. 




Celer. 


Celeriter 


Quickly, immediately. 


Cena. 


Cena vel Ccena 


Supper. 




Chart. 


Charta 


Paper. 




Chart, cerat 


Charta cerata 


Waxed paper. 




Chartul. 


Chart ula 


A small paper. 


Chin. 


Chininum 


Quinine. 


Cib. 


Cibus, gen. i 


Food, victuals. 


Circit. 


Circitu 


Near, around, about. 


Cit. 


Cito 


Quickly. 




Cito disp. 


Cito dispensetur 


Let it be dispensed quickly. 




Clar. 


Clarus, a, um 


Bright, clear. 




Claus. 


Clausus, a, um 


Closed, inclosed. 




Coch., Cochleat. 


Cochleare, Cochleatim 


A spoonful, By spoonsful ( 5j)- 




Coch. amp. 


Cochleare amplum 


A dessertspoonful ( 5ij)- 




Coch. mag. 


Cochleare magnum 


A tablespoonful ( §ss). 





1 is i OF CON in \n [ONS \\i 


' I \H\ PHRA! 


*5 


Contraction. 


1 or riir.is.-. 




Coch. med. 


1 Meare medium 


A dessertspoonful i Tjij). 




Coch. parv. 
Coct. 


Cochleare parvum 


ipoonful 1 . 
Boiling. 




Cog. 


Cogantur 


Let tln-m be combined. 




Col. 


Cola 


Strain. 




Colatur. 


Colaturs 


< M' the strained liquor. 




Colat. 


a us 


Strained. 




Colent 


Colentur 


Lei them be strained. 




Colet. 


Colet ur 


Let it be strained 




Coll. 


Collum, gen. i 


The neck. 




Collun. 


Collunarium, gen. i 


A nasal wash. 




Collut. 


Collutorium 


A mouth-wash. 




Collyr. 


( lollyrium 


An eye-wash. 




Coloret. 


Coloretur 


bet it be c olored. 




Commis. 


Commisce 


Mix together. 




Commod. 


Commode 


Rightly, properly, suitably. 




Comp. 
Con., Concis. 


Compositus 
Concisus 


Compound, compounded. 

Cut. 




Concus. 


Concuscus, gen. i 


Shaken. 




Concut. 


Concuti, Concutiatur 


Shake, Let it be shaken. 




Conf. 


Confectio 


Confei 




Cong. 


Congius 


A gallon. 




Conquas. 


Conquassando 


By vigorous shaking. 




Cons. 


Conserva, Conserve 


A conserve; Keep, preserve. 




Consperg. 


Consperge 


Dust, sprinkle. 




Cont. 


Contere 


Rub together. 




Cont. rem. 


Continuentur remedia 


Let the medicines be continued. 




Contus. 


Contusus 


Bruised. 




Coq. 


Coque, Coquantur 


Boil, I el them be boiled 




ad med con- 


Coque ad medietatis con- 


Boil to the consumption of half. 




sump. 


sumptionem 






Coq. S. A. 


Coque secundum artem 


Boil according to art. 




Coq. in S. A. 


Coque in sufliciente aquje 


Boil in sulYu ient water. 




Coq. simul 


Coquentur simul 


Boil them together. 




Cor 


Cor, gen. cordis 


The heart, Of the heart. 




Cort. 


Cortex, gen. corticis 


The bark, Of the bark. 




Cot. 


Cotula 


A measure. 




Cox. 


Coxa 


The hip. 




Cras 


Cras 


To-morrow. 




Cras mane sumend. 


Cras mane sumendus 


To be taken to-morrow morning. 




Cras nocte 


Cras nocte 


To-morrow night. 




Cras vesp. 


Cras vespere 


To-morrow evening. 




Crast. 


Crastinus 


For to-morrow, early. 




Cru. 


Cruor 


Blood, gore. 




Cucur. 


Cucurbitula 


A cupping-glass. 




Cuj. 


Cujus, Cujus-libet 


Of which, Of anv. 




Cum 


Cum 


With. 




Curs. hod. 


Cursu hodie 


During the day. 




Cyath., C. vinar. 


Cyathus, vel C. vinarius 


A wine-glass ( Sj-ij). 




Cvath. theas 


Cyatho these 


In a cup of tea. 




D. 


Dies, Dosis 


A <lay, A dose. 




Da, Det. 


Da, Detur 


Give, Let it be given. 




De 


De {prep. gov. ablative) 


From, down. 




Deaur. pil. 


Deaurentur pilulse 


Let the pills be gilded. 




Deb. spiss. 


Debita spissitudo 


To a proper consistent e. 




Deb. 


Debitus, a, um 


Due. proper. 




Dec. 


Decanta 


Pour olT. 




Decern 


Decern, decimus 


Ten, The tenth. 




Decoct. 


Decoctum 


A decoction. 




Decoq. 


Decoque 


Boil rlown. 





i 



85< 



LIST OF CONTRACTIONS AND LATIN PHRASES. 



Contraction. 


Word or Phrase. 


English Equivalent. 


Decub. 


Decubitus 


Lying down. 


De d. in d. 


De die in diem 


From day to day. 


Dein 


Dein vel Deinde 


Thereupon; afterward, then. 


Deglut. 


Deglutiatur 


Let be swallowed. 


Dej. alv. 


Dejectiones alvi 


Stools. 


Dejic. 


Dejiciatur 


Let be purged. 


Dent. 


Dentes; Dentur 


The teeth; Let them be given. 


Det. in. dup. 


Detur in duplo 


Let twice as much be given. 


Dext. 


Dexter, Dextra 


The right. 


Dieb. alt. 


Diebus alternis 


Every other day. 


Dieb. tert. 


Diebus tertiis 


Every third day. 


Dies vel D. 


Dies, gen. diei 


A day. 


Dig. 


Digere, Digeretur 


Digest, Let it be digested. 


Diluc. 


Diluculo 


At break of day. 


Dil. 


Dilue, Dilutus, a, um 


Dilute (thou), Diluted. 


Dim.' 


Dimidius, a, um 


One-half. 


D. P. vel Dir. prop. 


Directione propria 


With a proper direction. 


Disp. 


Dispensa, Dispensetur 


Dispense, Let it be dispensed. 


Div. in p. aeq. 


Dividatur in partes 
asquales 


Let it be divided into equal parts. 


Divid. 


Dividendus, a, um 


To be divided. 


Dol. 


Dolor, Dolore 


Pain, In pain. 


Don. 


Donee 


Until. 


Don. alv. dejec. 


Donee alvus dejecerit 


Until the bowels move. 


Don. alv. sol. ft. 


Donee alvus soluta fuerit 


Until the bowels shall be opened. 


Don. dolor neph. 


Donee dolor nephriticus 


Until the nephritic pain is removed. 


exulav. 


exulaverit 




Don. hab. colat. 


Donee habeas colatura 


Until you have of strained liquor. 


Don. len. dol. 


Donee leniatur dolor 


Until the pain is relieved. 


Don. sint res. 


Donee sint residuae 


Until there is ... of residue. 


Dos. 


Dosis 


A dose. 


Dr., 5 


Drachma 


A drachm (60 grains). 


Dulc. 


Dulcis, Dulcitas 


Sweet, Sweetness. 


Dup. 


Duplico 


In duplicate. 


Dur. dolor. 


Durante dolore 


While the pain lasts. 


Ead. 


Eadem (fern.) 


The same. 


Eburn. 


Eburneus 


Made of ivory. 


Ejusd. 


Ejusdem 


Of the same. 


Elect. 


Electuarium 


An electuary. 


Em. 


Emesis 


Vomiting. 


En., Enem. 


Enema, Enemata 


A clyster or enema, Enemas. 


Epistom. 


Epistomium 


A stopper, bung. 


Et 


Et 


And. 


Etiam 


Etiam 


Also, besides. 


Evan. 


Evanuerit 


Shall have disappeared. 


Ex 


Ex (gov. ablative) 


From, out of. 


Ex quib. sum. 


Ex quibus sumatur 


From which are given. 


Ex mod. p. 


Ex modo praescripto 


After the manner prescribed. 


Ex paul. aq. 


Ex paululo aquas 


From (In) a very little water. 


Ex parte 


Ex parte 


Partly. 


Exhib. 


Exhibeatur . 


Let it be exhibited. 


Exper. 


Experime 


Try (thou). 


Ext. 


Extende, Extendatur 


Spread, Let it be spread. 


Ext. sup. alut. 


Extende super alutem 


Spread upon leather. 


Ext., Extr. 


Extractum, gen. i 


An extract. 


Extr. 


Extrahe, Extrahatur 


Extract (thou), Let it be extracted. 


F. 


Fac 


Make (thou). 


F. L. A. 


Fiat lege artis 


Let it be made by the rules of art. 


F. pil. xij 


Fac pilulas duodecim 


Make 12 pills. 


Far. 


Farina 


Flour. 



I [ST OF CON ik ACTIONS \\i> LATIN PHH I 






Contraction. 

Fas. lint. 
Fascic. 
Febr. 
Febr. dur. 
Fern, intern. 
Ferv. 

Fict. 
Fil. 

Filt. 

FlStul, arm. 
Flav. 

Flor. 

Fluid. vel Fl. 

Fol. 

Form. 

Frig. 

Frust. 

Ft. 

Ft. cerat. 

Ft. chart, xij 

Ft. collyr. 

Ft. emuls. 

Ft. en. 

Ft. inject. 

Ft. pil. .xij 

Ft. pulv. 

Ft. pulv. xij 

Ft. sol. 

Ft. suppos. viij 

Ft. troch. x-x 

Ft. ung. 

Ft. venesec. 

Fuerit 

Fus. 

Garg. 

Gelat. quav. 

Ging. incid. 

Gm. 

gr. vj pond. 

Grad. 

Grat. 

Gros. 

Grum. 

Gtt. 

Guttat. 

Gtt. quibusd. 

H. 

Har. pil. 

Haust. 

H. p. n. 

Hebdom. 

Herb. 

Herb, recent. 

Heri 

Hie, H<xc. Hoc 

Hirudo 

Hirud. app. 

Hor. 

Hor. decub. 



Word or Phi 


i DgU b Equivalent 


Fascia lintea 


i 


1 1 ii ulus 


A small bundle. 


Febris 


Fever. 


Febrc durante 


During the I 


Femori interao 


To the inner thigh. 


Fervens, gen. ends 


Hot. 


Fictilis, e 


Earthen, An earthen vessel. 


Filtra 


Filter (thou). 


FUtrum, .;;<'"• • 


A filter. 


Fistula armata 


\ syringe ready for use. 


Flavus, a, um 


Yellow. 


Flores (pi.) 


Flowers. 


Fluidus 


Liquid. 


Folia, gen. orum 


Leaves. 


Formula, Formentur 


V prescription, Let them be forme id. 


Frigor, gni. oris 


Cold. 


Frustillatim 


In small pieces. 


Fiat, Fiant (pi.) 


Let it (or them) be made. 


Fiat ceratum 


Let a cerate be made. 


Fiant chartuls duodecim 


Let 12 powders be made. 


Fiat collyrium 


Let an eye-wash be made. 


Fiat emulsum 


Let an emulsion be made. 


Fiat enema 


Let an enema be made. 


Fiat injectio 


Let an injection be made. 


Fiant pilula: duodecim 


Let 12 pills be made. 


Fiat pulvis 


Let a powder be made. 


Fiant pulvcres duodecim 


Let 12 powders be made. 


Fiat solutio 


Let a solution be made. 


Fiant suppositoria octo 


Let 8 suppositories be made. 


Fiant trochisci viginti 


Let 20 troches be made. 


Fiat unguentum 


Let an ointment be made. 


Fiat venesectio 


Let a bleeding be done. 


Fuerit 


Shall have been. 


Fuscus, a, um 


Brown, dark. 


Gargarisma 


A gargle. 


Gelatina quavis 


In any kind of jelly. 


Gingivas incide 


Lance (or cut) the gums. 


Gramma 


A gramme. 


Granum, Grana 


A grain, Grains. 


Grana sex pondere 


Six grains by weight. 


Gradatim 


By degrees, gradually. 


Gratus 


Pleasant. 


Grossus, a, um 


Large, coarse. 


Grumus 


A clot (of blood). 


Gutta, Guttae, Guttas 


A drop, Drops. 


Guttatim 


By drops. 


Guttis quibusdam 


With a few drops. 


Hora 


An hour. 


Harum pilularum 


Of these pills. 


Haustus, gen. i 


A draught. 


Haustus purgans noster 


My own purgative draught. 


Hebdomada, Hebdomas 


A week. 


Herba, gen. ae 


An herb. 


Herbarum recentium 


Of fresh herbs. 


Heri 


Yesterday. 


Hie, Haec, Hoc 


This. 


Hirudo, gen. inis 


A leech. 


Hirudines appone 


Apply leeches. 


Hora, gen. a; 


An hour. 


Horaa decubitus 


At bedtime. 



( 



854 



LIST OF CONTRACTIONS AND LATIN PHRASES. 



Contraction. 


Word or Phrase. 


English Equivalent. 


Hor. j spat. 


Horas unius spatio 


After one hour. 


Hor. interm. 


Horis intermediis 


In the intermediate hours. 


Hor. som. 


Hora somni 


At the hour of sleep. 


Hor. xj matut. 


Hora undecima matutina 


At the eleventh hour of the morning. 


Id. 


Idem 


The same. 


Iden. 


Identidem 


Repeatedly, often. 


Idon. 


Idoneus, a, um 


Suitable, proper, convenient. 


Idon. vehic. 


Idoneo vehiculo 


In a suitable vehicle. 


111. 


Illico 


Then, immediately. 


Immit. 


Immitatur 


Let it be placed in. 


Imp. 


Impone 


Lay on, apply. 


Impr. 


Imprimis 


First, chiefly. 


In 


In 


In, within, upon, not. 


Inc. 


Incide, Incisus 


Cut (thou), Being cut. 


Ind. 


In dies 


Daily, or From day to day. 


Inde 


Inde 


Therefrom. 


Infun. 


Infunde 


Pour in. 


Infus. 


Infusum 


An infusion. 


Ing. 


Ingere, Ingerendus 


Put into, Putting into. 


Injec. 


Injectio 


An injection. 


Injic. enem. 


Injiciatur enema 


Let a clyster be injected. 


In lag. bene obt. 


In lagena bene obturator 


In a well-stoppered bottle. 


In loco frig. 


In loco frigido 


In a cold place. 


In mass. cog. 


In massam cogantur 


Let them be combined in a mass. 


In pulm. 


In pulmento 


In gruel. 


Instar 


Instar 


As big as, the size of. 


Int. 


Internus, a, um 


Inner, internal, between. 


Inter 


Inter 


Between. 


Intus 


Intus 


Inwardly. 


Invol. gelat. 


Involve gelatina 


Coat {or cover) with gelatin. 


Invor. 


Invoruntur 


Let them be moistened. 


Ita 


Ita 


In such manner. 


Iter. 


Iteretur, Iterentur 


Let it (them) be repeated. 


Jam 


Jam 


Now. 


Jentac. 


Jentaculum, gen. i 


Breakfast. 


Jucund. 


Jucunde 


Pleasantly. 


Jul. 


Julepum 


A julep. 


Juscel. 


Juscellum 


A broth. 


Juscul. 


Jusculum 


Soup. 


Jux. 


Juxta, Juxtim 


Near to, Close by. 


K. 


Kali, Kalium 


Potassa, Potassium. 


Kal. ppt. 


Kali praeparata 


Potassium carbonate. 


Lac. 


Lac, gen. Lactis 


Milk, Of milk. 


Lag. 


Lagena, gen. ae 


A flask, or bottle. 


Lam. 


Lamella 


Plate, leaf, layer, scale. 


Lan. 


Lana, gen. as 


Flannel, wool. 


Lang. 


Languor, gen. oris 


Faintness. 


Lapid. 


Lapideus, a, um 


Stony, made of stone. 


Larg. 


Largus, a, um 


Abundant, plentiful. 


Larid. 


Laridum, gen. i 


Lard. 


Lat. 


Latus, a, um 


Broad, wide. 


Lat. 


Latus, gen. eris 


The side. 


Lat. admov. 


Latere admoveatur 


Let it be applied to the side. 


Lat. dol. 


Lateri dolenti 


To the painful side. 


Lax. 


Laxus, a, um 


Loose, open. 


Lb., lb. 


Libra 


A pound. 


! Lect. 


Lectus, gen. i 


A bed. 


Len. 


Leniter 


Easily, gently. 


Len. ter. 


Leniter terendo 


By rubbing gently. 


Lev. 


Leviter 


Lightly. 









LISI 


OF COS IK \i 1 [ONS \\l 


1 \ll\ PHRAS1 S. 


Cos traction 


\\ "'-I di Phrase, 


1 Ogttl li 1 .|iiiv.ilrnl. 


Lig. 


itura 


i lire. 


Linct. 


Linctus, gen. i 


\ lint Hi-, (taken by li' ki 


Linim. 


Linimentum, gen. i 


A liniment. 


Lint. 


l inteum, gen. i 


Lint, linen. 


Liq. 


Liquor, gen. oris 


A solution 


Lot. 


I lOtio 


ion. 


Lut. 


Luteus, a, um 


Yellow, golden yellow. 


M., ItR 


Minimum, gen. ' 


A minim. 


M. 


Misee 


Mi\ (thou). 


M. 


Manipulus, gen. i 


\ handful. 


Macer. 


Macera 




Mag. 


Magnus, a, um 


Large. 


Man. 


Manipulus, gen. i 


A handful. 


Mane 


Mane (indecl.) 


Mot ning, in the morning. 


Mam- primo 


Mane primo 


Early in the morning. 


Manus 


Manus, gen. i 


The hand. 


M.l>S. 


Massa, gen. s 


A mass, a pill-mass. 


Mat. 


Matula, gen. be 


A vessel, a chamber-pi >t . 


Matut. 


Matutinus 


In the morning. 


Mod. 


Medius, a, um 


Middle. 


Mens. 


Mensura 


By measure. 


Mir. pan. 


Mica j>anis 


\ I iitml) of bread. 


Min. 


Minimum 


A minim. 


Minut. 


Minutum* 


A minute. 


Mis. 


Misee, Miscetur 


Mix (thou), Let it be mixed. 


Mis. bene 


Misce bene 


Mix well. 


Mis. caut. 


Misee caute 


Mix cautiously. 


Mist. 


Mistura 


A mixture. 


Mit. 


Mitte, Mittatur, Mittantur 


Send (thou), Let it hi' sent. Let them 
be sent. 


Mit. sang, ad uncias 


Mitte sanguinem ad uncias 


Take away blood to 12 ouii' 


xij salt. 


duodecim saltern 


least. 


Mit.'tal. 


Mitte tales 


Send of such. 


Mod. diet. 


Modo dictu 


As directed. 


Mod. pr. 


Modo prsescripto 


In the manner prescribed. 


Modic. 


Modicus, a, um 


Moderate-sized, middling. 


Mol. 


Mollis, Molle 


Soft. 


Mor. 


Mora, gen. x 


Delay. 


Mor. diet. 


More dictu 


In the manner directed. 


Mor. sol. 


More solito 


In the usual manner. 


Mort. 


Mortarium, gen. i 


A mortar. 


Natr. 


Natrium, gen. i 


Sodium. 


Xc tr. s. num. 


Ne trades sine nummo 


Do not deliver without the money. 


Necn. 


Neenon 


And also, and vet. 


Nig. 


Niger, nigra, nigrum 


Black. 


Nisi 


Nisi 


Unless. 


No. 


Numero, Numerus 


In number, A number. 


Noct. 


Noctis 


Of the night. 


Noct. maneq. 


Nocte maneque 


At night and in the morning. 


Non 


Non 


Not. 


Non repetat. 


Non repetatur 


Let it not be repeated. 


Noxa 


Noxa, gen. as 


An injury. 


Nucha 


Nucha 


The nape of the neck. 


Nunc 


Nunc 


Now. 


Nut. 


Nutricius, a, um 


Nutritious. 


Nutrit. 


NutritUS, gen. us 


Nutriment. 


Nux 


Nux, gen. nucis 


A nut. 


Nux mosch. 


Nux mosehata 


A nutmeg. 


O. 


Octarius 


A pint < .~>xvj). 


Obd. 


Obduce 


Cover, com eal, 1 


* This is medical Latin, or 


"bog-Latin." The proper Latin 


for a minute of time is Sexagesima pan hora. 



< 



8 5 6 



LIST OF CONTRACTIONS AND LATIN PHRASES. 



Contraction. 


Word or Phrase. 


English Equivalent. 




Obduct. 


Obductus, a, um 


Covered, coated. 




Obtrit. 


Obtritus, a, um 


Crushed. 




Occlus. 


Occlusus, a, um 


Enclosed. 




Oct. 


Octo, Octavus 


Eight, Eighth. 




Octup. 


Octuplus 


Eight-fold. 




Ocul. 


Oculus, gen. i 


The eye. 




Odor 


Odora, Odoretur 


Perfume, Let it be perfumed. 




Odorat. 


Odoratus, a, um 


Perfumed, odorous. 




Ol. lini sine ig. 


Oleum lini sine igne 


Cold-drawn linseed oil. 




Ol. O. Opt. 


Oleum olivae optimum 


Best olive oil. 




Olla 


Olla, gen. a; 


A pot, a jar. 




Ollic. 


Ollicula, gen. ae 


A little pot. 




Omn. hor. 


Omni hora 


Even' hour. 




Omn. bih. 


Omni bihorio 


Every two hours. 




Omn. quadr. hor. 


Omni quadrante horae 


Every \ hour. 




Omn. mane 


Omni mane 


Every morning. 




Omn. noct. 


Omni nocte 


Every night. 




Op. 


Opus 


Need, occasion. 




Opt. 


Optimus, a, um 


Best. 




Oryza 


Oryza, gen. ae 


Rice. 




Os 


Os, gen. oris, ace. os 


The mouth. 




Ov. 


Ovum, gen. ovi 


An egg. 




P. 


Pondere 


By weight. 




P. P. A. 


Phiala prius agitata 


The bottle having been first shaken. 




P. r. n. 


Pro re nata 


Occasionally, as needed. 




Pab. 


Pabulum, gen. i 


Food. 




Pallid. 


Pallidus, a, um 


Pale. 




Pan. 


Panis, Pannus 


Bread, A cloth or rag. 




Par., Pt. 


Pars, gen. Partis 


A part, Of a part. 




Para, Parat. 


Para, Paratus 


Prepare, Prepared. 




Pt. aeq. 


Partes aequales 


Equal parts. 






Pt. affect. 


Parte affecta 


On the affected part. 






Part. vie. 


Partitis vicibus 


In divided doses. 






Parv. 


Parvus, a, um 


Little. 






Parvul. 


Parvulus, a, um 


An infant, a parvule. 




Pastil. 


Pastillus, Pastillum 


A pastille, a lozenge. 






Pauc. 


Paucus, a, um 


Little, few. 






Paul. 


Paulatim 


Little by little, gradually 






Pect. 


Pectus, gen. oris 


The breast. 




Pediluv. 


Pediluvium 


A foot-bath. 




Penicil. cam. 


Penicillum camelinum 


A camel's-hair pencil or brush. 




Per 


Per {prep. gov. accus.) 


Through, by means of, very. 




Peract. operat. emet. 


Peracta. operatio emetici 


■When the emesis is finished. 




Percalef. 


Percalefactus, a, um 


Thoroughly heated. 




Per col. 


Percola 


Strain through, percolate. 




Per deliq. 


Per deliquium 


By deliquescence. 




Per fistul. vit. 


Per fistulam vitream 


Through a glass tube. 




Perg. 


Perge, Pergetur 


Proceed, Let be continued. 




Perind. 


Perinde 


Just as. 




Permit, vir. 


Permittentibus viribus 


The strength permitting. 




Perpur. 


Perpurus, a, um 


Very clean. 




Pervesp. 


Pervesperi 


Very late in the evening. 




Pes 


Pes, gen. pedis 


The foot. 




Pess. 


Pessarium, Pessulum 


A pessary. 




Ph. 


Phiala, gen. ae 


A vial, a bottle. 




Pil. 


Pilula, gen. ae 


A pill. 




Pil. 


Pilus, gen. i 


The hair. 




Ping. 


Pinguis, gen. is 


Fat, grease. 




Pist. 


Pistillum, gen. i 


A pestle. 




Plac. 


Placebo 


I will satisfy (please). 





l 1ST OF CONTRACTIONS wi> LATIN PHRASES. 



857 



Contraction, 


Word or Phrase. 


[tilvalent 


Plas. 


Plasma, Plasmetur 


1, Lei it be moulded. 


Plen. 


Plenus, a, am 


Filled. 


Poc. 


Pot ulum, Pocillum 


\ cup, \ little cup. 


Pon., P. 


Pondere 


By weight. 


Pon. civ. 


Pondus civile 


Civil weight (avoirdup 


Ton. med. 


Pondus medicinale 


Medicinal (apothi ■. . ight. 


Pone :uir. 


Pone aurem 


Behind thi 


Post cib. 


Post cibos 


After meals. 


Tost sing, sed. liq. 


Posl singulas sedes liquidas 


After every loose stool. 


Postrid. 


Postridie 


( >n the next day. 


Pot. 


PotUS, £<'"■ us 


\ drink. 


Prae 


Prae 1 [>rcf>. gov. abl.) 


Before, very. 


Prep. 


Prseparatus, a, um 


Prepared. 


Prand. 


Prandium, gen. i 


1 )inner. 


Prid. 


Pridie 


< )n the previous day. 


Prim. man. 


Primo mane 


Very early in the morning. 


Primus 


Primus, a, um 


The first. 


Pro 


Pro {adv. and prep., gov. 
ablative case) 


For, before, according to. 


Prop. 


Proprius, a, um 


Spet ial, particular. 


Pro rat. get. 


Pro ratione a?tatis 


According to the age of the patient. 


Pro r. n. 


Pro re nata 


Occasionally, as needed. 


Prox. 


Proximo 


Nearest. 


Pug. 


Pugillus 


A pinch. 


Pulm. 


Pulmentum, gen. i 


Gruel. 


Pulv. 


Pulvis, gen. eris 


A powder. 


Pulv. gros. 


Pulvis grossus 


A coarse powder. 


Pulv. subtil. 


Pulvis subtilis 


A smooth powder. 


Pulv. ten. 


Pulvis tenuis 


A fine powder. 


Pulvz. 


Pulverizatus, a, um 


Powdered. 


Pur. 


Purus, a, um 


Pure, clean. 


Purg. 


Purgativus, gen. i 


A purgative, a purging. 


Pyx. 


Pyxis, gen. idis 


A small box, a pill-box. 


Q- 


Quadrans, gen. tis 


A fourth part, a quart. 


Q. lib. 


Quantum libet 


As much as you please. 


Q.p. 


Quantum placet 


" " " " " 


Q.q. 


Quoque 


Also. 


Qq. 


Quisque, Quaque 


Each, or Every. 


Qq. hor. 


Quaqua hora 


Every hour. 


Q.s. 


Quantum sufficiat 


As much as is sufficient. 


Q. s. 


Quantum satis 


" " " " " 


Q. v 


Quantum vis 


As much as you please. 


Q. vol. 


Quantum volueris 


" " " " " 


Quad. 


Quadruplo 


Quadruple, in fourfold. 


Quam 


Quam 


As much as. 


Quart. 


Quartus, gen. i 


Fourth. 


Quat., Quater 


Quatuor, Quater 


Four, Four times. 


Quibus 


Quibus 


From which. 


Quinq. 


Quinque 


Five. 


Quint. 


Quintus 


The fifth. 


Quoq. 


Quoque 


Also. 


Quor. 


Quorum 


Of which. 


Quotid. 


Quotidie 


Daily. 


Quoties req . 


Quoties requiritur 


As often as is required. 


R 


Recipe 


Take (thou). 


Rar. 


Rarus, a, um 


Loose, thin, rare. 


Rat. 


Ratio, gen. onis 


Relation, proportion. 


Rec. 


Recens, gen. entis 


Fresh, recent, newly. 


Red. in pulv. 


Redactus in pulverem 


Reduced to powder. 


Redig. in pulv. 


Redigatur in pulverem 


Let it be reduced to powder. 



i 



8 5 8 



LIST OF CONTRACTIONS AND LATIN PHRASES. 



Contraction. 


Word or Phrase. 


English Equivalent. 


Reg. umbil. 


Regio umbilici 


The umbilical region. 


Rel. 


Relectus, a, um 


Opened, loosened. 


Reliq. 


Reliquus, gen. i 


Remaining, the remainder. 


Renov. 


Renova, Renovetur 


Renew, Let it be renewed. 


Renov. semel 


Renovetur semel 


Let it be renewed once only. 


Rept. 


Repetatur, Repetantur 


Let it (them) be repeated. 


Res 


Res, gen. rei 


A substance, thing, affair. 


Resid. 


Residuus, a, um 


Residual, remaining. 


Respon. 


Responde 


Answer (thou). 


Retin. 


Retinetur 


Let it be withheld. 


Rict. 


Rictus, gen. us 


A wide (distended) opening. 


Rig- 


Rigidus, a, um 


Rigid, hard, inflexible. 


Rub. 


Ruber, Rubra, Rubrum 


Red, ruddy. 


Rudic. 


Rudicula, gen. ae 


A spatula. 


Rudis 


Rudis, gen. is 


A stirring-rod. 


Rum. 


Rumen, gen. inis 


The throat. 


S. expr. 


Sine expressione 


Without expression. 


S. A. 


Secundum artem 


According to art. 


S. L. 


Secundum legem 


According to law. 


S.N. 


Secundum naturam 


According to nature. 


S.S.S. 


Stratum superstratum 


Layer upon layer. 


S. V. R. 


Spiritus vini rectificatus 


Alcohol. 


S. V. T. 


Spiritus vini tenuis 


Proof spirit. 


Sac. lac. 


Saccharum lactis 


Sugar of milk. 


Sac. sat. 


Saccharum saturni 


Sugar of lead. 


Saep. 


Saepe 


Frequently. 


Sal 


Sal, gen. salis 


Salt. 


Sal am. 


Sal amarum 


Magnesium sulphate. 


Sal mir. 


Sal mirabile 


Sodium sulphate. 


Sal vol. 


Sal volatile 


Ammonium carbonate. 


Saltern 


Saltern 


At least. 


Saltim 


Saltim 


By leaps. 


Sang. 


Sanguis, Sanguineus 


Blood, Bloody. 


Sap. 


Sapor, gen. oris 


A flavor, delicacy. 


Sat. 


Satis 


Enough, sufficient. 


Saturat. 


Saturatus, a, um 


Saturated. 


Scarif. 


Scarifica 


Scarify (thou). 


Scarif. expl. 


Scarificatione explicata 


Scarification having been effected . 


Scat. 


Scatula, gen. 32 


A box. 


Scil. 


Scilicet 


Namely. 


Scrup., 9 


Scrupulum, gen. i 


A scruple (20 grains). 


Scut. pect. 


Scuto pectori 


For protection to the breast. 


Sec. 


Secundo, Secundum 


Secondly, According to. 


Secund. 


Secundus 


Second. 


Sed. 


Sedes, gen. is 


The fundament, the feces. 


Semel 


Semel 


Once. 


Semidr. 


Semi-drachma 


Half a drachm. 


Semih. 


Semi-hora 


Half an hour. 


Sensim 


Sensim 


Gently, gradually, slowly. 


Separ. 


Separatim 


Separately. 


Sept ; 


Septem 


Seven. 


Septim. 


Septimana 


A week. 


Sero 


Sero 


Late, at a late hour. 


Sesq. 


Sesqui 


One and a half. 


Sesqh. 


Sesquihora 


An hour and a half. 


Sesunc. 


Sesuncia 


An ounce and a half. 


Sev. 


Sevum, gen. i 


Suet, tallow. 


Sex, Sext. 


Sex, Sextus 


Six, Sixth. 


Si 


Si 


If. 


Sic! 


Sic! 


So, thus. 






LIST "i CON! R ACTIONS \M> LATIN PHB 



859 



lentr.ution. 



Ward or Phrase. 



Sir. 


Si, ( .i. Siccetur 


Sic. 


Siccus 


Sig. 


Signa, Signetur 


Sig. nom. prop. 


Signatur nomine proprio 


Sign. 


Signanter 


Site hujvis! 


Sili- bujusl 


Simp. 


Simplex, gen. simplicis 


Simul 


Simul 


Sin. 


Sine 


Sing. 


Singulorum 


Si non val. 


Si non valeat 


Si op. sit 


Si opus sit 


Si vir. perm. 


Si vires permittebant 


Sit 


Sit 


Sit in promp. 


Sit in promptu 


Sitis, Siti 


Sitis. Siti 


Sol. 


Solus 


Solat. 


Solatium. gen. ii 


Solit. 


Solitus, a, um 


Solut. 


Solutus, a, um 


Solut. 


Solutio, gen. onis 


Solv. 


Solve. Solvetur 


Solv. c. calor. 


Solve cum calore 


Som. 


Somnus, gen. i 


Spiss. 


Spissus, a, um 


Spt. 


Spiritus, gen. us 


Spt. vin. rect. 


Spiritus vini rectificatus 


Spt. vin. ten. 


Spiritus vini tenuis 


Spt. vinos. 


Spiritus vinosus 


ss. 


Semis, Semissis, Semi- 


St. 


Stet, Stent 


Stat. 


Statim 


Stib. 


Stibium, gen. ii 


Stillat. 


Stillatim 


Stom. 


Stomachus, gen. i 


Strat. 


Stratum, gen. i 


Strat. superst. 


Stratum superstratum 


Suav. 


Suavis 


Sub 


Sub 


Subact. 


Subactus 


Sub fin. coct. 


Sub finem coctionis 


Subind. 


Subinde 


Subtil. 


Subtilis 


Sue. 


Succus, gen. i 


Sugil. 


Sugillationi 


Sum. 


Sume, Sumat 


Sum. 


Sumatur, Sumantur 


Sum. tal. 


Sumat talem 


Sumend. 


Sumendus 


Summit. 


Summitates 


Sum. mane sum. 


Summo mane sumendus 


Summ. 


Summus, a, um 


Sup. 


Super, Supra 


Sup. bib. haust. 


Superbibendo haustum 


Suppos. 


Suppositoria, gen. x 


Suppos. rect. 


Suppositoria? rectales 


Suppos. ureth. 


Suppositoria? urethrales 


Syr. 


Syrupus, gen. i 


T. d., vel T. i. d. 


Tcr die, vel Ter in die 



1 Equivalent. 



hou), Lei it be dried, 
iried. 
Write 1 thou), Let it be marked. 
Let it be written upon (marked) with 
its proper name, 
1 ly, distini tly. 
Kir] > silent e con< ei ning this. 

Simple, unmixed. 

Together. 

Without. 
Of each. 

If it does not answer. 
If necessary. 

If the strength will permit. 
Let it he. 

1 et it he in readiness. 
Thirst, For thirst. 
\i< 'He, only. 
A soothing, assuaging. 
Accustomed, ordi 
1 dissolved. 
A solution. 

Dissolve. Let it he dissolved. 
Dissolve with heat. 
Sleep. 

Dense, hard. 
Spirit. 

Rectified spirit of wine (Alcohol). 
Proof spirit. 

Anient spirit (of any strength). 
A half. 

Let it (or them) stand. 
Immediately. 
Antimony. 

By drops, drop by dVop. 
The stomach. 
Layer, stratum. 
Layer upon layer. 
Pleasant, agreeable. 
Under, somewhat. 
Subdued, sinking. 
When the boiling is nearly done. 
Frequently. 
Fine, smooth, nice. 
Juice, sap. 
To the bruise. 
Take (thou), Let him take. 
Let it (them) lie taken. 
Let him take one like thi-. 
To be taken. 

The highest points, summits. 
To be taken very early in the morning. 
Highest, summit. 
Above, upon. over. 
Drinking afterwards this draught. 
A suppository. 
Rectal suppositories. 
Urethral suppositories. 
Syrup. 
Thrice daily. 



i 



86o 



LIST OF CONTRACTIONS AND LATIN PHRASES. 



Contraction. 


Word or Phrase. 


English Equivalent. 




Tab. 


Tabella, gen. ae 


A lozenge, tablet. 




Tal. 


Talis, gen. is 


Of such, like this. 




Tam 


Tam 


So far, in so far. 




Tan. 


Tandem 


At last, finally. 




Tant. 


Tantum, gen. i 


So much, so many. 




Teg. 


Tegmen, gen. inis 


A cover. 




Temp. 


Tempus, gen. oris 


Time, temple. 




Temp. dext. 


Tempori dextro 


To the right temple. 




Ten. 


Tenuis 


Fine, weak, thin. 




Tep. 


Tepidus, a, um 


Tepid, lukewarm. 




Ter 


Ter 


Thrice, three times. 




Tere, Teret. 


Tere, Teretur 


Rub (thou), Let it be rubbed. 




Tere sim. 


Tere simul 


Rub (thou) together. 




Teres 


Teres, gen. etis 


Rubbed, smooth, polished. 




Tert. 


Tertius 


Third. 




Test. ov. 


Testa ovi 


An egg-shell. 




Thion. 


Thionas, gen. atis 


Sulphur, sulphate. 




Tinct., vel Tr. 


Tinctura, gen. a? 


Tincture. 




Tinct. herb, recent. 


Tincturae herbarum recen- 
tium 


Tinctures of fresh herbs. 




Tinct. theb. 


Tinctura thebaica 


Laudanum. 




Tr. 


Tres, Tria 


Three 




Trid. 


Triduum, gen. ui 


The space of three days. 




Trit. 


Tritura, Trituretur 


Triturate, Let it be triturated. 




Troch. 


Trochiscus, Trochisci 


A lozenge, or troche, Lozenges. 




Turn 


Turn 


Then, next, furthermore. 




Turb. 


Turbidus, a, um 


Turbid, muddy. 




Tus. 


Tussis, gen. is 


A cough. 




Tuto 


Tuto 


Safely. 




Ubi 


Ubi 


Where, wherever, whenever. 




Uln. 


Ulna, gen. ae 


The arm, elbow. 




Ult. 


Ultime, Ultima 


Lastly, at the last. 




Ult. praesc. 


Ultimo praescriptus 


The last ordered. 




Una 


Una 


Together. 




Unc, B 


Uncia, gen. ae 


An ounce. 




Unct. 


Unctus, a, um 


Anointed, besmeared. 




Unctul. 


Unctulus, a, um 


" " 




Ung. 


Unguentum, gen. i 


An ointment, unguent. 




Unguil. 


Unguilla, gen. ae 


An ointment-box. 




Urg. 


Urgens, gen. entis 


Pressing, urgent. 




Ust. 


Ustus, a, um 


Burnt. 




Ut 


Ut, Uti 


That, so that, in order that. 




Ut diet. 


Ut dictum 


As directed. 




Utend. more sol. 


Utendus more solito 


To be used in the usual manner. 




Utere 


Utere 


Use (thou), make use of. 




Vas 


Vas, gen. vasis 


A vessel, utensil, bottle. 




Vas vit. 


Vas vitreum 


A glass vessel. 




Vehic. 


Vehiculum, gen. i 


A vehicle, menstruum. 




Vel 


Vel (or Ve as a suffix) 


Or. 




Venaesec. brach. 


Venaesectio brachii 


Bleeding in the arm. 




Venen. 


Venenum, Yenenosus 


A poison, Poisonous. 




Ver. 


Verus, a, um 


True, real, genuine. 




Vesp. 


Vesper, gen. eris 


The evening. 




Vesper. 


Vesperma, gen. ae 


Supper. 




Vic. 


Vicis, Vices 


Change, changes. 




Vin. 


Yinum, gen. i 


Wine. 




Vir. 


Vires (pi. of Vis) 


Strength, vigor, life. 




Virid. 


Viridis, Viride 


Green. 




Vis 


Vis, gen. viris 


Strength, vigor, life. 




Vitel. 


Vitellus, gen. i 


Yolk. 





MM I RALS. 






Contraction. 



Word or Phrase. 



Yitel. ovi 
Vitel. ovi sol. 
Vitr. 
Vol. 
Vom. urg. 



Vitellus ovi 
\'it<'!K> ovi solutus 
Vitrum, Vitreus 
Volatilis, Volatile 
Vomitione urgente 



English Equivalent, 

Yolk of egg. 

Dissolved in the yolk of an egg. 

Glass, of glass, glazed. 

Volatile. 

Vomiting being severe. 



For Dangerous Abbreviations, see page 515, under the title Prescriptions. 



NUMERALS. 




< 



862 



GENITIVE CASE ENDINGS — VERBS. 



GENITIVE CASE ENDINGS. 



Nom. Gen. Exceptions. 




a 


ae 


Cataplasma, Enema, Physostigma, Aspidosperma and Gargarisma, all have 
the genitive in -atis. Folia is plural, gen. Foliorum. 




us 

um 

OS 

on 


i 


Rhus, Rhois; Flos, Floris; Bos, Bovis; Limon, Limonis; Erigeron, -ontis. 
Fructus, Cornus, Quercus, Spiritus, Haustus, Potus, do not change, being 
of the 4th declension. 




as atis Asclepias, -adis; Mas, Maris; Rhceas, Rhceados. 


is 


idis Pulvis, -eris; Arsenis, -itis; Phosphis, -itis; Sulphis, -itis, and all salts 
ending in -is, have the genitive in -itis. 




o onis Mucilago, -inis; Ustilago, -inis; Solidago, -inis. 




1 lis ' . Fel, Fellis; Mel, Mellis. 




e 

en 
ps 
rs 

r 

X 


Words which do not change in the Genitive. 
es ; Azedarach Cornus Hydrastis Sabal 
inis | Buchu Curare Jaborandi Sago 
pis Cannabis Digitalis Kino Sassafras 
rtis Caoutchouc Ethyl* Matico Sinapis 
ris Catechu Fructus Menthol* Spiritus 
cis Chloral* Gambir Potus Sumbul 
Condurango Haustus Quercus Thymol* 





*In the B. P. Chloral, Ethyl, Menthol, and Thymol are Latin nominatives, and do not change in the genitive, 
(e. g. Syrupus Chloral, Liquor Ethyl Nitritis, Emplastrum Menthol). In the U. S. P. the corresponding nomina- 
tives are Chloralum, .Ethyl, Menthol, and Thymol; but the genitive of .Ethyl is .Ethylis, and that of Thymol is 
Thymolis, (e. g. .Ethylis Carbamas, Thymolis Iodidum). 



Pronunciation. 
Attention is particularly directed to the accentuation of words commonly mispronounced; 
as, for example, acetas, angina, atropa, chimaphila (kimaphila), chloridum, codeia, conium, 
enema, iodidum, radicis ricinus, sinipis, syrupus, eczema, umbilicus, abdomen, bromidum, 
paresis. 

Verbs. 
The Verbs used in prescription writing are nearly all in the imperative mood, giving 
directions to the compounder, and having their objects in the accusative case. Such are — 

Adde, add. Extende, spread. Macera, macerate. Signa, write. 

Cola, strain. Fac, make. Misce, mix. Solve, dissolve. 

Divide, divide. Filtra, filter. Recipe, take. Tere, rub. 

A few verbs are found in the subjunctive mood, taking their subject or predicate in the 
nominative case. The most usual are — 



Fiat, let be made. 
Coletur, let be strained. 
Colore tur, let be colored. 



Bulliat, let boil. 
Capiat, let take. 
Detur, let be given. 



Dividalur, let be divided. 
Sit, let it be. 
Sumatur, let be taken. 



HYPODERMIC FORMUI I . 






PAHTICIP] is. 
Participles or Verbal Adjectives are occasionally used, and should agree with theii ■,- 
gpecUve nouns m gender, number, and case. Such are — 

Adhibendus, a, urn, to be administered. Dividend™, a, urn, to be divided 

Sumendus, ,i. turn, to be taken. 



I'i;i POSJ i tONS 

Those in the first column require the noun following to be in the accusative i asi 

those in the second column require the ablative ease. 

Ad, to, up to. Cum, with 

In, into. /'„, fo] 

Sttpm, upon. Sine, without. 
.I'M, of each, —is followed by the genitive ease. 



well. 
Wl, twiee. 
Vein, thereupon. 
I'.t, and. 

Gradatim, gradually 
GuUotim, by drops. 
In dies, daily. 
Da, give. 



Sun-dry Words \\n Phrases, in mom i ; ■, ,,, , .., llSK 



Wow, not. 
X it merits, number. 
Octarius, a pint. 
Semel, once. 
Simul, together. 
StaHtn, at once. 
Ter, thrice. 
Qualer, four times. 



Atl saturandum, to saturation. 
NumerO, to the number of. 

Quantum sufficial, as much as necessary. 
Pro re natd, according to need. 

1)1 partes <i-qu,iles, into equal parts. 

Redaetus in pulverem, let be pulverized. 
Secundum artem, according to art. 
Non repetatur, let it not be repeated. 



HYPODERMIC FORMULA. 



Apomorphine. 
I', Apomorphinae Hydrochlor., gr. j. 

Div. in pulv. xvj. One to four in ttjxx 
of water as required. 



1! 



Atropine. 

Atropine Sulphatis, gr. j. 

Aquae Destillatae, 3j. 

Solve. Sig. — For hypodermic use. irjjvj 
= gr- sV> IRiv = gr. r i„. 



Caffeine. 

R. Cafleina; Citratis, gr. xxiv. 

Aquae Destillatae, 5j- 

Solve. Sig. — irgxx contain gr. j. 

Chloral. 

R. Chlorali Hydrati, 5iv. 

Aquae Destil., oj- 

M. Sig. — itjjx contain gr. v of Hydrated 
Chloral. 

Chloroform. 

1$. Chloroformi Purif., 3ss. 

Sig. — ngv—xv can be used as one deep 
injection. (See page 222.) The spirit is 
safer, in somewhat larger doses. 

Cocaine. 

R. Cocainae Hydrochloride gr. v. 

Aquae Destillatae, 5ij- 

Solve. Sig. — irjjxij contain gr. ss. 



Coniine. 

R;. Coniinae Hydrobromidi gr. j. 

Aquae Destillat., §j. 

M. Sig. — 152.x contain gr. ,',. 



Curare. 

R. Curare (Merck), gr. j. 

Acidi Acetici, 15/v. 

Aquas Destillatae, q. s. ad . . 152c. 
M. et ftltra. Sig. — mjx contain gr. ,'„. 



R\ Curarinae Sulphat., gr. j. 

Aquae Destillat., 3ss. 

M. Sig. — njiv contain gr. „',,. 



R 



Daturine. 

Daturinae, gr. ss. 

Aquae Destil., 5 j. 

Solve. Sig. — njiv contain gr. *\ . Dose, 

njiv-x. 



Digitalin. 

R. Digitalini, gr. ss. 

Alcoholis, 

Aquie Destil aa ~)i j. 

Solve. Sig. — ngix contain gr. ,1,,. Dose 
njjiv-viij. 



i 



864 



HYPODERMIC FORMULAE. 



Duboisine. 

]$. Duboisinae Sulphat., gr. j. 

Aquae Destil., 3j- 

M. Sig. — irjjiv contain gr. ^foy. 



Ergot and Ergotin. 

]$. Fluidextr. Ergotae, oss. 

Filtra. Sig. — Dose, tijx. 



1$. Extracti Ergotae (Squibb),,. 3j- 
Aquae Destillat, § j. 

Solve et filtra. Sig. — ttjjx contain gr. j. 
Dose, rrgx-xx. 



Hyoscine, Hyoscyamine. 

1$. Hyoscinae Hydrobrom., vel 

Hyoscyaminae Hydrobrom., gr. j. 

Aquae Destillatae, Bj- 

M. Sig. — tijrv contain gr. £$. 



Mercury. 

]$. Hydrarg. Chlor. Corr., gr. j- 

Aquae Destillat., o j- 

M. Sig. — ttjjx contain gr. ^g. 



1$. Hydrarg. Chlor. Corrosivi, 

Ammonii Chloridi, aa gr. iij. 

Misce et solve in — 

Aquae Destillatae, 3jss. 

Dein adde — 

Albuminis Ovi, 5 jss. 

Aquae Destillatae, 3 v. 

Filtra, et adde — ■ 

Aquae Destil., q. s. ad 5*. 

Sig — Trgj contains gr. ^(j. Dose, njiij-x. 



Morphine. 

]$. Morpbinae Sulphatis, gr. xvj. 

Phenolis, Tijiij. 

Aquae Destillat., §j. 

Solve et filtra. Sig. — tijvijss contain 

gr. 'J. (Antiseptic Magendie's Solution.) 



3 



1$. Morphinae Sulphatis, gr. xxiv. 

Atropinae Sulphatis, gr. j. 

Ol. Amygdala; Amar gtt. j. 

Aquae Destillat., gij- 

Solve. Sig. — itjjx contain gr. \ of Mor- 
phine Sulphate, and gr. ^ of Atropine 
Sulphate. (Didama's Solution.) 



Phenol (Carbolic Acid). 

1$. Phenolis Purif ., gr. x. 

Aquae Destil. 5j- 

M. Sig. — Ttjviij contain gr. $ of Phenol, 
which may be given up to gr. ij or iij. 



Physostigmine (Eserine). 

1$. Physostigminae Sulph., gr. 

Aquae Destillatae, Sj> 

Solve. Sig. — TTgviij contain gr. ^. 



Morphine and Atropine. 

Morphinae Sulphatis, gr. xvj. 

Atropinae Sulphatis, gr. ss. 

Phenolis, nimj. 

Aquae Destillat., oj- 

Solve et filtra. Sig.— njjvijss contain 

gr. -J of Morphine Sulph., and gr. 2 --J-o of Atro- 
pine Sulphate. 



Pilocarpine. 

1$. Pilocarpinae Hydrochlor., . . gr. xvj. 

Aquae Destillat., oj- 

. M. Sig. — njv contain gr. J. 

Potassium Iodide. 

1$. Potassii Iorlidi, 3 j- 

Aquae Destillatae, 5 iv. 

Solve. Sig. — Dose, Tijvj-xx. 

Quinine. 

1$. Quininae Disulph. , gr. 1. 

Ac. Sulphurici Dil., ttjjc. 

Phenolis, iffiv. 

Aquae Destillatae, oj- 

Solve. Sig. — 5j contains gr. vj. (Lente. 
Is irritant (B). 



1$. Quininae Hydrobrom., gr. xlviij. 

Aquae Destillat 5iv. 

Solve. Sig. — ttjjxx contain gr. iv. 

T$. Quininae Bimur. Carbam- 

idat., oij- 

Aquae Destillatae 5 iv. 

Solve. Sig. — njx contain gr. v. 



Strychnine. 

1$. Strychninae Sulphat., gr. j 

Aquae Destillatae, oj- 

Solve sine alcohol. Sig. — njjx contain gr. ? V 






1$. Strychninae Nitratis, gr. iij. 

Aquae Fervid., 3*. 

Solve. Sig. — it£x contain gr. ^. 

(Portugaloff.) 



PATEN1 Ml IM. i\i S. 



865 



PATEN I' MEDICINES. 

These formuhe have hern published from time to time in various journals and formularies, 
and are supposed to represent the preparations designated. The name of the auth 
appended in each ease when known. 



Alcoholic Strength of Bitters, etc. 

Per cent. 

Alcohol. 

Hostetter 44.3 

Drake Plantation 33.2 

Rush 34.2 

Peruvian 22.4 

Hoofland 25.6 

1 Oxygenated 10.2 

California Wine Bitters 1S.2 

Walker's Vinegar Bitters 7.2 

Warner's Sate Tonic Bitters 35.7 

Lydia Pinkham's V'eg. Comp., 20.6 

Colden's Liquid Beef Tonie 26.5 

Parker's Tonic 41.6 

Howe's Arabian Tonic. 13.2 

Schenck's Sea-weed Tonic, 19.5 

Kilmer's Swamp-root, 7.2 

Famous Catarrh Remedy 27.3 

Kaufman's Sulphur Bitters, 20.5 

Goldcura No. 1, 41. 1 

Goldcura No. 2 28.2 

Whiskol, 28.2 

Peruna, 28.6 

Vinol, 16.8 

(Mass. State Board oj Health, and U. S. 
Government Chemists.) 



Amick's Consumption Cure. 

The Amick advertisements appeared 
shortly after the publication of Dr. N. B. 
Shade's paper in this and other journals. 
Amick copied Shade's language, speaking 
of the ''chemical" cure, etc., and, I believe, 
adopted Shade's methods of treatment. 
These were fully described by Shade, and 
consist in the use of Calomel, Iodoform, 
Guaiacol, etc. 

(Dr. Waugh, in Times and Register.) 



Ayer's Cherry Pectoral. 

Morphinae Acetat., gr. iij. 

Vini Antim. et Potass. Tartrat., 

Vini Ipecacuanhas aa 5iij- 

Tinct. Sanguinarire, oij- 

Syr. Pruni Virginian., oiij- 

■>6 



Ayer's Pills. 
Consist of Colocynth, < ramboge and 

coated with Starch and Sugar. 



Ayer's Sarsaparilla. 
Alcohol, 

Fluidextr. of Sarsaparilla, 
Fluidextr. of Stillingia,. . .aa oiij. 
Fluidextr. of Yellow Dock, 
Fluidextr. of Podophyllum, 

aa 3 i i 

Sugar, 5j. 

Potassium Iodide, 

Iron Iodide, gr. x. 



Ayer's Ague Cure. 
This, according to Churchill's analysis, is 
alleged to consist of a syrupy tincture of 
Peruvian Bark with Aromatics, each bottle 
holding sLx fluid ounces, and each fluid 
ounce containing 3.2 grains of amorphous 
Cinchona alkaloids. 3 grains Cinchonine, 
0.7 grain Cinchonidine, 0.8 grain Quinine, 
and one grain of Quinidine. 



Brandreth's Pills. 

Podophylli Radicis, gr. 

Extract! Podophylli, gr. 

Extr. Phytolacca Bacca?, . . gr. 

Pulv. Car) ophylli, gr. 

Cambogia; gr. 

Ol. Mentha: Piperita;, njjiij. 

Croci, gr. ij. 

Misee, fiat massa, et div. in pil. xxiv. 

(Hager.) 



lj-V. 



Castoria. 



Senna, av. oz. 2. 

Pumpkin seed, dr. 6. 

Rochelle salt, dr. 4. 

Wormseed, Levant, dr. 3. 

Sodium Bicarbonate dr. 2. 

Anise Seed, dr. 1. 

Oil of Gaultheria, dr. J. 

Oil of Peppermint dr. $. 

Sugar, av. oz. 8. 

Water, enough to make .. fl. oz. 16. 
Exhaust the vegetable drugs by boiling 
with water, evaporate to the proper volume, 
and dissolve the sugar and other ingredients. 
(Western Druggist.) 



Chlorodyne, Collis Browne's. 
Morphine Hydrochloride,., gr. vj. 

Chloroform 7)j. 

Cannabis Indica (Extract), gr. vj. 
Prussic Acid (Scheele's), . . . "' 

Treacle, to make 5j- 

Dose. — 10 to 30 minims. {Hygiene.) 



i 



866 



PATENT MEDICINES. 



Clarke's Blood Mixture. 

Potassium Iodide, gr. xlviij. 

Chloric Ether, 5iv. 

Liquor Potassas, ttjxxx. 

Water, colored with Burnt 

Sugar, 5 vijss. 

Dose. — One tablespoonful four times a 
day. {Hygiene.) 

Ely's Cream Balm 

consists of Vaselin, i ounce; Thymol, 3 
grains; Bismuth Carb., 15 grains: Oil Win- 
tergreen, 2 minims. The directions are to 
dip the little finger into the balm and insert 
up the nostrils, giving two or three full 
inhalations. (Medical Record.) 



Garfield Tea 

consists chiefly of Senna leaves and Couch- 
grass (Triticum), with aromatics. 

(Pro}. Leng field.) 



Hamburg Tea. 

Senna Foliorum, partes viij. 

Mannas, partes iv. 

Coriandri, partem j. 

Hamlin's Wizard Oil. 

Spt. Camphorae 5 j- 

Spt. Ammonias, 

Olei Sassafras, aa 3 ss. 

Olei Caryophylli, 3 ij- 

Chloroformi, 

Olei Terebinthinae, aa 3 ss. 

Alcoholis, q. s. ad 3 v. 



Helmbold's Buchu. 
Said to resemble the genuine. 

Short Buchu, 5 ix. • 

Uva Ursi, 5 ivss. 

Licorice root, 3 x- 

Macerate in 9 pints of boiling water, 
strain and add — 

Caramel, o i j • 

Molasses, 5 viij. 

Mix well and add — 

Cubeb (fluid extract), 3 v. 

Alcohol, Oij. 

Peppermint Oil, 3j- 

Water, sufficient to make, . . Oxij. 

(Lillard's Prac. Hints and Formula.) 



Holloway's Ointment. 
Has in 159 parts — 

Olive Oil, 62 \ parts. 

Lard, 50 " 

Rosin, 25 " 

White Wax, 12J " 

Yellow Wax, 3 " 

Turpentine, 3 " 

Spermaceti, 3 " 



Holloway's Pills. 
Have in 144 pills — 

Aloes, gr. lxij. 

Rhubarb, gr. xxvij. 

Saffron, gr. iij. 

Glauber's Salt, gr. iij. 

Pepper gr. vij. 

(Dorvalt.) 

Hostetter's Bitters. 
Sacchari Albi, 
Aurantii Corticis, 
Calami, 
Cinchonas, 

Gentianae, aa lb j. 

Rhei Pulv., 5iv. 

Cinnamomi, 3 ij. 

Caryophylli, 3 j- 

Alcoholis Diluti, Cij. 

(Med. Bulletin, 1884.) 



Keeley Gold Cure. 

The hypodermic injection, administered 
4 times daily for 3 weeks, contains Strych- 
nine (or Brucine) and Atropine (or Hyos- 
cine), with Codeine and Cocaine for the 
opium cases. The whisky supplied to the 
victims contains about gr. -'j, of Apomor- 
phine to each average drink. The " cross- 
shot" is an injection of Apomorphine. The 
" tonic " contains — 

Ammonium Chloride, gr. j. 

Aloin gr. ij. 

Tinct. Cinchonas Comp.,... 3 iij. 

Water, to make, 3 iv. 

(N. Y. Med. Record.) 



Laville's Gout Mixture. 
Calcium Chloride, Chinoi- 

din, of each, 5.0 Gm. 

Extract of Colocynth, 2.5 Gm. 

Water, 85.0 Gm. 

Alcohol, 100.0 Gm. 

Spanish Wine 800.0 Gm. 

Made into a solution. A pill of very 
complicated composition is used in connec- 
tion with the gout remedy. (Hager.) 
[See also page 247.] 



Liquozone. 

One sample was found to contain a total 
acidity of 1.34 per cent., of which 1.18 per 
cent, was in the form of Sulphuric and 
Sulphurous Acid. Other samples have 
shown an acid content as high as 1.73 per 
cent., indicating that the product is not by 
any means uniform in its composition. 

(North Dakota Agricul. College.) 



I'M I \ l MEDICINES, 






Morrison's Pills 



Powdered Colocynth,. . . 
Powdered Gamboge, ... 

Powdered Aloes 

Cream of Tartar 

Also syrup enough for 



gr. nj. 
gr. vj. 
gr i\ 
gr. xij. 
pills. Serious 



results arc often produced by large doses of 
these pills. 



Orange Blossom. 

Zinc. Sulphate 3j- 

Alum gr. xv. 

Expr. Oil of Almond ojss. 

Extract of Hyoscyamus, ... gr. i. 

White Wax gr. xx\. 

Oil of Theobroma ,~>iij. 

Made into oblong suppositories, one inch 
long, one and a half wide and half an inch 
thick, weighing 32 grains each. 



Perry Davis's Pain Killer. 

Tinct. Capsici oj. 

Spt. Camphors oil'. 

Guaiaci Resins, oss. 

Alcoholis, 3 ii ]". 

Tinct. Myrrhs, q. s. ut coloretur. 



Pierce's Favorite Prescription. 

Sabinae, Cinchonae, 

Agarici Albi, aa 5ij. 

Cinnamomi, gr. xv. 

Coq. in aq. suff. et ft. decoct. 5 viij. 
Deinde cola, et adde — 

Sacchari Albi, §ss. 

Acacia? 5 j- 

Solve, et addantur — 

Tinct. Opii Deodorat, 

Tinct. Digitalis, aa oss. 

Ol. Anisi, gtt. viij, in Alco- 
holis, ojss. 

Misce. (Hager.) 



Pierce's Golden Discovery. 

Extr. Lactuci, 5 j. 

Mellis, oj- 

Tinct. Opii Deodorat., oss. 

Alcoholis Diluti, 

Aquae, aa 3 ii j . 

(Hager.) 



Radam's "Microbe-Killer." 

Oil of Vitriol (impure) oiv. 

Muriatic Acid (impure), ... 5j- 

Red Wine, 5 j. 

Water Cj. 

(Eckels.) 



Radway's Ready Relief. 
Capsii i. 

A,qU6C \minoni.e, 

Alcoholis 

Linimenti Saponis 

(Hager.) 



Radway's Resolvent. 



Vini 2 

\'ini Cardamomi, 

Sacchari Albi,... 



aa Jiij- 
(.Hager.) 



Recamier Balm. 

Zinc < )\i<le His. 5, 

Glycerin dr, 

All ohol oz. 2. 

Mercuric Chloride, oz. |. 

I (istilled Water 

ton Herald.) 



Recamier Cream. 

Rice Flour, oz. [8. 

Zinc Oxide, oz. 60. 

Glycerin, oz. 640. 

Cacao Butter 0/ 

Lard, oz. 4S. 

Men uric Chloride OZ, 4. 

Make 32 pints. (Boston Herald.) 



Revalenta Arabica Food. 
Consists solely of Lentils ground up into 
a fine powder. (Stokes in "Hygiene.") 



Sage's Catarrh Remedy. 
Salis Culinaris(Sodii Chlor.) partes xx. 

Pulv. Camphora;, part. j. 

Acidi Carbolici, part. j. 

M. — To be dissolved in water and either 
injected or sniffed up the nose. 



Pulv. Hydrastis Canadensis, partes v. 

Pulv. Indigo part. ss. 

Pulv. Camphone, 

Acidi Carbolici, aa partes ij. 

Sodii Chloridi, partes 1. 

(New Remedies.) 



Sanford's Catarrh Cure. 
According to an analysis made by Prof. 
A. B. Lyons for the New Idea, this prepa- 
ration is composed of distilled extra 
Witch-hazel, containing a little Alcohol and 
Glycerin and some Morphine. The pro- 
portions of the constituents were not de- 
termined. (Nat. Druggist.) 



( 



868 



PATENT MEDICINES. 



Seigel's Syrup. 
Contains Aloes, gr. 30 to the oz. Also 
Borax, Capsicum, Licorice, and Treacle. 
(Stokes in "Hygiene.") 



Sequah's Oil. 

A mixture of § Turpentine and J Fish 
Oil, scented with a few drops of Oil of 
Camphor. (Stokes in "Hygiene.") 



Sequah's Prairie Flower. 
Has to the ounce — 

Aloes, gr. 52 \. 

Carbonate of Soda, gr. 17$. 

Water, gr. 362$. 

and a few drops of the Tinctures of Capsi- 
cum and Myrrh. (Stokes in "Hygiene") 



St. Jacob's Oil. 

Gum Camphor, 

Hydrated Chloral, 

Chloroform, 

Sulphuric Ether, . . .of each, oz. 1. 

Tinct. of Opium, 

Oil of Origanum, 

Oil of Sassafras, of each, oz. J. 

Alcohol, gal. J. 

Dissolve the Gum Camphor in the Oils 
and Alcohol, then add the other ingredients. 

Squibb says that it is a weak Aconite 
Liniment, also containing Ether, Alcohol, 
Turpentines, red coloring matter, and water. 
(Ephemeris, p. 114.) 



Swift's Specific, " S. S. S." 

Fluidextr. of Smilax Sarsaparilla, 16 parts. 

Fluidextr. of Stillingia Sylvatica, . 16 parts. 

Fluidextr. of Lappa Minor, 16 parts. 

Fluidextr. of Phytolacca, 16 parts. 

Tinct. of Xanthoxylum, 8 parts. 

(Registered Pharmacist.) 

Stearns' New Idea gives the following: 
Stillingia, Pokeroot, and Sarsaparilla, with 
Nitrate of Potash and a small quantity of 
Iron, and enough Alcohol to preserve it. 



Thompson's Eye-Water. 

Copper Sulphate, gr. v. 

Zinc. Sulphate, gr. xx. 

Tincture of Saffron, 5'j- 

Tincture of Camphor, 3ij- 

Rose-water, Oj. 

Mix and filter. 



Van Buskirk's Sozodont. 

Saponis Albi 3ss. 

Alcoholis, 5 j. 

Aquas, 3 vj. 

Glycerini, 5'j- 

Olei Gaultheriae, 
Olei Caryophylli, 
Olei Mentha; Piperitae, 

aa. q. s. ad saporem grat. 
Cocci Cacti, q. s. ut coloretur. 



Calcis Pra;cipitat., 
Magnesii Carbonatis, 
Iridis Florent. Radicis, . 
M. et triturat. 



aa p. a;q. 
(Hoffmann.) 



Vita Nuova. 

Cocaine, gr. viij. 

Pepsin (golden scale), gr. xlviij. 

Port Wine, Cj. 

(Boston Herald.) 






Walker's Vegetable Vinegar Bitters. 

Aloes Socotrin, 3ij- 

Guaiaci Resins, 3 iv. 

Sassafras Mucil., 3 j- 

Aceti, 3ij- 

Aqua;, q. s. 

Coque, et ft. decoctum, ad 5 xix, deinde 
cola, et addantur.. 

Sodii Sulphatis, 3j. 

Acacia;, 3ij- 

Spt. Anisi, 10 p. c, 3'j- 

Alcoholis, 5 j- 

M. Dose, 3ij- (Eberbach.) 






Warner's Safe Kidney and Liver Cure. 

In Germany each maker of patent medi- 
cines must furnish the government with 
the formula for the patent he makes. This 
is the one furnished by Warner for " Safe 
Kidney and Liver Cure." Each bottle 
contains: — 

Extr. Lycopus Virginiana, . . gr. 308. 

Extr. Hepatica (herb), gr. 322. 

Extr. Gaultheria, gr. 7 1 . 

Potassium Nitrate, gr. 39. 

Alcohol (90%), oz. 2\. 

Glycerin, dr. 10. 

Water sufficient to make one pint. 
(Formulary and Druggists' Magazine.) 



DIFFEREN n U ni ^.GNOSIS 






TABLES OF DIFFERENTIAL DIAGNOSIS 



Forms of Bright's Disease. 

Compared -villi Acute Nephritis and -villi tack other. 







« 


(1) Acute 

Bright's 

Disease. 

Acute 

Parenchy. 

Nephritis. 


Chronic Bright's Disease. 


Clinical 
Phenomena. 


J3 
Q, 

u 

u 

U 

< 


(a) Chron. 
Parenchy. 
Nephritis. 

(.Large 

While 

Kidnty.) 


(3) 
Fatty 

Kidney. 


(.1) 
Amyloid 

ft ixy 

Kidney. 


iron. 

1i1.1l 
rids. 

■ ■:<:lk 
Ki-i': 


g 
5 ' 

_ 




Normal 
or — 




nri 


Mi irmal 
or — 


Normal 
or + 


Normal 

<,r ■ 

Acid. 








Acid. 


Acid. Acid. 


Acid 


Add. 






Wine 


Dark 


Brown 


Pale. 


Pale. 


Clear. 




yellow. 


smoky. 


yellow. 


Sp.Gr 


Normal , H ; gh 




1. 01 5- 1. 030 


— , above 

I.OIO 


— I.OIO 






- 


- 


ual 
or — 


N'.nnal 


Chlorides Normal. — 


- 


- 




Normal. 


Albumin {percent.), 


,' 5 to J 1 to 6 


i to 2 


1 to 6 


A toi 

of 
globulin. 






Hyaline Blood 


Granular 
Hyaline. 
No blood. 


Fatty. 


Few and 
Hyaline. 


Very few. 




Epithel. Hyaline. 


Mucus Brown 
Sediment {macroscopical).\ giT^ ' cells. 

Urates. 


Kidney 

epithelium. 

Blood. 

Lymph. 


Free oil. 


Seldom 

any. 


Seldom 
any. 


Dr< 




Great. 
Seldom. especially 
of face. 


Never 
absent. 


Great. 


Trifling. 


stages. 






°»-» •••• ss 


Not 
marked. 


Rare. 


Rare. 




Oti 




Stiff 
joints. 
Sacral 




Tempera- 
ture low. 
No fever. 
Inflam. of 

serous 
membr's. 
Cardiac 

hyper. 


Face pale, 

puffy. 

Cardiac 

hyper. 


Emacia- 
tion, sal- 
low face, 
enlarged 


Retinitis. 
Tense, 
quick 






pain. 
Lassitude. 


spleen, Hyper, of 
thirst, heart, 
diarrhea. 


Prc 


or No. 2. (?) or Xo. 3. 


Always 
fatal. 


Depends 
on con- 
stitutional 
disease 
present. 


I'nf 1 

able, but 

course 

perhaps 

long. 



Note.— The signs + and — in the line entitled Sp. Gr.. respectively denote a specific gravity greater than t.o:<, 
or less than 1.018. 



< 



870 



DIFFERENTIAL DIAGNOSIS. 



Cancer. 



Cancerous {Malignant) Tumors. 
Are of constitutional origin. 
Have no cyst, but invade and convert the 

surrounding tissues. 
Cancer material is short-lived from rapid 

deterioration, but is rapidly reproduced. 
Severe increasing pain. 
Extend to remote parts, reappearing chiefly 

in lymphatic glands. 
Cancerous cachexia of general health. 
Recur after extirpation, fatal in end. 



Non-malignant Tumors. 
Origin, some local error of growth. 
Limited by a cyst; may compress, but do 

not invade adjacent tissues. 
Have uncertain period of increase, after 

which may remain stationary. 
Usually no pain. 
Are local, have no disposition to spread. 

Impair functions of part pressed on. 
Do not recur. 



Scirrhus. 
Is hard. 

Appears mostly on female breast. 
Hard kernel, movable under skin. 
Becomes fixed to adjoining structures, which 

it puckers. 
Single and grows slowly. 
Course slow — 2 to 4 years. 
Never in the young. 



Encephaloma. 
Is soft and brain-like. 
Most frequently on the limbs. 
At first deeply seated, hard to recognize. 
Spreads through loose textures, which it 

pushes aside and distends. 
Has numerous tumors, grows rapidly. 
Generally fatal in 1 to 2 years. 
Often in the young, even at birth. 



Endocarditis. 
Blowing sound. Excited heart action. 
Slight if any increase of percussion dullness. 
Impulse strong. 

Sounds normal or more distinct except at 
site, where a murmur is heard. 



Carditis, Endo- and Peri- 

Pericarditis. 
Friction sound. Excited heart action. 
Marked increase in effusion stage. 
Wavy and feeble. 
Feeble and muffled; no blowing sounds. 



Concussion. 
Patient can be roused; pupils react. 
Breathing seldom stertorous. 
Urinary action normal. 
Symptoms appear soon after accident. 



Cerebral 



Compression. 
Complete insensibility; motionless pupils. 
Breathing usually stertorous. 
May be either retention or incontinence. 
Frequently do not. 



Chancre and Chancroid. 



Chancre. 
Commences about 3d week after coitus. 
First as a papule, abrasion, or crack. 

Generally indurated (rarely not). 

Develops slowly. 

Discharge slight, unless irritated. 

Is soon limited and seldom phagedenic. 

Edges sloping, not undermined. 

Scanty serous secretion. 

Sore remains solitary, and cannot be multi- 
plied; is multiple in 18 per cent, of the 
cases (Fournier), in 25 per cent. (Gail- 
lard), in 33 per cent. (Julien). 

Followed by numerous buboes, rarely sup- 
purating, never furnish inoculable pus. 



Chancroid. 



In 24 hours to 3 days. 

First as a red spot, then a pustule, then a 
suppurating sore. 

Not on an indurated base. 

Develops rapidly. 

Suppurates profusely. 

Tends to invade surrounding tissues, or be- 
come phagedenic. 

Edges undermined. 

Discharge is purulent and copious. 

May be transplanted at will, and is seldom 
single. 



A single bubo may appear and suppurate. 



I'll ll Kl \ 11 \l Pi ^GNOSIS, 






Cholera. 



A sialic. 
Preceded by painless diarrhea. 
Not directly from error in diet. 
First pain shooting down thighs. 
Prostration rapid and overwhelming, and 

out of ratio to evacuations. 
Rapid reduction of surface temperature; 

high temperature in cavities. 
Evacuations like rice-water from the first. 

Cramps commence in extremities. 
Veins congested; tongue, lips and extremi- 
ties livid purple. 
Urine albuminous. 



Simple. 

Seizure Midden. 

illy is from error ill diet. 

First pain is abdominal (colic). 

Prostration gradual, less marked than the 

vomiting and purging. 
Gradual reduction ol surface temper. mire; 

internal temperature normal. 
Discharges bilious, causing burning and 

smarting pain; colorless only at veiy last. 
Cramps commence in abdomen. 
Not so. 

Not so. 



Croup and Diphtheria. 



Croup. 

Premonitory hoarse, metallic cough, with- 
out illness. 

A child's disease. 

Tenacious mucus covering the swollen mem- 
brane. 

A local disease. 



Diphtheria. 
Premonitory illness, marked by chills, fever 

and sore throat, without cough. 
Attacks adults as well. 
Distinguished by a false membrane, and 

the Klebs-Loeffler bacillus. 
A blood poison; great general depression. 



Epilepsy and Hysteria. 



Epilepsy. 

Loss of consciousness is sudden, complete. 

Livid face, frothy saliva escapes, eyelids 
half open, eyeballs rolling, teeth grind- 
ing, tongue biting; more or less insensi- 
bility of pupils to light. 

Countenance is distorted. 

Patient shows no feeling. 

Aura epileptica may precede attack. 

Short paroxysm, followed by heavy coma- 
tose sleep and dull intellect. 

Frequently occurs at night. 

Not necessarily of uterine connection, though 
a paroxysm often occurs at the menstrual 
period. 



Hysteria. 

Gradual and partial or apparent. 

Face flushed, or complexion unaltered, no 
froth on lips, eyelids closed, eyeballs 
fixed, no grinding of teeth, or biting of 
tongue; pupils react readily. 

Is not. 

Sighs, or laughs, or sobs. 

Globus hystericus. 

Longer paroxysm; patient not sleepy, usu- 
ally wakeful and depressed in spirits. 

Rarely occurs at night. 

Often connected with uterine or menstrual 
disorders. 



Gout and Rheumatism. 



Gout. 



Affects chiefly the small joints, especially 

the metatarsal joint of the great toe. 
Occurs from 35-50 years of age; rarely 

before puberty. 
Most frequent in men, and often the result 

of idle, intemperate and luxurious life. 
Is strongly hereditary. 
Chalk-stones (sodium urate) in external 

ear, on tips of fingers, or elsewhere. 
Uric Acid in the blood, absent from urine. 
A fit often affords temporary relief. 
Bronchitis common. 
Is confined to the temperate zone. 



Rheumatism. 
Large joints chiefly implicated. 

Occurs generally in young adults. 

Affects both sexes equally, and equally the 

poor and the rich. 
But slightly so. 
Not so. 

Lactic Acid in the blood. 

Quite the contrary. 

Not so. 

Is ubiquitous — prevails in all climates. 



« 



872 



DIFFERENTIAL DIAGNOSIS. 



Pleurisy and Pneumonia. 



Pleurisy. 

Sharp pain, friction sound, dry cough, im- 
paired chest motion. 

In stage of effusion, obliteration of inter- 
costal spaces, enlargement of the side, 
viscera displaced. 

Dullness, with enfeebled or absent respira- 
tion, voice, and fremitus. 

Sputa frothy, rarely any rales. 
Febrile symptoms slight usually. 
Temperature irregular, rarely high. 



Pneumonia. 
Dull pain, crepitant rale, cough followed 

by expectoration. 
In stage of hepatization none of these signs 

are present. 

Dullness, with marked bronchial respira- 
tion, distinct thoracic voice, increased 
vocal fremitus. 

Sputa rusty color, rales common. 

Febrile symptoms severe. 

Sudden elevations and falls, high tempera- 
ture not uncommon. 



Pleurisy and Intercostal Neuralgia. 



Pleurisy (Dry). 
Pain somewhat diffused, not limited to a 

certain area. 
Slight fever and cough. 
Herpes absent. 
Friction sounds. 



Intercostal Neuralgia. 
Pain localized to the exit of the intercostal 

nerves. 
No fever, no cough. 
Herpes common, in the affected area. 
No friction sounds. 



Pleurisy and Hydrothorax. 

Pleural Effusion. 



Hydrothorax. 



Disease is unilateral. 
Pain and cough. 
Often a primary affection. 
Friction sounds present. 
Organs often displaced. 
Slight fever. 



Disease is bilateral. 
No pain; cough slight. 
Secondary to other diseases. 
Friction sounds absent. 
Organs not displaced. 
No fever. 



Pneumonia. 



Lobular (Broncho-pneumonia). 

Is bilateral. 

Begins gradually, and is secondary to bron- 
chitis. 

Temperature is not typical. 

Affects lobules in both lungs. 

Sputum not characteristic. 

No herpes. 

Subcrepitant rales; broncho- vesicular breath- 
ing. 

A prolonged disease, ending by lysis. 



Lobar (Croupous). 
Usually unilateral. 
Begins suddenly, often with a chill, and is a 

primary disease. 
Temperature is typical. 
Affects one or more lobes of the lung. 
Sputum rusty. 
Herpes common. 
Crepitant rales, then bronchial breathing, 

followed by crepitus redux. 
A short disease, ending by crisis. 



Scarlet 

Scarlet Fever. 
Incubation, 1 day to weeks. 

Fever, great heat of skin, 
and frequent pulse, un- 
abated during eruption. 

Brilliant stare. 
Sore throat, rarely coryza 
or bronchitis. 



Fever, Measles and Smallpox. 

Measles. 
Incubation, 7 to 14 days. 



Same fever rather increased 
by eruption. 



Liquid, watery eye. 
Coryza and bronchitis very 

constant, sore throat 

rarely. 



Smallpox. 

Incubation, 6 to 20 days, 
average, 10. 

Fever often violent, bound- 
ing pulse, pain in loins; 
all are greatly relieved by 
eruption. 

Eyes injected, face red. 

Sore throat often, also a dry 
cough. 



I'll! I R] ■ \ I I \i hi VGNOSIS, 






• Ras] tongue, red. 

Temperature may be 105 - 
106° to 10th day, subsides 
dually, falls on 5th, 
10th, and 15th days. 
. ondary fever. 

Eruption on second day, 
not rough, first on neck 

and chest, spreads rapid- 
ly, white streak on pres- 
sure with nail. 

Eruption uniform, or in 
large patches, inter- 
spersed raised spots and 
some vesicles; rash scar- 
let, on its seventh day- 
very complete desquama- 
tion in large patches. 

Cerebral symptoms are fre- 
quent and grave. 

Pneumonia rare, pleurisy 
more frequent. 

Sequela? : Bright's disease, 
dropsy, deafness, con- 
junctivitis, phthisis, 
chronic diarrhea; glan- 
dular enlargements. 



lit I 

Tongue coated, may b 

at edges. 
I03°-io0-' before eruption, 
remains high for 1 
days thereafter, then falls 
suddenly. 

No secondary fever. 

Eruption on fourth day, on 
face, rough, spreads grad- 
ually, the streak lasts 
Only a short time. 

Eruption in c r e s c e n t i c 
patches, lasts about 5 
days, then partial de 
quamation, si-ales very 
fine. 



Not so. 

Pneumonia a frequent com- 
plication. 

Sequela; : chronic bronchi- 
tis, phthisis, conjunctivi- 
tis. 



Smallpox. 
'1'ongue coated, and -«"l 
len, may be red nt 
eruption often 
then rapidly -ink . to loo 
in 36 houi ., lises during 

the set ondai j 1 
Se< ondar) fever alw 1 

Eruption usually on third 

head and ham I 
rapidly. 

Eruption 1 ipular, 

t li e n vesii ular, finally 

pustular; pustules matu- 
rate on 8th day of erup- 
tion. 



Cerebral symptoms are fre- 
quently seen. 

Pneumonia not a very fre- 
quent complication. 

Sequels: chronic diarrhea, 
glandular enlargements, 
various eve di 



Typhus and 

Typhus Fever. 
Attacks quickly, incubation 9 days. 

Occurs at any age. 

Rare among the higher classes, except those 

exposed. 
Mulberry Eruption on 4th and 5th day, on 

extremities, lasts until the close. 



Brain chiefly affected; bowels often but 
little so; abdomen natural, evacuations 
dark, but never bloody (these are occa- 
sionally reversed). 

Contracted pupils, dusky face. 

Pulse and temperature rise to 120 and 105° 
until 3d day, high for 6 days, then fall. 

Lasts 2 to 3 weeks. 
Widal reaction negative. 

Relapses rare. 

Death from coma or congestion of the lungs, 
in 1st or 2d week. 

Arises from destitution, over-crowding, bad 
ventilation, is highly contagious and gen- 
erally epidemic. No microbe determined. 



Typhoid. 

Typhoid {Enteric) Fever. 
Commences slowly, incubation about 13 

days. 
Most common in youth and childhood, rare 

after the age of 40. 
As common among the rich as the poor. 

Rose Eruption on 7th to 10th day, isolated, 
flattened papules, few, on abdomen and 
back, in successive crops which fade and 
disappear. 

Bowels chiefly affected, evacuations ochre- 
color and watery, sometimes hemorrhage 
or even ulceration, abdomen tumid. 

Dilated pupils, cheeks flushed. 

Pulse and temperature rise and fall inde- 
pendently, and without uniformity, but 
both are usually high to the 15th day. 

Lasts 4 to 6 or more weeks. 

Widal reaction positive in 95 per cent, of 
the cases. 

Relapses frequent. 

Death from asthenia, pneumonia, hemor- 
rhage or perforation of intestine, in or 
after 3d week. 

From poisoned drinking water, putrid ani- 
mal matter, bad drainage; is not conta- 
gious, often sporadic. Eberth's bacillus 
present in the intestinal lesions, the spleen, 
liver, blood, etc. 



( 



874 



DIFFERENTIAL DIAGNOSIS. 



Typhus Fever. 
Post-mortem: changes not constant, the 
most frequent are dark blood, enlarged 
spleen, soft heart. 



Typhoid {Enteric) Fever. 
Post-mortem: morbid Peyer's patches, e 
larged mesenteric glands, ulcerated mu- 
cous coat of intestines; enlarged and soft 
spleen, ulcerated pharynx. 



n- 



Varicella and Varioloid. 



Varicella. 
Incubation, 14 days; may extend to the 27th 

day (Trousseau). 
Prodromes, none or slight; no initial rashes. 



Eruption, on the first day, on trunk and 
arms, slightly on forehead, rapidly becomes 
vesicular; is irregular, sometimes numer- 
ous, distributed universally in successive 
crops; lasts 5 to 8 days. 

Vesicles, not umbilicated, differ in size, uniloc- 
ular, when pricked collapse entirely. 

Crusts, yellowish-brown, slight. 

Pustules, ordinarily absent, may occur from 
irritation or infection, or in poorly-nour- 
ished children. 

Temperature, irregular, to 102 F., no secon- 
dary fever. 

Duration, 7 to 10 days. 



Varioloid. 
Incubation, 7 to 14 days. 

Prodromes, active for 2 days; headache often 
severe, backache slight or absent; initial 
rashes frequently occur. 

Eruption, usually within 36 hours, on fore- 
head and arms, then over body; regular, 
few, definitely localized; macular, papular, 
and then vesicular, raiely pustular; lasts 
about 14 days. 

Vesicles, umbilicated, of uniform size, mul- 
tilocular, when pricked they collapse 
partially. 

Crust-formation positive. 

Pustules, usually few in number. 



Temperature, rises suddenly, to 103 F., no 

secondary fever if pustules few. 
Duration, 2 to 3 weeks. 






Yellow and Bilious Remittent Fevers. 



Yellow Fever. 
Incubation 5 to 9 days. 
A disease of one paroxysm, terminating in 
recovery or collapse; duration 3 to 7 days. 

Very severe nausea and vomiting, early 

epigastric tenderness. 
Black vomit, due to gastric hemorrhage. 
Hemorrhages from various parts. 
Tongue clean, or slightly coated. 
Pulse variable, slow at end. 
Eye injected and humid. 
Supra-orbital pain, pain in back and in 

calves of legs. 
Rarely delirious, mind clear generally. 
Urine albuminous, usually suppressed. 
Convalescence rapid, no sequela?. 
Muscular prostration slight. 
Mortality high, disease epidemic. 
Treatment unsatisfactory. 
Autopsy: inflamed or congested stomach, 

enlarged yellow liver, filled with oil 

globules, muscular fibres of heart are 

often disintegrated. 



Bilious Remittent. 

Incubation may extend to months. 

A disease of several paroxysms, with inter- 
vening remissions; duration 9 days or 
more. 

These symptoms are not so severe, nor do 
they occur so early. 

Bilious vomiting. 

No hemorrhagic tendency. 

Tongue heavily coated. 

Pulse quick until convalescence. 

Eye natural. 

Headache, sense of fullness in head, often 
no loin or leg pains. 

Delirium frequent, mind dull. 

Not so. 

Convalescence slow, tedious sequehe. 

Muscular prostration greater. 

Mortality slight, disease endemic. 

Very amenable to treatment. 

Autopsy: stomach congested, rarely inflamed, 
liver olive or bronze hue, not fatty. 



DROPS i\ \ in ipk \ciiu. 






TABLE SHOWING ill !•: 

NUMBER OF DROPS IN A I I II DRACHM 
OF VARIOUS LIQUIDS, ALSO THE WEIGHT OK ONE I I I li'K \ni\i i\ GRAINS. 



Liquid. 



Acetum Opii 

Acetum Solla;, 

Acid, Acetic, 

Ac. Acetic. Dil 

Ac. Hydrochloric, 

Ac. Hydrocyanic, 

Acid, Lactic, 

Acid, Nitric, 

Ac. Xitro-hydrochloric. 

Ac. Phosphoric Dil 

Ac. Sulphuric, 

Ac. Sulph. Aromat 

Ac. Sulph.Dil 

Ac. Sulpburosum 

.Ether 

Alcohol 

Aqua 

Aqua Destillata, 

Balsam of Peru 

Bromine 

Chloroform, 

Copaiba, 

Creosote 

Fluidextr. Belladon. Rad 

Fluidextr. Buchu 

Fluidextr. Digitalis 

Fluidextr. Ergotae, 

Fluidextr. Ipecac 

Fluidextr Rhei 

Fluidextr. Senega? 

Fluidextr. Valeriana;, 

Fluidextr. Zingib., 

Glycerin 

Hydrargyrum 

I.iq. Aridi Arsenosi 

Liq. Ferri Chloridi 



Drops 
in fSi. 

(Illlx) 



oo 

68 

108 

6S 

7° 

60 

1 11 

102 

76 

50 

138 

146 

60 

59 

176 

146 

60 

60 

101 

250 

250 

110 

122 

156 

150 

134 

133 

120 

158 

137 

150 

142 

67 

150 

S7 

7i 



Weight 
of f.">j in 
grains. 



61 
57 
58 
55 
6S 
54 
66 
77 
66 
57 
101 

33 . 
58i 

55 
39 
44 
55 
53i 
60 
165 
80 
51 
S6J 

47i 
62 
60 
60 
61 
62 
40 
48 
68 
760 
55 



Liquid. 



Liq. Iodi Com] 

Liq, Potassii nydroxidi 

Liq. End Chloridi 

Olcores. Apsidii 

Oleores. Capsicj 

Oleores. Cubebc 

Oleum Anisi 

Oleum C'.iri 

Oleum Juniperi 

Oleum Limonis 

Oleum Ririni 

Oleum Rosa.', 

Oleum Tcrcbinthin.e.. . 

Oleum Tiglii, 

Phenol 

Spt. .Elhcris Comp 

Spt. .Etheris Nitrosi, . . 

Spt. Cam phone 

Syrupus, 

Syrupus Acacia' 

Syrupus Ferri Iodidi,... 

Syrupus Scilkc 

Syr. Scill.x- Comp., 

Syrupus Senega- 

Tinctura Aconiti 

Tinct. Belladonna', l'ol. 
Tinct. Bcnzoini Comp., 

Tinct. Cantharidia 

Tinct. Digitalis 

Tinct. Ferri Chlor.,..'. . 

Tinct. Iodi 

Tinct. Opii 

Tinct. Opii Camph 

Tinct. Opii Deodor.,... 

Vin. Colchici Sem 

Vinum Opii 






63 

So 
130 
120 

■ .•■ 
110 
132 
148 
120 

77 

MO 

IOJ 

I II 

148 

146 

Mi 

6s 

44 
65 
75 
102 
106 

I4<) 

■ I? 
14S 
131 

150 
148 

130 
130 
no 
in 
100 



nr 1111, 



I a 
5» 

54 

40 

47 

4>J 

50 

59 

■1. 

47 

47 

7 a 

73 

77 
74 
70 
70 

4" 

48 
5' 

53 
53 

47 
>< 
5 a 
54 
54 
55 



WEIGHTS AND MEASURES. 



APOTHECARIES OR TROY WEIGHT. 



Pound. 
lb 
I = 



Ounces. 

EC 

o 

12 
I 



Drachms. Scruples. 

5 3 

= 96 = 288 = 

8 = 24 = 

i=3 = 
1 



Grains. 

g r - 

S76o 

4S0 

60 

= 20 



METRIC WEIGHTS 

i Milligramme, . 
1 Centigramme 
1 Decigramme, . . 
1 Gramme, 

1 Kilogramme, 1000 



0.00 1 = gr. 
0.01 = gr. J 
0.1 = gr. iA 

I- = gr. 15.432 

1 lb 2.7 Troy. 
( lb 2.2 Av. 



APOTHECARIES' OR WINE MEASURE. 



Gallon. 

C. 
1 



Pints. 
O. 



FT ounces. 

= 128 = 

16 = 

1 = 



F l' dr'ms. 

fo 

1024 = 
[28 - 

8 = 
1 = 



ilimms. 
6t440 

7680 

480 
60 



APPROXIMATE EQUIVALENT IS. 

nnjorgr. j = .o6gramme. 

f 5jor 5j, = 4- grami 

f3j = 3°- 

Sj -3«- 

f 5j of Glycerin = 

f 3 j of Syrups = 4°- 



i 



876 



METRIC CONVERSIONS. 



TABLE FOR CONVERTING 
APOTHECARIES' WEIGHTS AND MEASURES INTO METRIC. 

(Adapted from Maisch.) 

[Multiply all grains, or fractions of a grain, by 6479 (or 648) for the metric equivalent in 

milligrammes. — Potter.] 



Troy Weight. 


Metric. 


Apothecaries' 


Fluid Grammes or Cubic Centimeters. 












Grains. 


Grammes. 


Measure. 


liquids 

Lighter than 
Water* 


Liquids of 
Specific 

Gravity of 
Water.t 


Liquids Heavier 
than Water. J 




Milligramme 


W 1 


•055 


.06 


.08 


¥ 


.001 


2 


.10 


.12 


•15 


?V 


.0015 


3 


.16 


.18 


.24 


1 


.002 


4 


.22 


.24 


•32 


2V 

1 


.003 


5 


.28 


•3° 


.40 




.004 


6 


•32 


•36 


.48 


T5 

1 


.005 
.006 
.008 
Centigramme 
.01 
.016 


7 


•38 


•42 


•55 


i 

i 

i 


8 

9 

10 
12 


■45 
•So 
•55 
■65 


•50 

•55 
.60 

■72 


•65 

•73 
.80 
.96 


i 


.02 


15 


.80 


.90 


1.20 


i 

1 

1 


•°3 
•OS 
.o6t 


16 
20 


.90 
1. 12 


1. 00 
125 


1.32 
1.60 


25 


1.40 


i-55 


2.00 




3 
Decigramme 


30 


1.70 


1.90 


2.50 


2 


•13 


35 


2.00 


2.20 


2.90 


3 


.20 


40 


2.25 


2.50 


3-30 


4 


.26 


48 


2.70 


3.00 


4.00 


s 


■32 


50 


2.80 


3.12 


4-i5 


6 


•39 


60 (f 5j) 


3-4o 


3-75 


5.00 


7 


•45 - 


6S 


3.60 


4.00 


S-3o 


8 


•52 


72 


4.00 


4-5° 


6.00 


9 
10 


•59 
•65 


80 

90 (f ojss) 


4-5° 

5.10 


5.00 
5.60 


6.65 
7-5° 




Gramme 


96 


5 -4o 


6.00 


8.00 


15 


1. 00 


100 


5.60 


6.25 


8.30 


20 ( 3j) 


1.30 


120 (f oij) 


6-75 


7-5° 


10.00 


24 


I.50 


150 (f Sijss) 


8.50 


9-5o 


12.50 


26 


I.62 


160 


9.00 


10.00 


13-3° 


3° ( 3ss) 


i-95 


180 (f 5iij) 


10.10 


11.25 


15.00 


40 


2.60 


210 (f 3iijss) 


11.80 


13.00 


i7-5o 


5° 


3.20 


240 (f 3iv) 


i3-5o 


15.00 


20.00 


60 ( 3j) 


3-9° 


300 (f 5v) 


16.90 


18.75 


25.00 


100 


6.48 


33° ( f ovss) 


18.60 


20.75 


27-50 


120 ( 5ij) 


7.80 


360 (f ovj) 


20.25 


22.50 


30.00 


180 


11.65 


420 (f ovij) 


23.60 


26.25 


35-o° 


240 ( 5ss) 


15-5° 


480 (f Sj) 


27.00 


30.00 


40.00 


300 


19.40 


540 (f Six) 


30-40 


33-75 


45.00 


360 


23-50 


600 (f 3x) 


33-75 


37-50 


50.00 


420 


27.20 


720 (f 3xij) 


40.50 


45.00 


60.00 


480 ( 5j) 


31.10 


840 (f 3xiv) 


47-25 


52-50 


70.00 


960 ( Bij) 


62.20 


960 (f oij) 


54.00 


60.00 


80.00 


1000 


64.79 


1000 


56.00 


62.50 


83.00 



* Lighter than water are tinctures, spirits, compound spirit of ether, sweet spirit of nitre, fixed and volatile oils. 
jEther, f3j = grammes 2.80. 

tSame as water are waters, liquids, decoctions, infusions, most fluidextracts, and tinctures made with dilute 
alcohol. 

t Heavier than water are syrups, glycerin, a few fluidextracts, and chloroform. Of the latter f3j =grammes 550. 



NDEX 



When English and Latin nanus are nearly alike, the former arc given in the index and 

the latter are omitted; but when they are dissimilar both names are indexed. Salt, of the 
metals are usually described in the book under the titles of their metallic constituents; some 
few (the Arsenates. Phosphates, etc.), also the salts of the alkaloids and tln.se . . i . 
mentary substances (the Bromides, Iodides, etc.) are placed under the titles iif ti. .■ me 

constituents. Salts arc therefore not mentioned individually in the Index except when their 
places in the text are exceptional and do not come within either of the ab 



Abasia and Astasia, 569 
Abbreviations, their use, 514 

Table of, 515, 849 
Abdominal Plethora, 569 
Abies, 394 

balsamea, 481 

canadensis, 395 

excelsa, 395 
Abortion, 569 
Abrin, 58, 441 
Abrus, 58 
Abscess, 5 70 

of the Liver, 695 

Mammary, 570 
Absinthe, 58 
Absinthium, 58 

Absorption by various channels, 50 
Acacia, 59 

Catechu, 209 
Accommodation of the Eye, 12 
Aceta, 533 
Acetamide, 59 
Acetanilide, 59 

Ammoniated, 60 

Antidotes and Antagonists, 769 

Compound, 59 
Acetates, — See the titles of their basic con- 
stituents. 
Acetone, 65, 103 

Chloroform, 215 

Preparations, 533 

in Urine, Test for, 831 
Acetopyrin, 141 
Acetous Preparations, 533 
Acetozone, 368, 370 
Acetphenetidin, 63 

Antidotes and Antagonists, 777 
Acetum, 65 
Acid, Abietic, 482 

Abric, 58 

Acetic, 65, 103 

Antidotes, etc., 769 

Acetyl-salicylic, 424 

Aconitic, 81, 86 

Agaricic, 92 



Acid, Aloctic, 1 13 
Anemonic, 406 
Angelic, 47S, 4c).' 
Arabic, 59 
Arsenous, 158 

Antjdotes and Antagonists, 771 
Artanthic, 338 
Benzoic, 173, 232 
Boracic, 66 
Boric, 66 
Brassic, 460 
Butyric, 342 
Cacodvlic, 159 
Cafieic, 186 
Calumbic, 195 
Camphoric, 196, 198 
Camphretic, 196 
Capronic, 157 
Caprylic, 157 
Carbazotic, 377 
Carbolic, — See Phenol, 232, 375 

Antidotes and Antagonists, 769 
Carbonic, 204 

Antidotes and Antagonists, 769 
Carminic, 245 
Caryophyllic, 208 
Caryophyllinic, 208 
Catechuic, 210 
Catechu-tannic, 210 
Cathartic, 438 
Cathartogenic, 43S 
Cerotic, 210 
Cetraric, r24 
Chelidonic, 211 
Chloric, 226 
Chromic, 226 
Chrysammic, 1 13 
Chrysophanic, 228, 412, 418, 438 
Cinnamic, 175, 169, 471 
Citric, 328 
Copaibic, 250 
Cresylic, 252 
Cubebic, 2;; 
Daturic, 467 
Diacetic, Test for, 831 



877 



i 



878 



INDEX. 



Acid, Dibromogallic, 69 
Ergotinic, 270 
Erucic, 460 
Eugenic, 344 
Euonic, 275 
Euphrastic, 276 
Filicic, 163 
Fluoric, 68 
Formic, 342 
Gallic, 68 
Gallotannic, 69 
Gambogic, 195 
Gentesic, 289 
Gentianic, 289 

Glycero-phosphoric, 384, 386 
Glycyrrhizic, 291 
Guaiac, 295 
Guaiaconic, 295 
Guaiarec, 295 
Gurjunic, 296 
Hydriodic, 315, 319 
Hydrobromic, 179 
Hydrochloric, 72 
Hydrocyanic, 73 

Antidotes and Antagonists, 769 
Hypophosphorous, 382 
Hypopicrotoxic, 389 
Igasuric, 349 
Ipecacuanhic, 320 
Isobutyric, 492 
Juglandic, 324 
Kinic, 230 

Kinotannic, 230, 326 
Kinovic, 230 
Kinovo-tannic, 230 
Lactic, 76 
Lactucic, 326 
Laricic, 92 
Linoleic, 329 
Lobelic, 332 
Lupulinic, 299 
Maizenic, 496 
Mastichic, 338 
Methyl-salicylic, 287 
Mezereinic, 341 
Morrhuic, 342 
Muriatic, 72 
Nitric, 76 

Nitrohydrochloric, 72, 76 
Nitromuriatic, 76 
Nucleinic, 137 
Oleic, 77 
Ophelic, 213 
Opianic, 308 

Ortho-phenol-sulphonic, 377 
Orthophosphoric, 382 
Oxalic, 78 

Antidotes and Antagonists, 770 
Palmaric, 482 
Phenol-sulphonic, 376 
Phosphoric, 342, 382 
Phytolaccic, 388 
Picric, 377 
Picrotoxic, 389 
Pinic, 482 



Acid, Piperonylic 251 

Podophyllin c, 399 

Polygonic, 399 

Protocatechuic, 399 

Prussic, 73 

Pyrogallic, 70, 71, 232 

Pyroligneous, 395 

Quercitannic, 69 

Rhatania-tannic, 69, 326 

Ricinoleic, 416 

Robustic, 295 

Rosolic, 376 

Salicylic, 232, 423 

Scheele's, 74 

Sclerotinic, 271 

Silvic, 482 

Sozolic, 377 

Sphacelinic, 270 . 

Stearic, 85 

Strychnic, 349 

Succinic, 115 

Sulphuric, 72, 79 
Aromatic, 79 

Sulphurous, 79 

Tannic, 69 

as an Antidote, 768 

Tartaric, 80 

Tiglinic, 488 

Toxicodendric, 414 

Trichloracetic, 66 

Tropic, 171 

Uric, Test for, 835 

Valerianic, 478 

Valeric, 490 

Vanillic, 491 

Viburnic, 495 
Acidifiers, Urinary, 47 
Acidity, Gastric, 668 
Acids, — their action, 13, 65, 72 

as Antidotes, 765 

Antidotes and Antagonists, 770 

Mineral, 72, 770 

Organic, 8 

Vegetable, 65 
Acne, 571 

Rosacea, 571 
Acocanthera Ouabaio, 469 
Aconine, 81, 83 
Aconite, 81 

Antidotes and Antagonists, 770 
Aconitine, 81 
Acorin, 191 
Acorus Calamus, 191 
Acrinyl, Sulpho-cyanate, 460 
Acrolein, 290 
Actinomycosis, 572 
Actol, 151 

Addison's disease, 572 
Adenitis, — See Glandular Affections, 671 
Adeps, 84 

Benzoinatus, 85 

Lanae, 85 

Lanae Hydrosus, 85 
Administration of Medicines, 50 
Adonidin, 86 



I MM \. 






Adonis, 86 

Adrenal Extract 131 

Adrenalin, 131 

Chloride, 133 
Adynamia, 57a 
.Ft her, 87 

Acetic, 87 
.Fthylis Carbamas, 471 
After-pains, 573 
Agalactia, 573 
Agaric, 92 
Agaricin, 02 
Agathin, 60 

Agropyrum repens, 489 
Ague, — Sec Intermittent Fever, 706 
Agurin, 186, 191 
Ailanthus, 93 
Airol, 177 
Alabastrine, 346 
Albaspidin, 163 
Albau, 269 
Albolene, 375 
Albumen, 04, 95 

Ovi, 95, 100 
Albumin, 04 

as an Antidote, 765 

in Urine, Test for, 832 

Phosphorized, 133 
Albuminates, 11 
Albuminoids, 11, 94 
Albuminuria, 574 
Albumoses, 100 
Alcohol, 102 

Amyl, 103 

Antidotes and Antagonists, 770 

Caustic, 462 

Ethyl, 102 

Methyl, 103 

Phenyl, 102 
Alcoholic Preparations, 533 

strength of Bitters, 865 
Alcoholism, 109, 574 
Aldehyde, 103 

Acetic, 103 

Cinnamic, 237 

Ethyl, 103 

Formic, 103, 284 
Alder Bark, 69, 113 

Buckthorn, 286 
Ale, 104 
Aletris, 113 
Alexins, 440 
Alkalies, their action, 13 

Antidotes and Antagonists, 770 
Alkaline Mineral Waters, 146 
Alkalinizers, Urinary, 47 
Alkalithia, 330 
Alkaloids, 5 

Antidotes and Antagonists, 770 

Liquid, 6 
Allium, 113 
Allspice, 392 
Allyl Sulphide, 162 

Sulpho-carbamide, 460 

Sulpho-cyanide, 460 



Almond, 1 

. Minis, 69, 1 1 ; 

Aloes, 1 1 3 
Aloin, 1 [3 
Alopecia, 575 

An 
Alatonia 1 onstrii ta, 267 

ilaris, 207 
Alstonine, 267 
Alteratives, 15 

Uterine, 48 
Althaea, 1 15 
Alum, 1 15 

Ammonio-ferric, 278 

Antidotes and Antagonists, 771 

Curd, 100 
Alumen, 1 15 

Exsiccatum, 115 
Aluminum, 1 15 
Alumnol, 1 15 
Alum-root, 69 
Amanita Musearia, 92 
Amaroids, S 
Amaurosis, 570 
Amber, 471 
Amblyopia, 15, 570 
Amenorrhea, 576 
Amick's Consumption-cure, S65 
Amido-benzene, ; 
Ammonia, 116 

as an Antidote, 766 

Antidotes and Antagonists, 771 
Ammonio-feiric Alum, 278 
Ammonium, 116 

Benzoate, 175 

Carbonate, as an Antidote, 766 

Picrate, 377 

Sulpho-ichthyolate, 474 
Ammonol, 60 
Amorphous Bodies, 526 
Amygdala, 74, 120 
Amygdalin, 74, 120, 405 
Amyl Alcohol, 130 

Chloride, 90 

Hydrate, 103 

Hydride, 91 

Nitrite, 121 

Antidotes and Antagonists, 771 
Amylamine, 342 
Amylene, 90 

Chloral, 215 

Hydrate, 215, 219 
Amyloform, 284 
Amyloid Substances, 5, n 
Amylopsin, 373 
Amylum, 123, 421 

Iodatum, as Antidote, 769 
Anacyclus Pyrethrum, 409 
Analgen, 60, 212 
Analgesics, 15 
Analgesine, 60 
Anamirta paniculata, 389 
Ananassa Sativa, 372 
Anaphrodisiacs, 10 
Anarcotine, 362 



88o 



INDEX. 



Anasarca, — See Dropsy, 639 

Anemia, 577 

Cerebral, 608 
Anemone, 406 
Anemonin, 406, 407 
Anesthesia, 89, 223, 578 

Hewitt's Method, 91 

Local, 16, 241, 579 

Sayre's Method, 224 

Schleich's Methods, 88, 91, 221 243 

Scopolamine-Morphine, 312 

Spinal, 244 

Therapeutics, 578, 579 
Anesthesin, 239 
Anesthetics, 16, 90, 220 

Antidotes and Antagonists, 771 

Local, 16, 241, 579 

Mixtures, 88 
Anesthol, 88 
Anethol, 11, 138 
Aneurism, 579 

Angina, — See Croup, Laryngitis Pharyn- 
gitis, Throat, Tonsillitis, etc. 
Angina Pectoris, 580 
Anhalonium, 185 
Anhidrotics, 17 
Aniline, 232 
Anilpyrin, 60 
Animal Extracts, 127 
Anise, 138 

Star, 313 
Anodynes, 15, 561 

Dental, 28 

Local, 16 
Ant-acids, 14 
Antagonism of Drugs, 18 

Toxicological, 18 
Antagonists, 17, 765 

Table of, 19 
Anthelmintics, 19 
Anthemis, 138 
Anthrax, 580 
Antiabrin, 441 
Antibilious Pills, 557 
Antidote, Arsenic, 277, 767 

Bouchardat's, 767 

Jeaunel's, 769 
Antidote-bag, 768 
Antidotes, 20, 765 

General, 769 
Anti-emetics, 32 
Anti-fat, 287, 388 
Antifebrin, 59 

Antigalactagogues, — See Galactophyga, 35 
Antikamnia, 60 
Antikol, 60 
Antilithics, 38 
Antilupin, 60 
Antimony, 139 

Antidotes and Antagonists, 771 
Antinervin, 60 
Antinosin, 315 
Antiperiodics, 20 
Antiphlogistics, 21 
Antiphlogistine, 115, 290 



Antiphthisin, 448 
Antipyretics, 21 
Antipyrine, 140 

Antidotes and Antagonists, 771 

Salicylate, 141, 424 
Antiricin, 441 
Antiseptic Fluid, 487 

Solutions, 66, 307 
Antiseptics, 21 
Antisialics, 45 
Antispasmodics, 23 
Antitoxin, 440 

Diphtheria, 443, 445 

Morphine, 457 

Plague, 454 

Rabies, 455 

Streptococcus, 451 

Syphilis, 455 

Tetanus, 445 

Tuberculosis, 450 

Typhoid, 452 

Vaccinia, 457 
Antitoxins, 440 
Antitussin, 68 
Antivenene, 456 
Antizymotics, 23 
Antrum Disease, 581 
Anus, Fissured, 581 

Prolapse of, 781 
Aperients, 26 
Aphonia, 582 
Aphrodisiacs, 24 
Aphtha, 582 
Apiin, 1,44 
Apiol, 144 

Apis mellifica, 210, 338 
Apnea, 585 
Apocynin, 145 
Apocynum, 145 
Apomorphine, 358, 362, 364 
Apoplexy, 582 
Apotheme, 540 

Apparatus for urinary tests, 835 
Appendicitis, 583 
Appetite, 583 
Approximate Measures, 505, 875 

Weights, 875 
Aqua, 145 

Carbonata, 205 

Regia, 76 
Aquae, 534 

Aqueous Preparations, 533 
Arabin, 5, 59, 488 
Arbor Vitae, 485 
Arbutin, 212, 410, 489 
Arctium Lappa, 327 
Arctostaphylos glauca, 489 

Uva-ursi, 489 
Argentamin, 151 
Argentol, 151 
Argentum, 150 

Antidotes and Antagonists, 779 

Compounds,. 151 
Argol, 400 
Argonin, 151 



IM>I \. 



[yria, 152 
yrol, 151 

Bristol, U4, 320 

V istolot hia, 458 

stolochine, 458 

V nica, 157 
Arnicine, 157 

Aromatic Fluidextract, 237 
Powder, 237 
Sulphuric Acid, 70 
Wine, 104 
Arrhenal, 159 
Arrow-root, 126 
Vrsenates and Arsenites, 150, 166 

nauro, 15c), 105 
Arsenic, 15S 

Antidote, 277, 767 
Antidotes and Antagonists, 771 
Trioxide, 158 
Artemisia Absinthium, 58 

pauciflora, 431 
Arterial Transfusion, 51 
Arthritis Deformans, 5S4 
Asafcetida, 162 
Asagrasa officinalis, 491 
Asaprol, 347 
Ui arides,— See Worms. 
Ascites, 584 
Asclepias, 163 
Aselline, 342 
Aseptol, 377 
Aseptolin, 377 
Ash, Flowering, 337 

Prickly, 495 
Asparagin, 115, 275, 291 
Asphyxia, 206, 583 
Aspidium, 163 
Aspirin, 424 
Assay, 531 
Astasia, 569 

Asthenia,— See Adynamia, Convalescence 
Asthenopia, 587 
Asthma, 587 
Astigmatism, 589 
Astragalus gummifer, 488 
Astringents, 24 
Intestinal, 37 
Pill, 556 
Powder, 558 
Urinary, 47 
Vegetable, 69 
Atheroma, 589 
Atoxyl, 159 

Atropa Belladonna, 171 
Atropamine, 171 
Atrophy, 589 
Atropine, 171, 310, 467 
and Morphine, 367 
Antidotes and Antagonists, 772 
Atrosin, 171 

Aufrecht's Formula, 236 
Aurantiin, 164 
Aurantium, 164 
Aurin, 376 

57 






Aurum, 165 

Authorities, I.Ui of, 568 
Wa kava, 
Ayer's Ague Cure, 

Cherry Pectoral, 86c 

1'ilu. 

Sa t, 865 

lee l rinai] Di 

A.-ulen, 338 



Balanitis, 589 
Baldness, See Uopeda, 
Balm, Cream, 866 
"i" Gilead, \8i 
Recamier, - 
Balnea, 534 

Balsam of Copaiba, 250 
of Fir, 4,81 
Friar's .75, 47 , 
Gurjun, 296 
of Peru, 169 
of Tolu, 1 70 
Balsamum Dipterocarpi, : 
Peruvianum, 169 
Tolutanum, 170 
Bandoline, 260 
Banting Dietary, 740 
Baptisia, 170 
Baptisin, 170 
Barberry, 176 
Barium, 170 

Chloride, 171 
Salts, 170 

Antidotes, etc., 7; 
Bark, Blackberry, 41S 
Casca, 209 
Chittem, 412 
Cramp, 494 
Cuprea, 229 
Elm, 489 
Honduras, 209 
Huxham's Tincture of 
Oak, 69 
Ordeal, 209 
Peruvian, 229 ' 
Pitaya, 229 
Sacred, 412 
Sassy, 209 
Soap, 410 
Willow, 425 
Barley, 124 
Barosma, 1K4 
Barosmin, 184 
Basham's Mixture, 278 
Bassorin, 5, 488 
Baths, 534 

Formulae, 534 
Pauley's Sedative, 358 
Bay-berry, 344 
Bay Rum, 344 
Beans, 126 
Bear-berry, 489 
Bed-sores, 589 
Bee-venom, Antidotes, et< ., ; 



5 75 



96 






88 2 



INDEX. 



Beef, 96 

Peptonoids, 96 

Raw, 100 

-tea, 100 
Beer, 104 

Ginger, 500 
Beet, Sugar, 421 
Behring's Law, 441 
Belladonna, 171 

Antidotes and Antagonists, 772 
Belladonnine, 171 
Benzaconine, 81, 83 
Benzaldehyde, 121 
Benzanilid, 60 
Benzene, 90, 232, 375 
Benzin, 374 
Benzoates, 175 
Benzoin, 175 
Benzoinated Lard, 85 
Benzol, 90, 375 
Benzonaphthol, 347 
Benzosol, 252, 255 
Benzosulphinide, 422, 423 
Benzoyl-acetyl Peroxide, 368 
Benzoyl Guaiacol, 252 

Pseudotropine, 238 
Benzozone, 368 
Benzyl Cinnamate, 169 

Morphine, 359 
Berberine, 176, 308, 370, 399 
Berberis, 176 
Beriberi, 590 
Betanaphthol, 346 
Beta vulgaris, 421 
Betol, 347 
Betula lenta, 423 
Bhang, 199 

Bibliography and References, 568 
Bile, 276 

Agents affecting, 26, 36 

Pigment in Urine, Test, 832 
Biliary Solvents, 38 
Biliousness, 590 
Bilious Remittent Fever, 874 
Bind-weed, 299 
Birch, Sweet, 423 
Bird-lime, 495 
Bismuth, 177 

Mixture for Children, 550 

Salts, 177 

Subgallate, 177 

Subiodide, 177, 315 
Bites and Stings, 806 
Bitters, Action of, 195 

Alcoholic Strength of, 865 

Hostetter's, 866 

Vinegar, 868 
Bittersweet, 268 
Blackberrv, 69, 418 
Black Draught, 438 

Drop, 357 
Haw, 494 
Sampson, 269 
Wash, 301 
Bladder, Inflammation of, 628 



Bladder, Irritable, 591 

Paralysis of, 591 
Bladder-wrack, 286 
Blancard's Pills, 277 
Blaud's Pills, 277 
Bleaching Powder, Antidotes, 774 
Blende, 496 
Blepharitis, 591 
Blistering Cerate, 201 

Collodion, 201 
Blisters, 38, 538 
Blood as Food, 100 
Blood-root, 429 
Blood-stains, 805 
Blue Cohosh, 210 

Flag, 323 

Mass, 300 

Methylene, 340 

Ointment, 300 

Pill, 300 
Boiling, 532 
Boils, 592 
Bolus, 552 
Bone Diseases, 593 

Marrow Extract, 135 
Boneset, 276 
Borax, 66 
Borine, 67 
Borism, 68 
Borneol, 11, 418 
Boroglyceride, 67, 68 
Boroglycerin, 66 
Borolyptol, 67 
Bos Taurus, 276, 372 
Botkin's Cholera Drops, 612 
Bouchardat's Antidote, 767 
Bougies, 560 
Bovinine, 96 
Bovril, 96 
Boxwood, 370 

Brain Disorders, — See Cerebral Anemia, 
Cerebral Concussion, etc. 

Extract, 134 

Fever, — See Meningitis, Cerebro-spinal 
Meningitis, Typhoid Fever, Typhus 
Fever. 
Brandreth's Pills, 865 
Brandy, 103 
Brassica nigra, 460 
Bray era, 260 
Breasts, — See Abscess, Lactation, Mastitis, 

Nipples. 
Breath, Fetid, 593 
Bright's Disease, Acute, 593 

Chronic, 593 

Diagnosis, 869 
Bromelin, 372 
Bromides, 179, 181 

Antidotes and Antagonists, 772 

Formulae for, 656, 744 
Bromidrosis, — See Feet, 662 
Bromine, 179 

Antidotes and Antagonists, 772 
Bromipin, 1S0, 183 
Bromism, 180 



IN ID \. 






Bromoform, 170. [83 
Bronchiectasis, 505 
Bronchitis, Vcute, 505 

Capillary, 596 

Chronic, 507 
Bronchot ele, See Goitre, 67 ; 
Bronchorrhea, 598 
Broom 436 
Brown Mixture, 292 
Brucine, 299, 313, 349, 355 
Bruises, 500 
Bryonia, [83 
Bryonin, 183 
Bubo, 599 
Buchu, iS( 

Helmbold's, S66 
Buckthorn, 286 
Buhach, S07 
Bulimia, 584 
Bunion, 500 
Burdock, 327 

Burnett's Disinfectant, 23, 407 
Burns, 600 
Bursitis, 600 
Buttermilk, 96, ior 
Butternut, ^24 
Butyl Angelate, 13S 

Chloral Hydrate, 215, 218 

Chloride, 90 

Hydride, 91 

Valerianate, 138 
Butylamine, 342 
Buxine, 370 
Buxus sempervirens, 370 



Cacao-butter, 1S8, 485 
Cachets, 557 
Cachexia?, 601 
Cactine, 185 

Cactus Grandiflorus, 185 
Cadmium, 185 
Caffeine, 185 

Citrated, 186 
Caffeol, 186 
Caffeone, 186 
Cajuput, Oil of, 191 
Calabar Bean, 386 
Calabarine, 386 
Calamine, 496 

Ointment, 499 
Calamus, 191 
Calcauro, 159, 166 
Calcination, 328 
Calcium, 191 

Chloride, Antidotes, etc., 772 

Hydroxide, as an Antidote, 766 

Salts, 192, 193 

Sulphide, 474 
Calculi, Biliary, 601 

Renal, 601 

Solvents of, 3S 

Vesical, 601 
Calendula, 195 



mel, 300 
Calumba, 195 
Calumbin, [95 
Calx, 191, 

Chlorinal 1 

Sulphurata, 171. 17(1 
Cambogia, 195 
Cameroon 1 

Camp Fever, See I yphu 
Campho-phenique, .;70 
Camphor. [96 

Antidotes and Antagonists, 77a 

Baldrian, 400 

Carbolated, 107. 376 

-chloral. 1117 
-cymol, loo 
Monobromated, io'> 
Naphthol, 3 (7 

Peppermint, See Menthol, 105 
Pulsatilla, 406 
Salicylated, 107 
Camphors, io 
Camphylene 
Canadian Hemp, 145 
Canadine, 30S 
Cancer, 603 

Diagnosis of, 870 
of Uterus, 836 
Cancrum Oris, 604 
Cannabene, 199 
Cannabin, jqij 
Cannabis, C98 

Antidotes and Antagonists, 772 
Cantharides, 20 1 
Cantharidin, 201 
Cantharis, 201 

Antidotes and Antagonists, 772 
Caoutchouc, 269 
Capsicin, 203 
Capsicum, 203 
Capsules, 534 
Caraway, 208 
Carbinol, 103 
Carbo Animalis, 204 

Ligni, 204 
Carbohydrates, 3, 125 
Carbon, 204 

Acids, 8 

Dioxide, 01, 204, 478 

Antidotes and Antagonists, 772 

Disulphide, 91, 204, 207 

Monoxide, 91, 204 

Tetrachloride, 91, 22r 
Carbonated Mineral Waters. 146, 205, 207 
Carbonates, as Antidotes, 706 
Carbonci Disulphidum, 91, 204 
Carboneum, 204 
Carbonization, 525 
Carbuncle, 604 
Carcinoma, — See Cancer, 603 
Cardamom, 207 
Cardiac Disorders,— See Heart, 681 

Sedatives, 24 

Stimulants, 25 

Tonics. 25 



88 4 



INDEX. 



Cardialgia, — See Pyrosis, 78S 

Cardine, 135 

Carditis, Diagnosis of, 870 

Carduus, 208 

Carica Papaya, 372 

Caries, 605 

Carminative, Dalbv's, 358 

Dewees', 162, 333 
Carminatives, 25 
Carmine, 245 
Carnogen, 135 
Caroval, 259 
Carragheen, 95 
Carron Oil, 192, 194, 330 
Carthamus tinctorius, 255 
Carvene, 208 
Carum, 208 
Carvol, 208 
Caryophyllin, 208 
Caryophyllus, 208 
Casca Bark, 209 
Cascara Amarga, 209 

Sagrada, 412 
Cascarilla, 209 
Cascarillin, 209 
Casein, 94, 95 
Cassia acutifolia, 438 

angustifolia, 438 

Cinnamon, 237 

Fistula, 209 

Purging, 209 
Castanea, 69 
Castor Oil, 415 

Emulsion; Formula, 622 
Castoria, 865 
Catalepsy, 605 
Cataplasmata, 534 
Cataract, 605 
Catarrh, Acute Nasal, 605 

Broncho-pulmonary, — See Bronchitis, 
Bronchorrhea. 

Chronic Nasal, 607 

Duodenal, 640 

Epidemic, — See Influenza, 703 

Gastric, — See Gastritis, Chronic, 670 

Genito-urinary, — See Bladder, Catarrh 
of, Cystitis, Endometritis, Gonorrhea, 
Leucorrhea, etc. 

Intestinal, — See Dysentery, Jaundice. 

Sage's Remedy, 867 

Sanford's Cure, 867 

Summer, — See Hay Fever, 679 
Catechol, 410 
Catechu, 69, 209 
Cathartics, 26 

in Poisoning, 766 
Catharto-mannit, 438 
Caulophyllin, 210 
Caulophyllum, 210 
Caustic, Lunar, 150 

Potash, 400 

Soda, 461 
Caustics, 34 
Cedar, Oil of, 471 

Red, 420 



Cedar, White, 485 

Celandine, 21 1 

Celerina, 238 

Cellulose, 124, 292 

Centaurea benedicta, 208 

Cephaeline, 320 

Cephaelis Ipecacuanha?, 320 

Cephalalgia, — See Headache, 679 

Cera, 210 

Cerata, 535 

Cerate, 210 

Blistering, 201 

Cantharides, 201 

Goulard's, 397 

Lead, Subacetate, 397 

Rosin, 482 

Savin, 420 

Theobroma, 485 
Cerates, 535 

Compounding of, 566 
Ceratum, 210 

Cerebellum, Agents affecting, 27 
Cerebral Anemia, 608 

Compression, Diagnosis, 870 

Concussion, 608 
Diagnosis, 870 

Congestion, 609 

Depressants, 27 

Excitants, 27 

Softening, 609 
Cerebrine, 134 
Cerebrinin, 134 
Cerebro-spinal Fever, 726 
Cereus, Night-blooming, 185 
Cerium Oxalate, 211 
Cerolein, 210 
Cetaceum, 85 
Cetin, 85 

Cetraria, 124, 127 
Cetyl Palmitate, 85 
Cevadilla, 491 
Cevadilline, 491 
Cevadine, 491 
Cevine, 492 
Chalk, 191, 192 
Chalybeate Waters, 146 
Chamomile, 138 

German, 139, 338 
Chamomilla, 139, 338 
Chancre, 609 

Diagnosis of, 870 
Chancroid, 609 

Diagnosis of, 870 
Change of Life, — See Climacteric, 616 
Chapped Hands and Lips, 610 
Charcoal, 204 

as an Antidote, 766 
Charts (Papers), 535 
Chartulffi, 557 
Chaulmoogra Oil, 211 
Cheese, 97 
Chekan, 346 
Chekanine, 346 
Chelerythrine, 211, 429 
Chelidonine, 211 



1MH V 






Chelidonium, 21 1 
Chelidoxanthin, 2 1 1 
Chelsea Pensioner, 536, 70 ( 
Chemical Incompatibility, 517 
Chenopodium, 21 1 
Cherry-laurel, 7.4. 7c 
Cherry Pectoral, 865 

Wild, 405 
Chestnut, 69 
Chest-pains, 610 
Chian Turpentine, 503 
Chicken-pox, — See Varicella, 840, 874 
Chilblains, 610 
Children, Dosage for, 55, 366 
Chimaphila, 2 1 2 
Chimaphilin, 212 
Chinicin, 232 
Chinoidin, 231 
Chinolin, 212, 232 
Chinopyrin, 236 
Chinosol, 213 
Chirata, 213 
Chiratin, 213 
Chiretta, 213 
Chittem Bark, 412 
Chloral, 214 

Analogues, 215 

Antidotes and Antagonists, 773 

Butyl, 215 

Hydrated, 213 
Chloralamide, 214, 21S 
Chloralformamide. 214, 218 
Chloral-habit, 216 
Chloralose, 214, 210, 
Chlorates, — See the titles of their metallic 

constituents. 
Chloretone, 215, 219 

Chlorides, — See the titles of their metallic 
constituents. 

in Urine, Test, 833 
Chlorinated Waters, 146 
Chlorine, 224 

as an Antidote, 766 

Antidotes and Antagonists, 773 
Chlorine-water, 225 
Chlorodvne, 220, 358 

Collis Browne's, 358, S65 
Chloroform, 91, 219 

Antidotes and Antagonists, 773 

Sayre's method of using, 224 
Chlorosis, 611 
Chocolate, 188, 485 
Choking, 611 
Cholagogues, 36 

Pills, 556 

Purgatives, 26 
Cholera Asiatica, 611 

Diagnosis of, 871 

Drops, 612 

Infantum, 613 

Mixture (Squibb), 358, 612 

Simplex, 613 

Toxin, 453 
Cholesterin, 96 
Chondodendron tomentosum, 370 



Chondrus, 95 
Chordee, 61 1 
Chorea, 61 1 
Choroiditis, 615 
Chromu Trioxidi 
Chromophj tosis, 818 

Chrysophan 

Churchill's Tincture of Iodine, ;i 1 

Churrus, 199 

Chyluria, 6i 5 

Cigarettes, Formula for, 588 

Ciliary Excitants, 27 

Cimicifuga, 

Cimicifugin, 

Cinchona, 221) 

Red, 2 2i), 230 
Cinchonidine, 230, 331 
Cinchonine, 230, 231 
Cinchonism, 2 3 j 
Cineol, 345 
Cinnaldehydum, 237 
Cinnamein, 169 
Cinnamomum, 237 

Camphora, 196 
Cinnamon, 237 
Cinquefoil, 753 

Circulation, Agents affecting, 24, 25, (S 
( lissampeline, 370 
Citarin. 284, 286 
Citrates, 32S, — Sec also the titles of their 

basic constituents. 
Citrine Ointment. 301 
Citron, 
Citrophen, 63 
Citrullus Colocynthis, 2 \f> 
Citrus acris, 32S 

Aurantium, 164 

Limonum, 

medica, 328 

vulgaris, 1(14, 328 
Clarification, i.'i 
Clarke's Blood Mixture, S66 
Classification of Medicines, 12 
Claviceps purpurea, 270 
ClavUS, — See Headache, 67)) 
Clemens' Solution, 
Climacteric Disorders, 616 
Cloves, 208 
Club-moss, 332 
Clysters, 543 
Cnicin, 208 

Cnicus benedictus, 20S 
Coal-gas, Antidotes, etc., 775 
Coca, 189, 237 
Cocaine, 238 

Antidotes and Antagonists, 77 j 
Cocaine-habit, 242 
Cocamine, 238 
Cocculus Indii us 
Coccus, 245 
Coccygodynia, 616 
Cochineal. 245 
Cocoa, 188 
Codamine, 356 



886 



INDEX. 



Codeine, 356, 359, 365 
Codol, 483 
Codfish, 341 
Cod -liver Oil, 341 

Emulsion, 539 
Coffea, 185 
Coffee, 187 
Cohosh, Black, 228 

Blue, 210 
Cola acuminata, 189 
Colation, 525 
Colchice'ine, 245 
Colchicine, 245 

Salicylate, 245 
Colchicum, 245 

Antidotes and Antagonists, 773 
Cold Cream, 85, 417 
Coldness, 616 
Colic, Hepatic, 617 

Intestinal, 616 

Lead, 617 

Renal, 617 
Colic-root, 113, 266, 511 
Collagen, 94 

Collagenes and Mucilaginous Bodies, 12 
Collapse, 618, — See also Exhaustion, Shock, 

Syncope. 
Collargol, 151 
Collidine, 478 
Collodia, 536 
Collodion, 293 

Blistering, 201, 293 

Cantharidal, 293 

Flexible, 293 

Styptic, 69, 71, 293 
Colloids, 527 
Colloxylin, 293 
Collunarium, 543 
Collyrium, 546 

Formulae for, 546 
Colocynth, 246 
Colocynthein, 246 
Colocynthin, 246 
Colocynthitin, 246 
Cologne-water, 104 
Coloring Matters, 8 
Coma, 618 

Alcoholic, no 

Opium, 360 
Combination, Principles of, 512 
Combustibles, 519 
Comminution, 525 
Commiphora Myrrha, 345 
Compounding Medicines, 523 

a Mixture, 549 

an Ointment, 566 
Compounds, Explosive, 519 

Miscellaneous, n 

Poisonous, 519 
Condurango, 256 
Condylomata, 618 
Condy's Fluid, 23, 335 
Confectio Damocratis, 536 
Confections, 536 
Conhdyrine, 247 



Coniine, 247 
Conium, 247 

Antidotes and Antagonists, 773 
Conjunctivitis, Catarrhal, 619 

Diphtheritic, 620 

Gonorrheal, 620 

Granular, 620 

Phlyctenular, 620 

Purulent, 621 
Conspergatives, 554 
Constipation, 621 
Constituents of Organic Drugs, 4 
Contractions, List of, 515, 849 
Contractors, Vascular, 48 
Convalescence, 623 
Convallamarin, 249 
Convallaria, 249 
Convallarin, 249 
Convolvulin, 323 
Convolvulus Scammonia, 434 
Convulsions, 623 

Infantile, 623 

Puerperal, 785 
Copaiba 250 

Emulsion, 539 

Mixture, 250 
Copper, 256 

Carbonate, as Antidote, 766 

Salts, Antidotes, etc., 773 
Coral, 192 
Cordial, Aletris, 113 

Cascara, 412 

Godfrey's 358 
Coriander, 251 
Corn, Indian, 123, 496 
Corn-silk, 496 
Corn-smut, 271 
Corneal Opacities, 624 
Corneitis, — See Keratitis, 711 
Cornin, 251 
Corns, 624 
Cornus, 251 
Cornutine, 270 

Corpulence, — See Obesity, 740 
Corrosive Sublimate, 300 

Antidotes and Antagonists, 773 
Coryza, — See Catarrh, Acute. 
Corson's Paint, 488 
Cosmoline, 374 
Cotarnine, 358, 365 
Coto Bark, 251 
Cotoin, 251 
Cotton, 292 

Gun, 124 

Iodized, Formulas for, 686 
Cotton-seed Oil, 293 
Cough-grass, 489 
Cough, 624 

Mixtures, 626, 755, 760 
Counter-irritants, 38 
Counter-irritation, 201 
Court Plaster, 93 
Coxalgia, 626 

Coxe's Hive Mixture, 139, 435 
Crab Lice, — See Pediculi, 751 



I\l»l \. 



887 



Crabs' -eyes, 102 
Cramp Hark, 404 

Cramps, — Sec Colic, Spasmodic Affections, 
Trismus. 

Cr.mesbill, 60, 2Q0 
Crataegus Oxyacantha, 580 
Cream, Cold, 85, a 1 7 

Recamiex, S67 

of Tartar, 401 
Crede's Ointment, 151 
Creolin, 377, 3S2 
Creosol, 251 
Creosotal, 252 
Creosote, 25 1 

Antidotes and Antagonists, 774 
Cresol, 377 
Creta, 191, 192 
Creuse's Iron Solution, 277 
Crocq's Solution, 383 
Crocus, 255 
Croton-chloral, 215 
Croton Eleuteria, 209 

Oil, 487 

Tiglium, 487 
Croup, Catarrhal, 626 

Membranous, 627 
Diagnosis, 871 
Cryoscopy, 8^ 
Cryptopine, 356 
Crystallization, 526 
Cubeb, 255 
Cubeben, 255 
Cubebene, 255 
Cubebin, 255 
Cuca, 189, 237 
Cucumber, Squirting, 270 
Cucurbita Pepo, 371 
Cucurbitine, 371 
Culver's Root, 327 
Cundurango, 256 
Cuprea Bark, 229 
Cuprol, 257 
Cuprum, 256 

Ammoniatum, 257 
Curare, 259 

Antidotes and Antagonists, 774 
Curarine, 259 

Cure, Keeley's Gold, 169, 866 
Cures, — See Patent Medicines, 865 
Cusso, 260 

Cutaneous Irritants, 38 
Cuttle-fish Bone, 192 

Cyanide of Potassium, — Antidotes, etc., 774 
Cyanides, — See the titles of their metallic 

constituents. 
Cyanosis, 628 
Cydonin, 260 
Cydonium, 260 
Cymene, 486 
Cynips tinctoria, 69 
Cypripedin, 260 
Cypripedium, 260 
Cystitis, Acute, 628 

Chronic, 628 
Cysts, 630 



Cytisine, 157 
Cytisus laburnum, 1 57 
Scoparius, 1 ;'i 



Dalby'a Carminative, 358 

1 1 tnuana, 260 

Dandelion, jS 1 

Dandruff, Sec Pityriasis, 760 

Hangers of incompatibility, 51S 

Daphne Mezereum, 3 1 1 

Daphnin, 3 1 1 

Datura Stramonium, 467 

Tatula, 467 
Daturine, 467 
l v ifness, 630 

Death, Signs of,— See Asphyxia, 5S6 
Debility, — Sec Adynamia, Anemia, Conva- 
lescence. 
Diminution, 526 
Decimal Weights, etc., 503 
Decocta (Decoctions), 537 
Decoloration, 526 
Deflagration, 527 
Deliquescence, 526 
Deliquescent Salts, List of, 555 
Deliriants, 28 
Delirium, 630 

Tremens, 108, 630 
Delphininc, 466 
Delphinium Staphisagria, 466 
Dementia, 704 

Paralytica, 632 
Demulcents, 28 
Dengue, 632 
Dental Anodynes, 28 
Dentifrices, 28 
Dentition, 632 
Deodorants, 28 
Deposits in Urine, 835 
Depressants, Cerebral, 17 

Hepatic, 35 

Motor, 39 

Renal, 31 

Respiratory, 42 

Uterine, 47 
Dermatol, 177, 178 
Desiccation, 527 
Destructive Metamorphosis, 29 
Dewees' Carminative, 162, j^t, 
Dextrin, 124 
Dextroform, 284 
Dextrose, 421 
Dhobie Itch, 632 
Diabetes Insipidus, 633 

Mellitus, 633 
Diabetin, 422 
Diacetyl-morphinc, 359 
Diacetyl-tannin, 70 
Diachylon Ointment, V)7 
Diagnosis, Differential, 869 
Dialysis, 527 
Dialyzed Iron, 279 
Diaphoretics, 29 
Diarrhea, 635 



INDEX. 



Diastase, 124, 372 

Diazo-reaction, 833 

Dichloro-methane, 221 

Didama's Solution, 864 

Didymin, 132 

Diet, — See Albumin and Amylum. 

Diethyl-diamine, 393 

Diethyl-malonyl-urea, 472 

Diethylsulphon-diethyl-methane, 471 

Diethylsulphon-dimethyl-methane, 471 

Diethylsulphon-methyl-ethyl-methane, 471 

Diffusate, 527 

Digalen, 262 

Digestive System, Agents affecting, 13 

Digitale'in, 261 

Digitalin, 261 

Digitalis, 260 

Antidotes and Antagonists, 774 
Digitin, 261 
Digitonin, 261 
Digi toxin, 261 
Dihydro-toluidine, 342 
Dilators, Vascular, 48 
Diluents, 29, 548 
Dimethyl-amido-antipyrine, 141 
Dimethyl-ethyl-carbinol, 215 
Dimethyl-ketone, 65, 103 
Dimethyl-piperazin Tartrate, 393 
Dimethyl-xanthin, 186 
Di-oleyi-lecithin, 134 
Dionin, 358 
Dioscorea, 266 
Dioscore'in, 266 
Diospyros, 69 
Dipentene, 482 
Diphtheria, 637 

Antitoxin, 443, 445 

Diagnosis, 871 

Laryngeal, 627 

Temperature in, 813 
Dipsomania, — See Alcoholism, Delirium 

Tremens. 
Discs, 544 
Discutients, 30 
Disinfectants, 22 

Burnett's, 23 

Condy's, 23 

Labarraque's, 23 
Disinfecting Fluid, 497 
Disinfection Oil, 377 
Dislocations, 666 
Dispensatories, 501 
Dispensing, 523 

by Physicians, 515 
Displacement, 529 
Distillation, 527 
Dita Bark, 267 
Ditaine, 267 
Ditamine, 267 
Dithymol-Iodide 314 
Diuretics, 30 

Formulas for, 640, 830 

List of, 31 
Diuretin, 186, 191 
Dizziness, — See Vertigo, 841 



Dobcll's Nasal Wash, 544, 608 
Dock, Yellow, 418 
Dog-wood, 251 

Jamaica, 394 
Domestic Measures, 505 
Donovan's Solution, 159 
Dormiol, 2 1 5 
Dosage of Medicines, 55 

of Official Preparations, 56 
Doses, Average, 56 

Table of, — See inside of cover. 
Dover's Powder, 321, 357 
Drastic Purgatives, 26 
Draught, 542 

Black, 438, 507 

Effervescing, 542 
Drink, 557 

Imperial, Formula, 557 
Drops, 505 

Botkin's Cholera, 612 

Drops to a Drachm, 505, 875 
Dropsy, 639 
Drosera, 267 

Drowning, — See Asphyxia, 585 
Drug-eruptions, 657 
Drug-experimentation, 3 
Drugs, 1 

Active principles, 5 

Antagonism of, 17, 19 

Constituents of, 4 

Inorganic, 4 

Neutral principles, 8 

Organic, 4 
Dryopteris Filix-mas, 163 

Marginalis, 163 
Duboisia, 267 
Duboisine, 267 
Dulcamara, 268 
Dulcamarin, 26S 
Dulcin, 423 
Duodenal Catarrh, 640 
Duotal, 252 
Durande's Remedy, 91 
Dutch Liquid, 220 
Dyscrasiae, — See Cachexia;, 601 
Dysentery, 641 

Tropical, 642 
Dysmenorrhea, 643 
Dyspepsia, 644 
Dysphagia, 646 
Dyspnea, 646 
Dysuria, 647 



Ear Affections, 647 

Agents affecting, 35 
Earache, — See Otalgia, 744 
Eau Sedative, 117, 196 
Ebullition, 532 
Ecballium Elaterium, 270 
Ecbolics, 41 
Ecboline, 271 
Ecchymosis, 647 
Ecgonine, 238 
Echinacea, 269 



!M>I \. 









Eclampsia, — See Puerp. Convulsions, 785 
Ecthyma, 648 
Ectropion, 648 

■■. 6 |S 
Efflorescence, 526 
Efflorescent Salts, List of, 555 
Egg-albumen, 95 
Egg-shell, 192 
Egg, Yolk of, 95, ior 

l'"ggs as Food, ()() 

Elastica, 260 
Elaterin, 270 
Elaterium, 270 
Elder, 428 
Electuaries, 536 
Electuary For Piles, 536 
Elettaria repens, 207 
Elixir Adjuvans, 292 

Aromatic, 165 

McMunn's, 357 

Simple, 165 

of Vitriol, 79 

Yvon's Hypnotic, 706 
Elixiria, 537 
Elm, Slippery, 4S9 
Elutriatioft, 532 
Ely's Cream Balm, S66 
Emaciation, 650 
Embrocation, 545 
Emetics, 32 

in Poisoning, 766 
Emetine, 320 
Emissions, 650 
Emmenagogues, 3 ^ 

Formula; for, 577 

Pills, 556 
Emodin, 412 
Emollients, 28, ^^ 
Emphysema of Lungs, 650 
Emplastra, 537 
Empyema, 651 
Emulsa, 538 
Emulsirkation, 538 
Emulsin, 74, 120, 405 
Emulsions, 538 
Encephaloma, — See Cancer, 603 

Diagnosis of, 870 
Endarteritis, — See Atheroma, 589 
Endermic Method, 54 
Endocarditis, 651 

Diagnosis of, 870 
Endometritis, 652 
Enemata, 543, 652 

Formulae for, 544, 653 
Enepidermic Method, 54 
Enteralgia, — See Colic, Intestinal, 616 
Enteric Fever, — See Typhoid, 823, 873 
Enteritis, 653 
Enteroclvsis, 149 
Entropion, 648 
Enuresis, 653 
Enzymes, 24 
Epicarin, 347 
Epidermic Method, 54 
Epididymitis, 654 



Epilation, 
Epilepsy, i>i 1 

Diag ,871 

Epinephrin, 131 
Epispastii 
Epistaxis, 656 
Epsom Salt, 3 j j 
Epulis, See Teeth, 81 1 
Equinia, ,,-, 

Erei tii 

Ergo-apiol, tyi 
Ergone, 271 
Ergot, 270 

Antidotes and Antagonists, 771 

of Corn,— See UstilagO, 271 

Ergotin, 271 
Ergotinine, 271 
Ergotism, 272 
Encolin, j.s ., 
Erigeron, 274 
Eriodictvon, 27 1 
Errhines, 3 ; 
Eructations, 644, 663 

Eruptions , . . Drills, etc., 657 

Erysipelas, 658 

Toxin, 457 
Erythema, 650 
Erythrol Tetranitrate, 122 
Erythrophlcein, 209 
Erythrophloeum Guinensi 
Erythroxylon Coca, 189, 257 
Escharotics, 34 
Eseridine, 386 
Eserine, 386 

Esophageal Affections, 660 
Essential Oils, 10 
Ethene, 90 

Chloride, 90 

Dichloridi ,91 
Ether, 87 

Acetic, 87, 90 

Chloric, 220 

Chlorinated Muriatic, 220 

Hydriodic, S7, 90 

Hydrobromic, 87 

Methylene-di-methvl, 2 i 5 

Methylic, 90 

Nitrous, 87, 88, 90 

Sulphuric. 87 
Ethereal Oil, 87 

Preparations, ^$3 
Ethyl Acetate, 87 

Alcohol, 102 

Aldehyde, ro^ 

Bromide, 87, 90, 91 

Carbamate, 471, 473 

Chloride, go, 220, 224 

Hydrate, 102 

Hydride, r 

Iodide, 87 

Nitrite. 87, 1 22 

Oxide, 87 
Ethylene Bichloride, 
Ethylidene Chloride, 

Oxide, 103 



8 9 o 



INDEX. 



Ethylirtes Chloral-urethane, 214 

Eucaine, 239 

Eucalyptene, 274 

Eucalyptol, 274 

Eucalyptolen, 274 

Eucalyptus, 274 

Euchinin, 231 

Eudoxin, 177 

Eugenia aromatica, 208 

Jambolana, 324 
Eugenin, 208 
Eugenol, 208, 392 
Euonymin, 276 
Euonymus, 275 
Eupatorin, 276 
Eupatorium, 276 
Euphorin, 60 
Euphormol, 67 
Euphrasia, 276 
Euphthalamin, 239 
Euquinine, 231 
Europhen, 315, 320 
Eurotium oryzas, 372 
Euthymol, 67 
Evaporation, 532 

Spontaneous, 532 
Exalgin, 60 

Exanthemata, Diagnosis of, 872 
Excipients, 538, 548, 552 
Excitants, Cerebral, 27 

Ciliary, 27 

Motor, 39 
Excoriation, — See Intertrigo, 708 
Exhaustion, 660 
Exodyne, 60 
Exogonium Purga, 323 
Exophthalmos, 660 
Exostosis, 661 
Expectorants, 34 
Explosive Compounds, 519 
Expression, 528 
Exsiccation, 526, 528 
Extemporaneous Pharmacy, 522 
Extract, Adrenal, 131 

Bone Marrow, 135 

Brain, 134 

Goulard's, 396 

Lymphatic, 138 

Malt, 124, 127 

Mammai)' Gland, 137 

Meat, 96 

Orchitic, 132 

Ovarian, 136 

Pancreatic, 136 

Parotid, 136 

Pineal, 136 

Pituitary, 136 

Pond's, 297 

Splenic, 135 

Supra -renal, 131 

Testicular, 133 

Thymus, 136 

Thyroid, 129, 131 

Uterine, 136 
Extracta, 540 



Extractive, 540 
Extracts, 540 

Animal, 127 

Distilled, 297 

of Meat, 96 
Eye, Agents affecting, 12, 15, 40, 49 

Diseases, 661 

Ointments, Formulae for, 619 

Sensibility, Agents affecting, 15 

Water, Formulas for, 619, 868 
Eye-bright, 276 
Eyelids, 662 



Fabiana imbricata, 388 

Face, 662 

Face-ache, — See Neuralgia, Tic Douloureux- 

Fagara Clava-Herculis, 495 

Fainting, — See Syncope, 808 

False Pains, 662 

Farcy, 671 

Fat, — See Obesitv, 740 

Hog, 84 

Wool, 85 
Fatigue, — See Exhaustion, 660 
Fats and Oils, 9 

as Antidotes, 767 
Favus, — See Tinea Favosa, 816 
Febricula, — -See Fever, Simple, 664 
Febrifuge, 231 
Febrinol, 60 
Feet, 662 

Fehling's Solution, 257 
Fel Bovis, 276 

Tauri, 276 
Felon, — See Onychia, 741 
Fennel, 283 
Fermentation, 23 

Lactic, 422 
Ferments, 12, 24 

Agents affecting, 23 
Fern, Male, 163 

Marginal Shield, 163 
Ferratin, 279 

Ferrier's Snuff, Formula, 607 
Ferrinol, 279 
Ferrocyanide of Potassium, 74 

as an Antidote, 767 
Ferropyrin, 141 
Ferrum, 276 

Dialysatum, 279 

Reductum, 276 
Ferula fcetida, 162 

galbanifiua, 287 
Fever, 663 

Bilious Remittent, Diagnosis, 874. 

Cerebro-spinal, 726 

Enteric, — See Typhoid, 823, 873 

Hay, 679 

Hectic, 685 

Hemoglobinuria 688 

Intermittent, 706 

Miliary, 730 

Milk, — See Lactation, 712 






IM>I \. 






Fever, Pernicious,- -See Intermittent Fever, 
Remittent Fever. 
Puerperal, 787 

Relapsing, 790 
Remittent, 700 

Diagnosis of, S74 

Rheumatic, 701 

Scarlet, 70; 

Diagnosis of, 87a 

Simple, 664 

Spotted, — See Typhus Fever; also Men- 
ingitis, Cerebro-spinal. 

Surgical, 808 

Traumatic, — See Surgical Few 

Tropical, 665 

Typhoid, 823 

Diagnosis of, S73 

Typho-malarial, — See Typhoid, 823 

Typhus, S26 

Diagnosis of, S73 

Yellow, 847 

Diagnosis of, 874 
Fibrin, 11, 94, 95 
Ficus, 283 
Fig, 2S3 
Filix Mas, 163 
Filmaron, 163 
Filtering paper, 52s 
Filtration, 528 
Fir, Balsam of, 481 

Scotch, 395 

Silver, 481 
Firs, 394 
Fish-berries, 389 
Fish-poison, Antidotes, etc., 774 
Fistula, 665 
Fits, — See Apoplexy, Convulsions, Epilepsy, 

Hysteria, Syncope. 
Flatulence, 665 
Flavoring Agents, 548 
Flaxseed, 329 
Flea-bane, 274 

Fleming's Tincture of Aconite, Si 
Flooding, — See Hemorrhage Post-partum, 

Menorrhagia, Metrorrhagia. 
Fluavil, 269 
Fluid, Antiseptic, 487 

Burnett's, 497 

Condy's, 335 

Disinfecting, 497 

Extract, Aromatic, 237 

Extracts, 540 
Flushing-heats, 666 
Fly-agaric, 92 
Fceniculum, 283 
Fomentation, 545 
Food, Horlick's, 124 

Mellin's, 124 

Parrish's Chemical, 384 

Revalenta Arabica, 867 

Producing Eruptions, 658 
Foods, 43, 97 — also Albumin, Amylum. 
Foreign Bodies, 585, 666 
Formaldehyde, 103, 284 

Antidotes and Antagonists, 774 



Jin, 18 1 
Formamide, 1 1 1 
Forman, 

Formula, Hypodermii 
Formyl, 184 

Iodide, 31 i 
Fotus, 54S 

Fowler's Solution, 1 58 
Foa glove, 161 
Fractures, 666 
Franciscea uniflora, .; (5 
Frangula, 286 
Frangulin, 286 
Frankincense, 48a 
Franklinite, 496 
Fraxin, 338 
Fraxinus Ornus, 337 
I'n 1 kles. 667 
Friar's Balsam, 175, 471 
Fucus Vesiculosus, 286 
I'ungi, Antidotes, etc., 774 
Furuncle, — See Boils, ~,()2 
Fusel Oil, 103 
Fusion, 528 



Gadus Morrhua, 341 

Galactagogues, 35 

Galactophyga, 35 

Galbanum, 287 

Galena, 396 

Galla, 69 

Gallipots, 566 

Gallobromol, 69 

Gall-stones, — See Calculi, Biliary, 601 

Gambir, 210 

Gamboge, 195 

Antidotes and Antagonists, 774 
Gangrene, 667 

of Lungs, 720 
Garcinia Hanburii, 195 

mangostana, 337 
Garfield Tea, 866 
Gargarisma, 541 

Gargles, Formula; for, 542, 639, 756, 815 
Garlic, 113 
Gas, Illuminating, — -Antidotes, etc., 775 

Laughing, 347 
Gases, Agents affecting, 28 

Antidotes and Antagonists, 774 
Gastralgia, 667 
Gastric Acidity, 668 

Dilatation, 669 

Fever, — See Fever Simple, Gastritis, Re- 
mittent Fever, Typhoid Fever. 

Pain, 667 

Sedatives, 32 

Tonics, 46 

Ulcer, 669 
Gastritis, 670 
Gastrodynia, 667 
Gaultheria, 287, 423 
Gaultherilene, 287 
Gelatin, 94, 99, 101 



892 



INDEX. 



Gelatin, as an Antidote, 767 

Capsules, 534 
Gelsemine, 287 
Gelsemium, 287 

Antidotes and Antagonists, 774 
Generative System, Agents alTecting, 16, 24, 

4i 
Genitive Case-endings, 862 
Gentian, 289 
Gentianin, 289 
Gentopicrin, 289 
Geoform, 252 
Geranium, 69, 290 
Gin, 104, 325 
Ginger, 499 
Glanders, 671 

Toxin, 456 
Glandulae Suprarenales, 132 

Thyroideae, 131 
Glandular Affections, 671 

Extracts, 127 
Glass, Antidotes for, 774 

Soluble, 401, 459 
Glauber's Salt, 462 
Glaucoma, 672 
Gleet, 672 
Globulins, n 
Glonoin, 122 
Glossitis, 673 
Glottis, Edema of, 673 
Gluco-chloral, 214 
Gluco-pepsine, 372 
Glucose, 421 

in Urine, Test for, 833 
Glucosides, 7 
Glusidum, 422 
Gluten, 11, 95 

as an Antidote, 767 
Glutol, 284 
Glycerin, 290 
Glycerines, 533 
Glycerites, 96, 542 
Glycerol, 290 
Glycerophosphates, 384 
Glyceryl Borate, 66 

Trinitrate, 122 
Glycocholate, Sodium, 275 
Glycocoll, 64 
Glyco-formalin, 284 
Glycogen, 124 

Agents affecting its production, 36 
Glyconin, 96 

Glycosuria, Temporary, 834 
Glycozone, 36S 
Glycyrrhetin, 292 
Glycyrrhiza, 291 
Glycyrrhizin, 291 

Glycyrrhizinum Ammoniatum, 292 
Glykaolin, 290 
Glymol, 375 
Gnoscopine, 356 
Goa-powder, 228 
Godfrey's Cordial, 358 
Goitre, 673 
Gold, 165 



Gold, Antidotes and Antagonists, 774 

"Bichloride," 169 

Bromide, 165 

Chloride, 165 

Cure, Keeley's, 169, 866 
Golden Discovery, Pierce's, 867 

Seal, 308 
Gonorrhea, 674 
Gossypii Cortex, 293 
Gossypium, 292 
Goulard's Cerate, 397 

Extract, 396 
Gout, 676 

Diagnosis of, 871 
Granatum, 69, 294 

Granular Lids, — See Conjunctivitis, Oph- 
thalmia. 
Granulation, 529 
Granule, 552 
Grape, Oregon, 176 
Grass, Ribbed, 396 

Worm, 466 
Gravel -root, 276 

Graves' Disease, — See Exophthalmos, 660 
Gray Oil, 307 
Gray Powder, 300 
Griffith's Mixture, 277 
Grindelia, 294 
Grindeline, 295 
Grippe, — See Influenza, 703 
Guaiac, 295 

Guaiacol, 252, 253, 254, 295 
Guaiaform, 252 
Guaialin, 252 
Guarana, 186, 189, 191 
Guaranine, 189 
Gum Arabic, 59 

as an Antidote, 767 

Kauri. 471 

Sweet, 470 
Gumboil, — See Gums, 677 
Gum-resins, 9 
Gums, 5, 677 
Gum-tree, Blue, 274 
Gun-cotton, 124, 293 
Gunjah, 199 
Gurjun Balsam, 296 
Gutta, 269 
Guttae (Drops), 505 
Gutta-percha, 269 
Gynocardia odorata, 211 . 
Gypsum, 192 



Haematoxylin, 296 
Haematoxylon, 69, 296 
Hagenia abyssinica, 260 
Hager's Tincture, 231 
Hair, 575, 678 

Tonic, 575, 678 
Washes, 575, 678 
Haller's Dictum, 3 
Halogen Elements, 44 
Haloid Salts, 44 
Hamamelin, 297 



I\1H \. 






Hamamelis, 69, 207 
Hamburg Tea, 866 
Hamlin's Wizard Oil, Son 

Hands, Sec Chapped Hands, (no 

Hashish, 199 

Haustus, 542 

Haw, Black, 404 

Hawthorn, 580 

Hay ah, 200 

Hayden's Viburnum Compound, 404 

Hay-fever, 070 

Head-ache, Bilious Sick, 679 

Congestive, 6S0 

Nervous, 6S0 
Hearing, $5 
Heart Affections, 681 

Dilated, 683 

Fatty, 683 

Hypertrophied, 6S3 

Palpitation, 683 

Valvular Disease, 6S4 
Heartburn, — See Pyrosis, 788 
Heart's-ease, 405 

Heat-stroke, — See Insolation, 704 
Hectic Fever, 685 
Hedeoma, 297 
Hedonal, 215. 219 
Hellebore, 29S, 491 

American, 491 

False, 86 

White, 491 
Helleborein, 298 
Helleborin, 298 
Hellebores, 298 
Helmbold's Buchu, 866 
Helmitol, 284 
Hematemesis, 685 
Hematics, 43 
Hematocele, Pelvic, 686 
Hematuria, 686 
Hemeralopia, 687 
Hemicrania, 687 
Hemiopia, 688 
Hemiplegia, 688 
Hemlock, 247 

Spruce, 395 
Hemogallol, 279 
Hemoglobinuric Fever, 688 
Hemoptysis, 6S9 
Hemorrhage, 689 

Intestinal, 691 

Post-partum, 691 
Hemorrhagic Diathesis, 689 
Hemorrhoids, 692 
Hemostatics, 46 
Hemp, 198 

Canadian, 145 

Indian, 198 
Henbane, 310 
Hepar Sulphuris, 474 
Hepatalgia, 693 
Hepatic Abscess, 695 

Cirrhosis, 693 

Congestion, 604 

Depressants, 35 



Hepatic I >iseases, 1 

Stimulani . 
1 lepatitis, 695 

I lernia, <k)(> 

lien. in, 

. 696 
Zoster, (hj7 
I [esperidin, t6 \, 338 
1 leuchera, 69 
Hevea, 269 

Hewitt's Method of Anesthesia, 91 
Hexamethylenamine, 184, 286 
1 lexylamine, 3 12 

Hip joint I >isi ase, See Coxalgia, 626 

Hive Mixture, [39 

Syrup, 
Hives,— See Urticaria, 
Hoang Nan, 

Hoarseness, See Aphonia, 583 
Hodgkin's Disease, 722 

1 inn's Anodyne, 88 
Hoff's Malt Extract, 124 
Hog, 84, 372 
Holloway's Ointment, 866 

Pills, 866 
Holocaine, 239 
Homatropine, 1 72 
Homeopathic Practices, 516 
Homochelidonine, 429 
Homococamine, 238 
Homoisococamine, 238 
Honey, 338 
Honeys (Mellita), 546 
Hooper's Female Pills, 556 
Hope's Mixture, 636 
Hops, 299 

Hordeolum, — See Eyelids, 662 
Hordeum distichum, 124 
Horehound, 338 
Horlick's Food, 124 
Horse-nettle, 465 
Hostetter's Bitters, 866 
Housemaid's Knee, — See Bursitis, 600 
Humulus, 299 

Hunger, — See Appetite, 583 
Hunyadi Water, 622 
Huxham's Tincture of Bark, 230 
Hwang-Nao, 299 
Hydragogue Diuretics, 30 

Purgatives, 26 
Hydrangea, 300 
Hydrargyrism, 303 
Hydrargyrum, 300 

Ammoniatum, 300 

Antidotes and Antagonists, 773, 775 

cum Creta, 300 
Hydrastin, 176. 308 
Hydrastine, 308 
Hydrastininc, 308 
Hydrastis, 308 
Hydrides, — See the titles of their metallii 

constituents. 
Hydrobromides, — See the titles of their basil 
constituents. 



8 94 



INDEX. 



Hydrocele, 698 
Hydrocephalus, 698 

Acute, — See Meningitis, Tuberculous. 
Hydrochlorides, — See the titles of their basic 

constituents. 
Hydrocotarnine, 356 
Hydrocotyle, 309 
Hydrogen Carbonate, 204 

Dioxide, 367, 369 

Peroxide, 367, 369 

Sulphide, 474, 475 

Sulphuretted, 474 
Hydronaphthol, 347 
Hydrophobia, 698 

Toxin, 453 
Hydroquinone, 232, 410 
Hydrothorax, 698 

Diagnosis of, 872 
Hydroxides, — See the titles of their metallic 

bases. 
Hydroxybenzene, 375 
Hydroxymethane, 103 
Hygroscopic Bodies, 526 
Hyos'cine, 171, 267, 310 
Hyoscyamine, 171, 310, 326, 467 
Hyoscyamus, 310 

Antidotes and Antagonists, 774 
Hyperidrosis, — See Perspiration, 753 
Hypnal, 141, 214 
Hypnone, 103, 215, 219 
Hypnotics, 36, 706 
Hypochlorites, Antidotes, etc., 774 
Hypochondriasis, 699 
Hypodermic Formula, 307, 863 

Injections, 52, 307 

Method, 52 

Solutions, 53, 863 

Tablets, 53 
Hypodermoclysis, 149 
Hypophosphites, 383, — See also the titles of 

their basic constituents. 
Hyposulphites, 80, — See also the titles of 

their basic constituents. 
Hysteria, 699 

Diagnosis of, 871 



Ice, 148 

Iceland Moss, 124 
Ichthalbin, 474 
Ichthargan, 151 
Ichthoform, 475, 477 
Ichthyocolla, 94 
Ichthyol, 474, 476 

Albuminate, 474 
Ichthyosis, 700 
Icterus, — See Jaundice, 710 
Igazol, 284 
Ignatia, 313 
Ignition, 529 

Ileus, — See Intestinal Obstruction, 70S 
Ilex Paraguayensis, 189 
Illicium, 313 
Immunity 441 



Illuminating-gas, Antidotes, etc., 775 
Impetigo, 700 
Impotence, 700 
Incineration, 529 
Incompatibility, 317 

Chemical, 517 

Dangers, of, 518 

Pharmaceutical, 520 

Rules for avoiding, 521 

Therapeutical, 520 
Incompatible Substances, 521 
Indian Corn, 496 

Hemp, 201 

Tobacco, 331 
Indican in Urine, Test for, 834 
Indigestion, — See Dyspepsia, 644 
Indigo, Wild, 170 
Inflammation, 701 
Influenza, 703 
Infusa (Infusions), 542 
Infusion, 149 
Ingluvin, 372, 374 
Inhalations, 543 
Injection Brou, 544 
Injections, 543 

Antiseptic, 307 

Formulas, 544 

Hypodermic, 52, 307, 543 

Nasal, 544 

Parenchymatous, 53 

Urethral, 344, 676 

Vaginal, 544 
Injuries, — See Bruises, Burns, Ecchymosis, 

Fractures, Sprains, Wounds. 
Inoculation, 54 
Inosit, 421 
Insanity, 704 

Insect-venom, Antidotes, etc., 772 
Insolation, 704 
Insoluble Salts, 518 
Insomnia, 705 

Integument, Absorption by, 53 
Intemperance, — See Alcoholism, Delirium 

Tremens, Opium Habit. 
Intermittent Fever, 706 
Intertrigo, 708 
Intestinal Astringents, 37 

Diseases, — See Appendicitis, Colic, Con- 
stipation, Diarrhea, Dysentery, Duo- 
denal Catarrh, Enteritis, Hemorrhoids, 
Hernia, Intestinal Obstruction. In- 
tussusception, Typhlitis, Tabes Mesen- 
terica, Worms. 

Obstruction, 708 

Parasites, — See Worms, 845 
Intussusception, 708 
Inulin, 157 
Inunction, 54 
Iodides, 314 
Iodine, 314 

as an Antidote, 767 

Antidotes and Antagonists, 775 

Carbolated, 315 

Disulphide, 474 
Iodipin, 315, 319 



IM>1 \. 






[odism, ; i6 
[odized Cotton, 686 

Phenol, 315 
Iodoform, ,; 1 i. 
[odol, 314, 320 
lodomuth, 315 
[odophen, ,^15 
[odothyrin, [30 
[odum, 314 
Ipecacuanha, 320 

Antidotes and Antagonists, 775 
Iriilin, 323 
Iris, 323 
Irish Moss, 93 
Irisin, 323 
Iritis, 700 
Iron, 276 

as an Antidote, 767 

Antidotes for, 775 

Dialyzed, 279 

and Manganese, 335 

Mixtures, 277, 279 

Pills, 556 
Irritability, 709 
Irritants, Cutaneous, 38 
Ischuria, — See Urinary Disorders, 829 
Isinglass, 04 

Isobutyl-orthocresol Iodide, 315 
Isococamine, 238 
Isonandra Gutta, 269 
Iso-naphthol, 387 
Isopral, 215, 219 
Itch, — See Scabies, 795 

Dhobie, 632 
Itching, — See Lichen, Prurigo, Pruritus, 

Pediculi, Scabies, Urticaria, etc. 
Itrol, 151 
Ivy, Poison, 414 
Izal, 377 



Jaborandi, 390, 778 
Jaborine, 390 
Jalap, 323 
Jalapin, 52^, 434 
Jambul, 324 
Jamestown Weed, 467 
Jamun, 324 
Japaconitine, 81 
Jasmine, Yellow, 287 
Jateorhiza palmata, 195 
Jaundice, 710 

Javelle Water, Antidotes, etc., 774 
Jeaunel's Antidote, 769 
Jequirity, 58 
Jervine, 491 
Joint Affections, 710 
Juglans, 324 
Juices, 559 
Juniper, 323 
Juniperin, 325 
Juniperus communis, 325 
O.xycedrus, 325 



Juniperus Sabina, \i 1 
Virginlana, 420 



Kairin. 
K, ilium, 400 
kaltnia latifolia, 
Kamala, 335 
Kaolin. [15, 
Kaputin, (ii 
Kauri ( rum, 47 1 
k.wahin, 396 
Kava-kava, 
Kauin. 3 16 

Keeky Gold Cure, [69, 866 
Kelir, c)7 
K.elene, 220 
Keratitis, 71 1 
Ketone, 103 

Kidneys, Diseases of, — See Albuminuria, 
jii'.-. I lisease, Call uli, Colic Renal, 
Diabetes, Dropsy, Gout, Hematuria. 
Kino, 69, 326 
Kinoin. 
Kino-red, 326 
Kinovin, 230 
Koch's Lymph, 447 
Kola, 189, 190 
Kolanin, 189 
Koomiss, 97 
Koussin, 260 
Kousso, 260 
Krameria, 69, 326 
Kumysgen, 97 
Kumyss, 97, 99, 102 
Kurung Oil, 400 



Labarraque's Solution, 23, 223 

Antidotes, etc., 774 
Labor, 712 
Laburnum, 157 
Lac Sulphuris, 474 
Lactation, 712 
Lactocin, 326 
Lactopeptine, 372 
Lactophenin, 63 
Lactopicrin, 326 
Lactose, 421 
Lactuca virosa, 326 
Lactucarium, 326 
Lactucerin, 326 
Lactucin, 326 
Lactyl-para-phenetidin, 63 
Ladies' Slipper, 260 
Lady Webster's Pill, 114 
La Fayette's Mixture, 250 
Lallemand's Specific, 677 
Lamella;, 544 
Lanolin, 85 
Lanthopine, 356 
Lapathin, 
Lappa. 327 
Larch. 
Lard, 84 



8 9 6 



INDEX. 



Lard, Benzoinated, 85 

Oil, 85 
Largin, 151 
Larix Europaea, 482 
Laryngismus Stridulus, 713 
Laryngitis, Acute, 713 

Catarrhal, 713 

Chronic, 714 

Tuberculous, 714 
Laryngotomy, 715 
Latin in Prescriptions, 510 

Genitive Case-endings, S62 

Numerals, 861 

Participles, 863 

Phrases and Terms, 510, 849, 863 

Prepositions, 863 

Pronunciation, 862 

Verbs, 862 
Xaudanine, 356 
Laudanosine, 356 
Laudanum, 357 
Laurel, Cherry, 74 

Mountain, 339 
Laurocerasus, 74 
Lavandula, 327 
Lavender, 327 
Laveran's Formula, 236 
Laville's Gout Mixture, 247, 866 
Laxatives, 26, 558 
Lead, 396 

Colic, 617 

Plaster, 397 

Salts, — Antidotes, etc., 775 

Sugar of, 396 

Water, 397 

and Laudanum, 398, 546 

White, 398 
Lecithin, 133 
Leek, 113 
Lemon, 328 

Lentigo, — See Freckles, 667 
Leopard's Bane, 157 
Leprolin, 457 
Leprosy, 715 
Leptandra, 327 
Leptandrin, 328 
Lettuce, 326 
Leucocythemia, 716 
Leucolin, 212 

Leucoma, — See Corneal Opacities, 624 
Leucomai'nes, 6 
Leucorrhea, 716 
Leukemia, 716 
Levigation, 532 
Levulose, 421 
Lice, — See Pediculi, 751 
Lichen, 717 
Lichenin, 124 

Licoperdon giganteum, 328 
Licorice Root, 291 

Wild, 58 
Lily-of-the-Valley, 249 
Lily, Pond, 6g 
Lime, 191, 192, 328 

Antidotes and Antagonists, 775 



Lime, Chlorinated, 225 

Kinovate, 230 

Sulphurated, 474 

Water, 192 
Limon, 328 
Linimenta, 544 
Liniments, Formula?, 545 
Linseed, 329 
Linum, 329 

Lips, — See Chapped Lips, 610 
Lip-salve, Red, 485 
Liquid-ambar orientalis, 470 
Liquores, 545 
Liquozone, 866 
Listerine, 67 
Litharge, 396 
Lithemia, 718 
Lithium, 330 

Benzoate, 175 
Lithontriptics, 38 
Liver, — See Hepatalgia, etc., 693 
Liver of Sulphur, 474 
Lixiviation, 529 
Lobelacrin, 332 
Lobelia, 331 

Antidotes and Antagonists, 775 
Lobelin, 332 
Lobeline, 332 
Lochia, — See Labor, 712 
Lock-jaw, — See Tetanus, 445, 814 
Locomotor Ataxia, 718 
Loeffler's Solution, 639 
Loganin, 349 
Logwood, 69, 296 
Lotion, 545 

Black, of Mercury, 301 

Yellow, of Mercury, 301 
Lozenges, 564 
Lugol's Solution, 314 
Lumbago, 719 
Lumbrici, — See Worms, 845 
Lung Diseases, 720 

Emphysema of, 650 

Gangrene of, 720 
Lupulin, 299 
Lupuline, 299 
Lupus, 721 
Lycetol, 393 
Lycopodium, 332 
Lyctonine, 81 
Lymphadenoma, 722 
Lymphangitis, 722 
Lymphatic Extract, 13S 
Lysidin, 393 
Lysoform, 377 
Lysol, 377 



Mace, 344 

Maceration, 529 

Macis, 344 

Macrotin, 228 

Magendie's Solution, 358, 864 

Magma, 530 

Magnesia, ^^^ 






IMM \. 



Magnesia, as an Antidote, 707 
Magnesium, 333 

urate, "7, 602 
Silicate, 450 
Maize, [23, 421, 
Malakin, 61, 424 
Malaria, 722 
Male Fern, 163 
Mallein, 45(1 

Mallotus philippinensis, 525 
Malt, 124 

Extract, 124, 127 
Hoff's, 124 
Mammary Abscess, 570 
Gland Extract, 137 
Manaca, 335 
Mandragora, 467 
Mandragorine, 467 
Mandrake, 399, 511 
Manganauro, 159, 166 
Manganese. 335 
Mangano-ferri Peptonatus, 53s 
Manganum. 335 
Mangifera indica, 337 
Mango. .537 
Mango-fruit, 337 
Mangosteen, 337 
Mania, 723 

Puerperal, 7S5 
Manna. 337 
Mannit, $38 
Mannite, 294 
Manzanita, 489 
Marasmus, — See Atrophy, Emaciation 

Tabes Mesenterica. 
Marc, 541 
Margarin, 85 

Marginal Shield Fern, 163 
Marigold, 195 
Marrubiin, 33S 
Marrubium, ^^8 
Marsh's Test, 159 
Marsh-mallow, 115 
Marsh Rosemary, 6q 
Mass, Blue, 300 

of Ferrous Carbonate, 277 
of Mercurv, 300 
Pill. 551 • 
\ allet's, 277 
Massae, 546 
Mastic, 338 
Mastiche, 33S 
Mastichin, 33S 
Mastitis. 724 
Mastodynia, 724 

Masturbation,— See Emissions, 650; Sper- 
matorrhea, 802 
Mate, 189 
Materia Medica, 1 
Matico, ^^8 
Matricaria, 338 
May Apple, 399 

McMunn's Elixir of Opium, 357 
Meadow Anemone, 406 
Meadow Saffron, 245 






Diagnosis of, 87a 

Fake, Si , 7 , M 

Temperature in, 81 j 

Measures. Anlagonisli. 

Antidotal, 7(15 

Apothecaries', 503, 875, 876 

Approximate, 505 

British, 503 

Dom 

Metric, 505. 875, 876 

and Weights, 502, 875 

Wine, 875 
Meat Diet, 99 
Extract: 
-juii 1 
Mi 1 onidine, 356 
Meconin, 
Meconoiasin, 356 
Medicines, Administration of, 50 
Classification of, 12 
Dosage of, 55 
Patent, 865 
Medulline, 135 
Meerschaum, 4^0 

Mel, 338 
Melachol, 384 

Melaleuca l.eucadeinin.n, 101 
Melancholia. 733 

Puerperal, 7S7 
Mellin's Food, 124 
Mellita, 5 , 

Meniere's Disease, See Vertigo, 84] 
Meningitis, Cerebral, 72(1 

Cerebrospinal, 720 

Spinal, 727 

Tuberculous, 727 
Menispermin, 389 
Menispermum Cocculus, j8g 

Menopause,— See Climacteric, - 

Menorrhagia. 728 

Menstrual Disorders. 7.0 

Menstruum, 521; 

Mentagra,- Si is, 808 

Mentha piperita, 
spicata, 340 
viridis, 340 

Menthol, 1 1 

Mercaptol, 

Mercauro, 159. 166 

Mercurio-vegetal, 335 

Mercurol, 301, 307 

Mercury, 300 

Antidotes and Antagonists, 773, 775 
Vegetable, 335 
Mesenteric Disease,— See Tabes Mesen- 
terica, 811 
Mesotan, 424 

Metabolism, Agents affecting, 15 
Metadioxybenzene, 410 
Metallic Salts, Antidotes, etc., 776 
Metamorphosis, Destructive, 29 
Methacetin, 63 
Methane, 90 
Methene Chloride, 90 



8 9 8 



INDEX. 



Methol, 103 
Methyl-acetanilide, 60 

Methyl Alcohol, 91 

Blue, 341 

Bromide, 90 

Chloride, 90, 221 

Conilne, 247 

Hydrate, 103 

Methylene-dimethyl, 215 

Salicylate, 287, 424 
Methylal, 91, 215,. 219 
Methylated Spirit, 103 
Methylene Bichloride, 221 

Blue, 340 
Methylene-dimethyl Ether, 215 

Ditannin, 70 
Methylthionine, 340 
Methysticin, 326 
Metric Prescriptions, 513 

System of Weights, etc., 503 

Table for Conversions, 876 
Metritis, 729 
Metrorrhagia, 729 
Mezcaline, 185 
Mezereon, 341 
Mezereum, 341 

Antidotes and Antagonists, 776 
Mica Panis, 553 
Microbe-killer, 867 
Microbes, Agents affecting, 21 

in Water, 148 
Migraine, — See Hemicrania, 687 
Migranin, 61, 141 
Miliaria, 730 
Miliary Fever, 730 
Milk as an antidote, 767 

as a food, 96, 99, 101; See also Aga- 
lactia and Lactation. 

of Asafetida, 162 

Condensed, 96 

Desiccated, 96 

Papaw, 372 

Peptonized, 97 

Sugar of, 421 

of Sulphur, 474 

Substances excreted in, 713 
Milk-fever, — See Lactation, 712 
Mindererus, Spirit of, 117 
Mineral Green, 159 

Waters, 145, 205 
Mint, 340 

Miscarriage, — See Abortion, 569 
Mistletoe, 495 
Misturae, 546 
Mixture, A. C. E., 88 

Basham's, 278 

Bismuth, for Children, 550 

Brown, 292 

Chalk, 192 

Clarke's, 866 

Copaiba, Compound, 250 

Cough, 626, 755, 760 

Coxe's Hive, 139, 435 

Diarrhea, 358 

Ferro-saline, 279 



Mixture, Griffith's, 277 

Hive, 139, 435 

Hope's, 636 

Iron, Compound, 277 
Laxative, 279 

Lafayette's, 250 

Laville's, 247, 866 

Licorice, Compound, 292 

M. S., 88 

Magnesia and Asafetida, 162, ^^^ 

Meyer's, SS 

Narcotic, 221 

Nussbaum's, 88 

Quinine, 550, 708 

Rhubarb and Soda, 413 

Schleich's, 221 

Scudamore's, 677 

Squibb's, 358, 612 

Vienna, 88 
Mixtures, 346 

Anesthetic, 88 

Compounding of, 549 

Substances suitable to, 547 
Moccasin-plant, 260 
Molasses, 421 
Mole, — See Nevus, 738 
Mollities Ossium, — See Bone Diseases, Ra- 
chitis. 
Monk's-hood, 81 
Monochlorethane, 220 
Monsel's Solution, 278 
Morbilli, — See Measles, 725 
Morphine, 356, 357 

and Atropine, 367 

Antidotes and Antagonists, 777 

Habit, 742 

Tests for, 359 
Morrhuas Oleum, 341 
Morrhuine, 342 
Morrhuol, 342 
Morrison's Pills, 196, 867 
Moschus, 343 
Mosquitoes, 807 
Motor Depressants, 39 

Excitants, 39 
Mouth, Absorption by, 50 

Diseases, — See Aphthae, Cancrum Oris, 
Gums, Parotitis, Ptyalism, Stomatitis, 
Toothache, Tongue. 

Washes, Formulae, 678 
Mucilages, 550 
Mucilagines, 550 
Mucilaginous Bodies, 12 
Mucus in Urine, Test for, 834 
Mullein, 494 

Mumps, — See Parotitis, 750 
Muscat Yolitantes, 730 
Muscarine, 93 

Antidotes and Antagonists, 776 
Muscular Disorders, — See Atrophy, Chorea, 
Hydrophobia, Laryngismus, Lumbago, 
Myalgia, Pleurodynia, Rheumatism, Teta- 
nus, Torticollis. 
Mushrooms, Antidotes, etc., 776 
Musk, 343 



INDIA. 






Mustard, 
Myalgia, 731 
Mydriasis, 40 
Mydriatics, 40 
Myelitis, 731 
Myopia, 731 
Myopsin, 373 
Myotics, 40 
Myrda, 344 
M\ ri( a, 69 

cerifera, .mo 
Myrii in, 210 
Myristica, 344 
Myristicol, 344 
M\ ronate, Potassium, 
Myrosin, 460 
Myrrh, 345 
Myrrhin, 345 
Myrrhol, 345 
Myrtle, 69, 210, 345 
Myrtol, 345 
Myrtus communis, 345 

Chekan, 346 
Myxedema, 129, 731 



Xails, Ingrowing, 732 
Napelline, 81 
Naphthalene, 232, 346 
Naphtalin, 346 
Naphthol, 346 

Camphorated, 347 
Narceine, 356 
Narco-hypnotics, 37 
Narcosis, 360 
Narcotic Mixture, 221 
Narcotics, 40 

Antidotes and Antagonists, 776 
Narcotine, 356, 359 
Nargol, 152 
Nasal Affections, 732 
Natrium, 461 
Nausea, 732 
Necrosis, 733 
Nectandra, 370 
Nepenthe, 338 
Nephritis, Diagnosis of, 869,— See also 

Bright's Disease, 593 
Nervous Affections, 733 

Exhaustion, — See Neurasthenia, 737 
Nervousness, 734 
Neuralgia, 734 

Intercostal, Diagnosis, S72 
Ovarian, 746 
Neurasthenia, 737 
Neuritis, 738 
Neurodin, 61 
Nevus, 738 

Nicotiana Tabacum, 478 
Nicotianin, 478 
Nicotine, 478, 479, 480 

Antidotes and Antagonists, 780 
Bitartrate, 470 
Nicmeyer's Pill, 760 
Nigger-head, 269 



Nighti 

idly, 171 
Woody, 
Nighi 

Hon, Hut 
Nipples, 
Nirvanin, 
Nitrate 

lotes .Hid Antagonist 
Nitre, 401 
Chili, 46a 

I Spirit of, 88 

Nitrites, taa, 770, See also the titles of their 

metallic constituents. 
Nitro-benzene, 2 ;_■ 
azol, tai 
Antidotes, etc., 77(1 
-glycerin, taa 

Antidotes, etc., 77(1 
Nitrogen Monoxide, 
Nitrous Ether, 87, 00 
Oxide, 90, 3 |S 

Antic 77(1 

Nodes, 730 

Normal Salt Solution, 463, 801 
Norway Spruce, 395 
Norwood's Tincture, 49a 
Nose-bleed,— See Epistaxis, 656 
Nosophen, 315 
Nucin. 324 
Nuclein, 137 
Numerals, Latin, 861 
Nutgall, 69 
Nutmeg, 344 
Nux Vomica, 349 

Antidotes and Antagonists, 776 
Nyctalopia, 6S7 
Nymphaea, 69 
Nymphomania, 739 



Oak-bark, 69, 71 
Oak, Poison, 414 

White, 69 
Oat, 126 
Obesity, 740 
Odontalgia, 740 
Official Operations. 535 

Preparations. 533 
Oil of Allspice. 30:? 

of Almond. Bitter, 120 
Expressed, ur 

of Amber, 477. 

of Anise, 13S, 313 

of Anthemis, 138 

of Aurantium Cortex, 165 

of Bay, 344 

of Betula, 424 

of Birch, 424 

of Cade, 325 

of Cadinum, 335 

of Cajupu 

Camphor, t96 



900 



INDEX. 



Oil, Camphorated, 197 
of Caraway, 208 
Carron, 192, 194, 330 
of Carum, 208 
of Cassia, 237 
Castor, 415, 622 
of Caryophyllus, 208 
of Cedar, 431 
Chamomile, 138 
Chaulmoogra, 211 
of Chenopodium, 211 
of Cinnamon, 237 
of Cloves, 208 
Cod-liver, 341 
of Copaiba, 250 
of Coriander, 251 
of Cotton-seed, 293 
Croton, 487 
of Cubeb, 256 
Disinfection, 377 
of Erigeron, 274 
Essential, 10 
Ethereal, 87 
of Eucalyptus, 274 
of Fennel, 283 
of Fleabane, 274 
Fusel, 103 

of Gaultheria, 287, 424 
of Gossypium-seed, 293 
Gray, 307 

Hamlin's Wizard, 866 
of Hedeoma, 297 
of Hemlock, 396 
Jecoris Aselli, 341 
of Juniper, 325 
Kurung, 400 
Lard, 85 

of Lavender flowers, 327 
of Lemon, 328 
of Linseed, 329 
of Linum, 329 
of Mentha Piperita, 339 
of Mentha Viridis, 340 
of Mirbane, 121 
of Morrhua, 341 
of Mustard, Volatile, 460 
of Myrcia, 344 
of Myristica, 344 
of Myrtle, 345 
of Nutmeg, 344 
Olive, 355 

of Orange flowers, 164 
of Orange-peel, 165 
of Pennyroyal, 297 
of Peppermint, 339 
of Pimenta, 392 
of Pinus Silvestris, 395, 483 
of Pix Liquida, 395 
of Pongamia, 400 
of Ricinus, 415 
of Rose, 417 
of Rosemary, 418 
of Rue, 419 
of Ruta, 419 
of Sabina, 420 



Oil, Salad, 355 

of Sandalwood, 430 

of Santal, 430 

of Sassafras, 434 

of Savin, 420 

of Scotch Fir, 395, 483 

Sequah's, 868 

of Sinapis, Volatile, 460 

of Spearmint, 340 

of Spruce, 396 

St. Jacob's, 81, 868 

Sweet, 355 

of Succinum, 471, 483 

of Tabacum, 479 

of Tanacetum, 481 

of Tansy, 481 

of Tar, 395 

of Terebinthina, 482 

of Theobroma, 188, 485 

of Thuja, 483, 485 

of Thyme, 486 

of Tiglium, 487 

of Tobacco, 479 

of Turpentine, 482 

of Valerian, 490 

Volatile, 10 

of Wintergreen, 287, 424 

Wizard, 866 

Wood, 296 
Oils, as Antidotes, 767 

and Fats, 9 

Essential, 10 

Expressed, 528 

Fixed, 9, 528 

Hydrocarbon, 10 

Nitrogenous, 10 

Oxygenated, 10 

Sulphuretted, 10 

Volatile, 10 
Ointment, 211 

Antipruritic, 566 

Blue, 300 

Calamine, 499 

of Carbolic Acid, 376 

Citrine, 301 

Diachylon, 397 

Holloway's, 866 

Pagenstecher's, 620 

of Phenol, 376 

of Rose Water, 83 

Spermaceti, 85 

of Tannic Acid, 69 

Tar, 395 

Unna's, 717 

White Precipitate, 301 
Ointments, 565 

Compounding, 566 

Dispensing of, 566 

Formulae for, 566 
Olea Europaea, 355 
Oleaginous Preparations, 533 
Oleata, 550 
Oleates, 77, 550 
Olein, 85 
Oleoresina, 550 



IM'I \. 



Oleo-iesins, o, 550 
Olive, 3SS 

Onion, 1 [3 

Onychia. 741 

Operations, Pharmaceutical, 525 

Ophthalmia, 741 

Opisthotonos,— Sec Tetanus, Si 4 

Opium, 356 

Alkaloids, 356, 363 
Antidotes and Antagonists, 771 
Denarcotized, 357 
Deodorized, 357 
Habit, 742 
Opodeldoc, 432 
Orange, 164, 328 
Blossom, 867 
Orchitic Extract, 132 
Orchitis, 744 
Ordeal Bark, 209 
Oregon Grape, 176 
Orexin, 213 
Orphol, 177 

Ortho-dihydroxy-benzene, 410 

Orthoform, 239 

Oryza sativa, 124 

Ossein, 94 

Otalgia, 744 

Otitis, 745 

Otorrhea, 745 

Ouabain, 469 

Ourouparia Gambir, 210 

Ovaralgia, 746 

Ovarian Extract, 136 
Neuralgia, 746 
Tumors,— See Cysts, 630 

Ovaritis, 746 

Ovis Aries, 86 

Ox, 276, 372 

Oxalates, 78, 211 

Antidotes and Antagonists, 770 

Oxaluria, 747 

Ox-gall, 276 

Oxides, 368,— See also the titles of 

metallic constituents. 
Oxidizers, 519 
Oxy -camphor, 198 
Oxyethyl-chinolin, 212 
Oxygen, 367 
Oxymel, 339 

Oxymethyl-acetanilide, 63 
Oxynarcotine, 356 
Oxyphor, 197 
Oxytocics, 41 
Oxyuris Vermicularis, 20 
Oyster-shel], 192 
Ozena, 747 
Ozone, 367, 369 

Pagliari's Stvptic, 691 
p ain. 365, 747 

Gastric, 667 

Remedies relieving, 15, 747 
Pain-killer, Perry Davis', 867 
Pains, After-, 573 



<;Oi 



their 



Pains, Chest, 610 

1'aini 

I ana's, 
Paints, 550 

Pan n ., 4 , 

Pancreatic Extrai I. 
Pancreatin, 371 
Pancreatine, [35 
Pancreopepslne, 37a 

Pannus, -See Corneal ( (pacitie 

Panopepton, 96 

Pansy, 493 

Papain, 372 

Papaiva, 37.' 

Papaver somniferum, 356 

Papaveramine, 356 

Papaverine, 356 

Papaw Milk, 372 

Papayotin, 372 

Paper, Filtering, 528 

Papers (Chart*), 535 

Papine, 357 

Papoid, 372 

Para Rubber, 269 

Paraconii'ne, 247 

Paracoto Bark, 251 

Paracotoin, 251 

Paraffin, 374 

Paraform, 2S4 
Paraldehyde, 103, 215, 218 
Paralysis, 749, 804 
Agitans, 750 
Bladder, 591 
Spinal, S04 
Paramenispermin, 389 
Paramorphine, 356 
Paraphenetol Carbamide, 423 
Paraphimosis, — See Phimosis. 756 
Paraplegia,— See Paralysis, 749 
Parasiticides, 41 
Paregoric, 357 
Pareira, 370 

Parenchymatous Injection, 53 
Paresis,— See Paralysis, 749, So; 
Parigenin, 433 
Parilla, Yellow, 37S 
Parillin, 433 
Paris Green, 159 
Paronchia, 741 
Parotid Extract, 136 
Parotitis, 750 

Parrish's Chemical Food, 3S4 
Parsley, 144 

Parson's Local Anesthetic, 
Participles, Latin, 863 
Parvoline, 478 
Parvule, 552 
Pasque-flower, 406 
Passiflora Incarnata, 371 
Passion-flower, 371 
Pasteur's Inoculation, 455 
Pastilles, 564 
Patent Medicines, 865 



579 



. 



902 



INDEX. 



Paullinia Cupana, 186, 189 

curare, 259 
Paw's Solution, S33 
Pearson's Solution, 159 
Peas, 126 
Pectin, 69 
Pediculi, 751 
Pelletierine, 294 
Pellitory, 409 
Pellotine, 185 
Pelosine, 370 
Pemphigus, 751 
Pencils, 560 
Penis, — See Chancre, Chancroid, Chordee, 

Gleet, Gonorrhea, Phimosis, Urethra. 
Pennyroyal, 297 
Pennywort, 309 
Pental, 88 
Pepo, 371 
Pepper, Black, 392 

Cayenne, 203 

Water, 399 
Peppermint, 339 
Pepper-vine, 392 
Pepsin, 371 
Peptenzyme, 372 
Peptogenic Milk Powder, 97, 372 
Pepto-mangan, 335 
Peptones, 11, 98 
Peptonoids, 96 
Percolation, 529 
Pericarditis, 751 

Diagnosis of, 870 
Periostitis, 752 
Peritonitis, 752 

Puerperal, 788 

Tuberculous, 753 
Permanganate of Potassium, 335, 337, 767 

as an Antidote, 337, 767 
Pernicious Fever, — See Intermittent Fever, 

Remittent Fever. 
Peronin, 359 

Perry Davis' Pain-Killer, 867 
Persimmon, 69 
Perspiration, 753 
Pertussin, 136 
Pertussis, 754 
Peruvian Bark, 229 
Petrolatum, 374 
Petroleum Benzin, 374 

Ointment, 374 
Petroselinum sativum, 144 
Phagedena, — See Chancre, Chancroid, Gan- 
grene, Ulcers. 
Pharmaceutical Incompatibility, 520 

Operations, 525 

Preparations, 533 

Rules, 524 
Pharmaceutists, — Their objectionable prac- 
tices, 515, 522,542 
Pharmacodynamics, 1 
Pharmacology, 1 
Pharmacopoeias, List of, 501 
Pharmacy, 1, 501 

Extemporaneous, 522 



Pharmacy, Official, 525 

Rules for neophytes, 524 
Pharyngitis, 755 
Phaseo-mannit, 421 
Pheasant's Eye, 86 
Phenacetin, 63 

Antidotes and Antagonists, 777 
Phenatol, 61 
Phenazone, 140 
Phenetidin, 63 
Phenocoll, 64 
Phenol, 232, 375 

Antidotes and Antagonists, 769 

Camphor, 376 

Iodized, 315 

Sodique, 376 
Phenolid, 61 
Phenols, 376 

Phenolsulphonates, 376, 381 
Phenopyrin, 141 
Pheno-resorcin, 377 
Phenosalyl, 377 
Phenyl, 232 

Alcohol, 102 

Salicylate, 424, 427 
Phenyl-acetamide, 59 

Ammoniated, 60 
Phenyl-dihydro-chinazolin, 213 
Phenyl-dimethyl-pyrazolon, 140 
Phenyl-methyl-acetone, 103 
Phenyl-methyl-ketone, 215 
Phenyl-urethane, 60 
Phimosis, 756 
Phlebitis, 756 

Phlegmasia Alba Dolens, 757 
Phlegmon, 757 
Phloridzin, 405 
Phosgene, 224 
Phosphates, 383 

Test for, 834 
Phosphites, 383 
Phospho-albumen, 134 
Phosphorus, 382 

Antidotes and Antagonists, 777 
Photophobia, 757 
Phthisis, 757 

Temperature in, 813 
Physiological Antagonism, 18 
Physostigma, 386 

Antidotes and Antagonists, 778 
Physostigmine, 386 
Phytolacca, 388 
Phvtolaccin, 388 
Phvtoline, 388 
Pichi, 388 
Picraconitine, 81 
Picrasma excelsa, 409 
Picratol, 152 
Picroglycion, 268 
Picropodophyllin, 399 
Picrotoxin, 389 

Antidotes and Antagonists, 77S 
Pierce's Favorite Prescription, 867 

Golden Discovery, 867 
Pigmenta, 550 



1\1>1 X. 









69a 
Pill, Vnaphrodisia< . 550 

Anti-bilious, 557 

Aperient, 550 

Astringent, 556 

AVer's, 865 

Blan card's, 277 

Blaud's, 277 

Blue, 300 

Brandreth's, S65 

Cathartic, Compound, 246 
Vegetable, 247 

Chalybeate, 277 

Cholagogue, 556 

Emmenagogue, 556 

Ferruginous, 277 

Holloway's, 866 

Hooper's, 556 

Iron, 556 

Lady Webster's, 114 

Lapactic, 114 

Laxative. 1 14 

Morrison's, 196, 867 

Xiemeyer's. 760 

Tanjore, 806 

Tonic. 557 
Pill-making, 552 
Pill-mass, 551 
Pills. 551 

Coated. 555 

E.xcipients for, 552 

Formula: for, 556 

Official, 551 

Process of making, 552 

Substances suitable for. 554 
Pilocarpene, 390 
Pilocarpidine, 390 
Pilocarpine, 390 

Antidotes and Antagonists, 77S 
Pilocarpine-phenyl-hydroxide, 377 
Pilocarpus, 390 
Pilula?. 551 
Pimenta, 392 
Pimpinella Anisum, 1 58 
Pimples, — See Acne, 571 
Pine, Prince's, 212 

Yellow, 481 
Pineal Extract, 136 
Pineapple, 372, 374 
Pinene, 345 
Pines, 394 
Pinipicrin, 485 
Pinites succinifer, 471 
Pink, Carolina, 465 
Pink-root, 465 

Demarara, 646 
Pinus, 394 

australis, 482 

Canadensis, 395 

palustris, 394, 4S1 

sylvestris, 395 

Tseda, 482 
Piper, 392 

angustifolium, 338 

cubeba, 255 



Pipei methystii urn, 

nigrum, 
Piperazin, 303 
Piperidin, 39a 
Piperine, 
Pipsissewa, -• 1 a 
l'i>i idia, 394 
Piscidin, 394 
Pisscnlit, 48] 
I'iM.ui.i Lentiscus, 

Terebinthus, 481 
Pitch, 31)4 

Burgundy, 31)0 
Pituitary Extract, 130 
Piturine, 207 
Pityriasis, 760 
Pix, 394 

Liquida, 304 
Plague, Bubonic, 7(11 
Planat's Tincture, 3S9 
Plantago, 396 
Plantain, 396 
Plaster, Adhesive, 397 

Anodyne, 570 

Cantharidal, 201 

Capsicum, 203 

Counterirritant, 538 

Court, 95 

Isinglass, 95 

Lead, 397 

Mercurial, 300 

Pitch, 201 

Rosin, (S2 

Soap, 432 

Vesicating 

Warming, 201 
Plasters, 537 

Formula; for, 538 
Plethora, 761 

Abdominal, 560 
Pleurisy, 761 

Diagnosis of, i 
Pleurisy-root, 163 
Pleuritis, 761 
Pleurodynia, 762 
Pleuro-pneumonia, 763 
Plum, 404 
Plumbism, 397 
Plumbum, 396 
Pneumonia, 702 

Diagnosis of, 872 

Lobular. 596 
Podophyllitoxin, 399 
Podophyllum, 399 
Poison Ivy, 414 

Xut, 349 

Oak, 414 

Antidotes and Antagonists 

Sumach, 414 
Poisoning, 764, — Sec also the several poisons 
under their titles in Part 1. 

Antidotes and Antagonists, 17. ao, 

Treatment of,— Indications f»r, 
General Principles of. 765 
Poisonous Compounds, 510 



9°4 



INDEX. 



Poisons, Energetic, 764 
Poke-berry, 388 
Poke-root, 388 
Polygala Senega, 437 
Polygonum, 399 
Polyporus fomentarius, 92 

officinalis, 92 
Polypus, 780 

Polyuria, — See Diabetes Insipidus, 633 
Pomade de Bareges, 760 
Pomegranate, 69, 294 
Pond Lily, 69 
Pond's Extract, 297 
Pongamia, 400 
Poplar, 423 
Poppy, White, 356 
Populus, 423 
Porphyrization, 532 
Porphyroxin, 356 

Porrigo Capitis, — Tinea Tonsurans, 817 
Porter, 104 
Port Wine, 104 
Potash, 400 

Antidotes, etc., 778 
Potassa, 400 

Sulphurata, 476 
Potassio-ferric Tartrate, 278 
Potassium, 400 

Alum, 115 

Cyanide, 74, 75, 774, 778 

Dichromate, 227, 778 

Ferrocyanide, 74, 767 

Guaiacol Sulphonate, 252 

Myronate, 460 

Nitrate, 401, 778 

Nitrite, 122 

Permanganate, 335, 337, 767 

Salts, 400 

Silicate, 401, 459 

Sozo-iodolate, 315 

Tartraborate, 67, 602 
Potato, 126, 268 

Spirit, 103 
Potentilla Sarmentosa, 753 
Potus, 557 
Poultices, 534 
Powder, Antipruritic, 558 

Aromatic, 237 

Astringent, 558 

Bismuth and Soda, 558 

Bleaching, Antidotes, etc., 774 

Catarrh, 558 

Dover's, 321, 357 

Effervescing, 401 

Gastric Sedative, 558 

Gray, 300 

Laxative, 558 

Licorice, 292 

Purgative, 323 

Seidlitz, 401 

Tully's, 358 
Powders, 557 

Formulae for, 558 

Substances suitable to, 558 
Prairie Flower, 868 



Precipitant Solutions, Table of, 519 
Precipitate, White, 300 

Red, 301 
Precipitation, 530 
Pregnancy, Disorders of, 781 

Vomiting of, 843 
Preparations, 533 

Official, 56, 533 

Pharmaceutical, 533 
Prepositions, Latin, 863 
Prescription, Pierce's Favorite, 867 

Writing, 507 
Prescriptions, 506 

Abbreviations in, 514 

Analysis of, 507 

Blanks for, 517 

Combination, 512 

Contractions, 514, 849 

Filling of, 523 

Latin Phrases used in, 510, 849, 863 

Metric, 513 

Renewals, 515 

Table of Doses, — See cover. 

Tonic, 573, 578 

Use of Latin, 510 
Prickly Heat, — See Miliaria, 730 
Prince's Pine, 212 
Principles in' Drugs, 5 

Bitter, 8 

Neutral, 8 
Proctitis, — See Rectum, 789 
Prodigiosus Toxin, 515, 450 
Prolapsus Ani, 781 

Uteri, 781 
Pronunciation, 862 
Propyl Oxide, 342 
Propylamine, 157 
Prosopalgia, — See Neuralgia, Odontalgia, 

Tic Douloureux. 
Prostate, Hypertrophied, 781 
Prostatitis, 782 
Prostatorrhea, 782 
Protargol, 152 
Protectives, 41 
Proteid, Coagulated, 11 
Proteidin, 442 
Protein, 94 

Bodies, 11 
Protonuclein, 138 
Protopine, 211, 356, 429 
Protoveratridine, 491 
Protoveratrine, 491 
Prune, 404 
Prunum, 404 
Prunus Amygdalus, 120 

domestica, 404 

Laurocerasus, 74 

Serotina, 405 

Virginiana, 405 
Prurigo, 782 
Pruritus, 783 
Pseudaconitine, 81 
Pseudococcus cacti, 245 
Pseudo-hyoscyamine, 267 
Pseudo-jervine, 491 



IM'I \ 






Pseudo-morphine, 356 
Psoria.-i-, 7S4 

Pterocarpus Marsupium, 326 
santalinus, 431 
gium, 7S5 
Ptomaines, 770 

Ptosis, 7S5 

Ptyalism, 785 

Puerperal Convulsions, 785 

Disorders, 786 

Fever, 787 

Mania, 7S7 

Melancholia, 787 

Peritonitis, 788 
Puff-ball, 328 
Pulmonary Sedatives, 42 
Pulsatilla, 406 

Antidotes and Antagonists, 778 
Pulse, 7S8 

and Temperature, S13 
Pulveres, 557 
Pulverization, 532 
Pulvis Doveri, 357 

Purgans, 323 
Pumpkin-seed, 371 
Punica Garnatum, 294 
Purgatives, 26 
Purpura, 78S 
Pus in Urine, Test for, S34 
Pustule, Malignant, — See Anthrax, 580 
Pustules, — See Anthrax, Ecthyma, Erup- 
tions, Impetigo, Variola. 
Pustulants, 38 
Pyemia, Soo 
Pyramidon, 141 
Pyrethrine, 409 
Pyrethrum, 409 
Pyretine, 61 
Pyridine, 232, 478 
Pyrocatechin, 232, 410 
Pyrogallol, 70, 232 
Pyrrol, 314 
Pyrosis. 78S 
Pyroxylin, 124, 293 
Pyrozone, 368 



Quaker Button, 349 

Quantities, Prescription, — See Cover. 

Quassia, 409 

Quassin, 409 

Queen's Delight, 466 

Quercin, 69 

Quercus, 69 

Quicksilver, 300 

Quillaja, 410 

Quinalgen, 61, 212 

Quince-seed, 260 

Quinetum, 231 

Quinicin, 232 

Quinidine, 230 

Quinine, 230 

Antidotes and Antagonists, 778 

Carbonic Ester, 231 
Ether, 231 



Quinine, H) podermii all] . 

Mixtures, 

Solutions, ; 1 3 

Substitute 
Quinoidin, 131 
Quinolin, 
Quinosol, 7 1 ; 
Quinquinin 1 
Quinsy, See Tonsillitis, 



Rabies, See Hydrophobia, 698 
Antitoxin, 455 

Toxin. 155 
Rachitis, 

Radam's Mi. robe killer, 867 
Railway's Ready Relief, 867 

Resolvent, 867 
Raspail's Eau Sedative, 117. io<> 
Raspberry, 1 1 8 

Rat-pastes, Antidotes, etc., 778 
Ratsbane, 7 78 
Recamier Balm, etc., 867 
Rectum, Absorption by, 5 1 

Diseases of, 

Prolapse of, 781 

Ulceration of. - 
Red-Gum, — See Strophulus, S07 
References and Bibliography, = 
Refrigerants, 42 
Reinsch's Test, 159 
Relapsing Fever, 790 
Remittent Fever, 790 

Diagnosis of, 874 
Renal Depressants, 31 
Renewals of Prescriptions, 5 15 
Resin, 9, 482 
Resina, 4S2 
Resina;. 550 
Resinol, 483 
Resins, 9, 559 

Pharmaceutical, 9 

True, 9 
Resorcinol, 232, 410 

Antidotes and Antagonists, 778 
Respiration, — See Bronchitis. Croup. Dysp- 
nea, Emphysema, Pneumonia. . 

Agents affecting, ^^, 42 

Artificial, 586 
Respiratory Depressants, 42 

Stimulants, 42 

Tract, Absorption by, 5 1 
Restoratives, 43 
Retina, Affections of, 790 
Retinol, 483 
Revalenta Arabica, 867 
Rhamnoxanthin, 286 
Rhamnus Frangula. 286 

Purshiana, 412 
Rhatanine, 326 
Rhatany, 69, 326 
Rhein, 412 
Rheum, 412 
Rheumatin, 424 
Rheumatism, Acute, 791 



906 



INDEX. 



Rheumatism, Chronic, 793 

Diagnosis of, 871 

Gonorrheal, 794 

Muscular, 794 
Rheumatoid Arthritis, 584 
Rhinitis, — See Catarrh Acute Nasal, In- 
fluenza, Nasal Affections. 
Rhceadine, 356 
Rhubarb, 412 
Rhus, 414 

Antidotes and Antagonists, 778 
Rice, 124 
Ricin, 416, 441 
Ricinine, 416 
Ricinolein, 416 
Ricinus communis, 415 
Rickets, — See Rachitis, 789 
Ring-worm, — See Dhobie Itch, 632; Tinea, 

816 
Risus sardonicus, 351 
Roasting, 531 
Rochelle Salt, 401 
Rosa, 69, 417 
Rose, 69, 417 

Attar of, 417 

Honey of, 417 
Rosemary, 69, 418 
Roseola, 794 
Rosin, 482, 485 

Cerate, 482 

Plaster, 482 
Rosmarinus, 418 
Rottlera, 325 
Rottlerin, 325 
Rubber, 269 
Rubefacients, 38 
Rubeola, — See- Measles, 725 
Rubidium Iodide, 314 
Rubijervine, 491 
Rubini's Tincture, 196 
Rubus, 69, 418 
Rue, 419 
Rules for Incompatibility, 521 

for Pharmaceutists, 524 
Rum, 104 

Bay, 344 
Rumex, 418 
Rumicin, 418 

Rupia, — See Pemphigus, 751 
Russian Spirit, 794 
Ruta, 419 
Rye, 270 



Sabadine, 491 
Sabadinine, 491 
Sabal, 420 
Sabina, 420 

Antidotes and Antagonists, 779 
Saccharin, 422, 423 
Saccharum, 421 

Lactis, 421 
Sacred Bark, 412 
Safflower, 255 
Saffron, 255 



Saffron, Meadow, 245 

Saffron-tea, 255 

Safrol, 196, 434 

Sage, 428 

Sage's Catarrh Remedy, 867 

Sago, 126 

Sal Alembroth, 307 

Sal-ammoniac, 117 

Salbromalide, 60 

Salfene, 61 

Salicin, 423 

Salicylate, Para-amidol, 424 

Physostigmine, 386 

Sodio-Theobromine, 186 
Salicylates, 424 
Salicyl-bromalide, 60 
Salicyl-para-phenetidin, 61, 424 
Saligenin, 425 
Saline Mineral Waters, 146 

Purgatives, 26 
Salipyrin, 141, 424, 428 
Saliva, Agents affecting, 44 
Salivation, 44, 304, 785 
Salix, 423 

Nigra, 423 
Salochinin, 425 
Salol, 424, 427 
Salophen, 424, 428 
Saloquinin, 231, 425 
Salt, common, 462 

as an Antidote, 768 

Epsom, 3^ 

Glauber's, 462 

Rochelle, 401 
Saltpetre, 401 

Antidotes and Antagonists, 7 78 

Chili, 462 
Salt-rheum, — See Eczema, 648 
Salts, 43 

Deliquescent, List of, 555 

Efflorescent, List of, 555 

Insoluble, 518 

of Lemon, 770 

Metallic, Antidotes, etc., 776 

of Sorrel, 770 
Salve, Reri Lip, 485 
Salvia, 428 
Salviol, 428 
Sambucus, 428 
Sampson, Black, 269 
Sandal-wood, 430 

Oil, 43° 
Sand-brier, 465 
Sanford's Catarrh Cure, 867 
Sanguinaria, 429 

Antidotes and Antagonists, 779 
Sanguinarine, 211, 429 
Sanitas, 368, 483 
Sanmetto, 420 
Sanose, 96 
Sanosin, 274 
Santalum Album, 430 

Citrinum, 430 

Rubrum, 431 
Santonica, 431 



I N D 1 \ . 



'J07 



Santonin, 131 
Sapo, 4.^-' 
Sapogenin, 437 
Saponification, 43a 

Saponin, 210, 410 

Saprol, 377 

Sarcinae, 795 

Sarcocele,— See under Cancer, Testicles. 

Sarsaparilla, 433 

Ayer's, 865 
Sassafras. 4,^ 
Sassy Bark, 209 
Saunders, Red, 431 
Savin, 420 

Antidotes and Antagonists, 770 
Saw Palmetto, 420 
Saxin, 42} 

Sayre's Method for Chloroform, 224 
Scabies, 795 

Scald-head, — See Eczema, Tinea. 
Scalds, 600 
Scammonium, 434 
Scammony. 434 
Scarlet Fever, 705 

Diagnosis of, 872 

Temperature in, 813 
Scheele's Acid, 74 

Green, 159 
Schleich's Method of Anesthesia, 91 

Narcotic Mixture, 221 

Solutions, 88, 238 
Sciatica, 796 
Scilla, 435 
Scillin, 435 
Scillipicrin, 435 
Sdllitin, 435 
Scillitoxin, 435 
Scirrhus, — See Cancer, 603 

Diagnosis of, 870 
Scleroderma, 798 
Sclerosis, 798 

Spinal, 804 
Scoparin, 436 
Scoparius, 436 
Scopola, 310 
Scopolamine, 310 
Scorbutus, — See Scurvy, 799 
Screaming, — See Nightmare. 739 
Scrofulosis, 798 
Scudamore's Mixture, 677 
Scurvy, 799 
Scutellaria, 437 
Scutellarin, 437 
Sea-sickness, 799 
Sea-wrack, 286 
Seborrhea, 800 
Secale cereale, 270 
Secaline, 271 
Sedative, Battley's, 358 
Sedatives, 44 

Cardiac, 2*4 

Gastric, 32, 558 

General, 32 

Pulmonary, 42 

Urinary, 47 



Sedatives, 1 

Vascular, \8 
il. ig 
Seidlitz Powder, 401 
Seigel'S Syrup, 868 
Senega, 437 
Senegin, 1 57 

Senna, 1 ;S 

Sennacrol, 1.38 
Sennapu rin, t v s 
Separation, 530 

Septicemia, 800 
Sequah's < til, 868 

Prairie Flower, 868 
Serpentaria, 1.58 

Serpent-venom, Antidotes, etc.. 770 
Sera, 439, 1 13 
Serum, Anti-anthrax, 457 

Anti-diphtheric, 445 

Anti-dysenteric, 457 

Anti-lepra, 457 

Anti-phthisic, 4 17 

Anti-pneumococcus, 452 

Anti-streptococcus, 15 1 

Anti-syphilis, 455 

Antitoxic, 442 

Anti-tuberculous, 447 

Artificial, 738 

Cholera, 453 

Erysipelas, 457 

Hay Fever, 457 

Inorganic. 458 

Morphine, 457 

Nutrient, 458 

Pertussis, 457 

Plague, 454 

Rabies, 455 

Scarlet Fever, 457 

Tetanus, 445 

Thyroid, 457 

Typhoid, 452 

Vaccinia, 457 

Yellow Fever, 457 
Serums, 439, 443 
Serumtherapy, 439 
Sevum, 86 

Shampoo Mixture, 678 
Sheep, 8s, 86 
Shells, 189 
Sherry Wine, 104 
Shingles,— See Herpes Zost< 1 
Shock, 800 
Sialogogues. 44 
Sickness at Stomach, — See Nausea, Se 

ness, Vomiting. 
Sick-room, 801 
Siddhi, 199 
Silicates, 459 

Silicious Mineral Waters, 147 
Silicon, 459 
Silver, 150 

Antidotes and Antagonist 

Compounds, 151 
Sinalbin, 460 
Sinapine, 460 



go8 



INDEX. 



Sinapis, 460 
Sinapism, 535 

Singultus, — See Hiccough, 697 
Sinigrin, 460 
Sinistrin, 435 

Siriasis, — See Insolation, 704 
Skin Diseases, — See Acne, Anthrax, Bed- 
sores, Boils, Burns, Carbuncle, Chapped 
Hands and Lips, Chilblains, Condylo- 
mata, Dhobie Itch, Ecchymosis, Ecthy- 
ma, Eczema, Eruptions, Erysipelas, Ery- 
thema, Freckles, Herpes, Herpes Zoster, 
Ichthyosis, Impetigo, Intertrigo, Lep- 
rosy, Lichen, Lupus, Miliaria, Nevus, 
Onychia, Pemphigus, Perspiration, Phleg- 
mon, Pityriasis, Prurigo, Pruritus, Psori- 
asis, Roseola, Scabies, Scleroderma, Seb- 
orrhea, Strophulus, Sycosis, Syphilis. 
Tinea, Ulcers, Urticaria, Warts, Wen. 
Skull-cap, 437 
Sleep, Abnormal, — See Delirium, Insomnia, 

Nightmare, Somnambulism. 
Slippery Elm Bark, 489 
Smallpox, — See Variola, 840 

Diagnosis of, 872 
Smart-weed, 399 
Smell, Agents affecting, 45 
Smilacih, 433 
Smilax, 433 
Snake-root, 458, 311 
Sneezing, 801 

Agents producing, 33, — See also Ca- 
tarrh, Hay Fever, Influenza. 
Soap, 432 

as an Antidote, 768 
Bark, 410 
Soda, 461 

Antidotes and Antagonists, 778 
Caustic, 461 
Chlorinated, 225 
Water, 205, 207 
Sodio-Theobromine Salicylate, 186 
Sodium, 461 

Benzoate, 175 

Bisulphite, 80 

Borate, 66 

Chloride, as an Antidote, 768 

in Urine, Test for, 833 
Cinnamate, 175 
Glycocholate, 275 
Hydroxide, 461 
Hyposulphite, 80 
Nitrite, 122 
Phenolsulphonate, 376 
Phosphate, 129, 383, 386 
Silicate, 459 
Sulphite, 79 
Tetraborate, 67 
Thiosulphate, 80 

as an Antidote, 768 
Solanine, 268 
Solanum Carolinense, 465 

Dulcamara, 268 
Solid Preparations, 533 
Soloid, 362 



Soluble Substances, 547 
Solution, 530 

Aids to 548 

Alkaline Cupric Tartrate, 257 

Antiseptic, 66, 307 

Circulatory, 531 

Clemens', 159 

Creuse's, 277 

Crocq's, 383 

Didama's, 864 

DobelPs, 544, 608 

Donovan's, 159 

Fehling's, 257 

Fowler's, 158 

Glass, 459 

Labarraque's, 23, 225, 774 

Loeffler's, 639 

Lugol's, 314 

Magendie's, 338, 864 

Monsel's, 278 

Normal Salt, 463, 801 

Pavy's, 833 

Pearson's, 159 

Quinine, 548 

Sal Alembroth, 307 

Salt, Normal, 463, 801 

Saturated, 530 

Villate's, 258 

Vleminck's, 633 
Solutions (Liquores), 545 

Hypodermic, 52, 863 

Precipitant, Table of, 519 

Schleich's, 88, 238 

Stock, 524 
Solutol, 377 
Solvents, 531 
Solveol, 377 
Somatose, 96 
Somnal, 214, 219 
Somnambulism, 802 
Somnoform, 221 
Sorbefacients, 30 
Sores, 826 

Bed, 589 
Sorghum, 421 
Sorrel, 78, 418, 770 
Sozodont, 868 
Spanish Flies, 201 
Sparteine, 436 
Spasmodic Affections, 802 
Spearmint, 340 
Specific Gravity, 505 

Volume, 506 
Spermaceti, 85 
Spermatorrhea, 802 
Spermine, 134 
Sphacelotoxin, 270 
Spigelia, 465 
Spina Bifida, 803 
Spinal Concussion, 803 

Congestion, 803 

Inflammation, — See Meningitis, Mye- 
litis, etc. 

Irritation, 803 

Paralysis, 804 



1MH \. 






Spinal S( lerosis, 8o i 

Softening) 
Spirit of Mindererus, 117 

Methylated, 103 

Perfumed, 104 

Potato, 103 

Proof, 104 
Rectified, 104 

Russian. 704 

Wood, 103 
Spirits (Spirit us), 550 
Splenic Affections, S04 

Extract, [35 
Spongia Usta, 79S 
Spongio-piline, 545 

Spotted Fever, — See Typhus Fever, Men- 
ingitis Cerebro-spinal. 
Sprains, S04 
Spruces. 394, 395 
Sprue, 805 
Spunk, 02 

Squama?. — See Ichthyosis, Pityriasis, Pso- 
riasis, etc. 
Squaw-root, 210 
Squibb's Mixture, 35S, 612 
Squill, 139, 435 
St. Ignatius' Bean, 313 
St. Jacob's Oil, 8i, 868 
St. Mary's Thistle, 208 
St. Vitus' Dance, — See Chorea, 614 
Stains. 805 
Stammering. S06 
Staphisagria, 466 
Starch, 123, 421 

as an Antidote, 768 
Star-wort, 113, 511 
Statice, 69 
Stavesacre, 466 
Steapsin, 373 
Stearin, S5 
Sterility, 806 
Sternutatories, ^^ 
Stillingia, 466 
Stimulants, 45 

Cardiac, 25 

Diffusible, 45 

Hepatic, 36 

Local, 45 

Pancreatic, 41 

Respiratory, 42 

Vascular, 48 
Stings and Bites, 806 
Stock Solutions, 524 
Stokes' Liniment, 545 
Stomach, Absorption by, 50 

Diseases, — See Dyspepsia, Gastralgia, 
Gastric Ulcer, Gastritis, etc. 
Stomachics, 46 
Stomatitis, 807 
Stone, — See Calculi, 38, 601 
Storax, 470 
Stovaine, 239 
Strabismus, 807 
Straining, 525 
Stramonium, 467 



Stramonium, Intidotes and \m • 
Strangury, See Cystitis, l >w> 
Stricture, See Re< turn, 780, 

I retnral, 
Strontium, (68 
Strophantbin, .|<n) 
Stropnanthus, 469 

Strophulus, 807 
Strychnine, 199, 313, 

Antidotes and Antagonists, 77'' 
1 313 

Gautheriana, 

\u k \ omii a, .; 10 
Stye, -See Eyelids, 66a 

Styptic Collodion, (iij, 71, 
Slypticin, 358 
Styptics, 4(1, <>oi 
Styracin, 471 
Styrax, 470 

Benzoin, 175 
Styrol, 471 
Sublamin, 302 
Sublimation, 531 
Substances, Amyloid, 5, 11 

best given alone, 52 1 

difficult to combine in pill, 5^4 

suitable for mixtures, 547 

suitable for pills. 554 

suitable for powders, 558 

unsuited to pill-form, 555 
Succi (Juices), 559 
Succinum, 471 
Succus Alterans, 466 

Limonis, 328 
Sucrol, 423 
Sudorifics, 29 
Suet, 86 
Sugar, 421 

Grape, 421 

of Lead, 396 

of Milk, 421 

in Urine, — See Diabetes Mellitus, 633 
Tests for, 833 
Sulphaminol, 475. 477 
Sulphates, — Sec the titles oi 
stituents. 

as Antidotes, 768 
Sulphides, 473, 780 
Sulphites, 79, So 
Sulpho-carbolates, 376 
Sulpho-cyanate, Acrinyl, 460 
Sulpho-cyanide, Ally], 460 
Sulpho-ichthvolates, 474 
Sulphonal, 471 

Antidotes, etc., 779 
Sulphonethylmethane, 47 r 
Sulphonmethane, 471 
Sulphur, 473 

Antidotes and Antagonists, 780 

Iodide, 474, 476 
Sulphuretted Hydrogen, 474 
Sulphurous Mineral Waters, 146 
Sumach, 414 
Sumbul, 478 
Sun-dew, 267 



cpio 



INDEX. 



Sunstroke, — See Insolation, 704 
Suppositoria, 559 
Suppositories, Formula;, 561 

Official in Br. Phar., 560 
Suppuration, 807 
Surgeon's Agaric, 92 
Surgical Fever, 808 
Sus scrofa, 84, 372 
Svapnia, 357 
Swallowing, — See Dysphagia, Esophageal 

Affections. 
Sweet Flag, 191 

Gum, 470 
Swertia Chirayita, 213 
Swift's Specific, S. S. S., 868 
Sycosis, 808 

Sydenham's Laudanum, 357 
Syncope, 808 
Synovitis, 809 
Syntonin, 98 
Syphilis, 809 

Diagnosis, — See Chancre, 870 
Syrup, 422 

Siegel's, 868 

Mrs. Winslow's Soothing, 358 
Syrupi (Syrups), 561 



Tabacum, 478 

Tabellae, 562 

Tabes, — See Locomotor Ataxia, 718 

Tabes Mesenterica, 811 

Table of Antagonistic Drugs, 19 

Drops in a Drachm, etc., 505, 875 

Latin Words, Phrases, etc., 849 

Metric Conversion, 876 and cover. 

Precipitant Solutions, 519 

Prescription Doses and Quantities, — See 
cover. 
Tables of Differential Diagnosis, 869 

of Weights and Measures, 503 
Tablets, 562 

Compressed, List of, 562 

Hypodermic, List of, 53, 562 

of Nitroglycerin, 122 
Tabloid, 562 
Tag Alder, 113 
Taka-diastase, 372 
Talc, 459 
Tamarind, 480 
Tamar-Indien, 438 
Tamarindus, 480 
Tanacetin, 481 
Tanacetum, 481 
Tannalbin, 70, 71 
Tannigen, 70 
Tannin, 69 

as an Antidote, 768 
Tannocol, 70, 71 
Tannoform, 70, 71 
Tansy, 481 

Tapeworms, 20, 294, 845 
Tapioca, 126 
Tar, 394 
Tar-water, 395 



Taraxacerin, 481 
Taraxacin, 481 
Taraxacum, 481 
Tartar, Cream of, 401 

Crude, 400 

Emetic, 139 

Antidotes and Antagonists, 771 
Tartraborate of Potassium, 67, 602 
Tartrate, Antimony and Potassium, 139 

Potassio-ferric, 278 

Potassium and Sodium, 401 
Tartrates, 80 
Taste, Agents affecting, 46 

Disordered, 811 
Taurocholate of Sodium, 276 
Tea, 188 

Boneset, 276 

Flaxseed, 330 

Garfield, 866 

German Breast, 115 

Hamburg, 866 

Linseed, 330 

Saffron, 255 

Tansy, 481 

Worm, 466 
Teeth, 811 

Agents affecting, 28 
Teething, — See Dentition, 632 
Temperature in Disease, 812 

Drugs affecting, 21 

and Pulse, 813 
Tenesmus, — See Dysentery, 641 
Teniae, 20, 294, 845 
Teniafuges, 20, 294 
Terebene, 482, 484 
Terebinthene, 482 
Terebinthina, 481 
Terpenes, 482 
Terpin Hydrate, 482, 485 
Terpinol, 483 
Terraline, 374 
Testa Praparata, 192 
Testicles, 813; See also Orchitis, 744 
Testicular Juice, 132 
Testing, 531 
Tests for Arsenic, 159 

Brucine, 350 

Morphine, 359 

Strychnine, 350 

Urine, 831 
Tetanus, 445, 814 
Tetra-hydro-parachinanisol, 212 
Tetra-hydroparamethyl-oxychinolin, 212 
Tetra-iodo-pyrrol, 314 
Tetranitrin, 122 
Tetronal, 471, 473 

Tetter, — See Herpes, Pityriasis, Psoriasis. 
Thallin, 212 
Thea sinensis, 185, 188 
Thebaine, 356 
Theine, 185" 
Theism, iSS 

Theobroma Cacao, iSS, 485 
Theobromine, 1S6, 4S4 
Theocin, 1S6, 191 






i\m \. 



')! I 



Theophylline, 186, 191 
Therapeutii al Lni ompatibilitj . , 
Therapeuti 

Applied, 2, 569 

Empirical, 2 
Natural, 1 
Rational, 2 

Special, 5 (,s 
Theriaca, 421 
Thermodin, 61 
Thermol, 64 

Thermometer, clinical, Su 
Thialion, 331 
Thigenol, 475' 477 
Thimble-berry, 418 
Thiocol, 252, 255 
Thiol. 4 75- 4 7 s 
Thiosinamin, 460 
Thioxy-diphenyl-amine, 47 q 
Thirst', 84 1 

Agents allaying, 42 
Thistle, Blessed, 208 

St. -Mary's, 208 
Thompson's Eye-water, S6S 

Tincture, 383 
Thorn-apple, 467 
Thorough-wort, 276 

Throat, — See Aphonia, Croup, Diphtheria, 
Laryngitis, Pharyngitis, Scarlet Fever, 
Tonsillitis, etc. 

Sore, 815 
Thrush, — See Aphtha;, 582 
Thuja, 483 
Thujetin, 485 
Thujin, 485 

Thus Americanum, 482 
Thyme, Garden, 486 
Thymene, 486 
Thymoform, 284 
Thymol, 486 

Carbonate, 487 

Iodide, 314, 320 
Thymotal, 487 
Thymus (gland) Extract, 136 

vulgaris, 486 
Thyreo-antitoxin, 130 
Thyroid Extract, 129 

Glands, 131 
Tic Douloureux, 814 
Tiglii Oleum, 487 

Tin, Antidotes and Antagonists, 780 
Tinctura Antiperiodica, 231 

Pyrexialis, 231 
Tincturae (Tinctures), 562 
Tincture, Churchill's, 314 

Fleming's, 81 

Hager's, 231 

Huxham's, 230 

Norwood's, 492 

Planat's, 389 

Rubini's, 196 

Thompson's, 383 

Warburg's, 231 
Tinea Circinata, 816 

Decalvans, 816 



Tin. 

[mbricata, 
J] 7 
,817 

Tinnitus Aurium, . '>i7 

Tobacco, 17S 

Antidotes and Antagonist 

Indian, 331 

Sympton 
ness. 
Toe-nails, See Nails, Ingrowing. 
Tokelau Ringworm, 81 7 
Tolene, 170 
Toluene. 375 
Toluifera Pereirae, 169 

Balsamum, 1 70 
Tomato, 268 
Tongue, 818 

Absorption by, 50 
Tonii 3, 

Cardiac, 23 

Gastric, 46 

Hair. 678 

Nerve, 734, 738 

Pill for Women, 557 

Prescriptions, 573,578, 734, 738 

1 terine, \S 

Vascular, 48 

Vesical, 4.) 
Tonsillitis. 818 
Tonsils, Enlarged, 819 

Ulcerated, 8 ig 
Toothache, — See Odontalgia, 740 
Toothrash. — See Strophulus, 807 
Torrefaction, 5 ; 1 
Torticollis, 820 
Torula;, — See Sardine, 705 
Toxemia, 820 

Toxicological Antagonism 18 
Toxicology, 1, 17. 7'>4 
Toxin, Cholera, 453 

Erysipelas, 451 

Prodigiosus, 450 

Rabies, 455 

Streptococcus, 450 

Tuberculosis, 447 
Toxins, 439 

Tracheitis. — See Croup, 626 
Trachoma,— See Conjunctivitis Granular, 

620; Ophthalmia, 741 
Tragacantha, 488 
Transfusion, 51 

Traumatic Fever, — See Surgical Fever. 
Traumaticin, 269 
Treacle, 421 
Tree of Heaven, 93 
Tremor, 820 
Tri-bromo-methane, 17) 
Trichiniasis, 821 
Trichloraldehyde, 2T4 
Trichloro-methane, 210 
Tricophytosis,- -See Tinea, 816 
Trihydroxy-benzene, 70, 232 
Triiodo-methane, 314 



912 



INDEX. 



Trikresol, 377 

Trimethylamine, 157, 158, 270, 299 

Trimethyl-ethylene, 88 

-xanthin, 185 
Trinitrate of Glyceryl, 122 
Trinitrophenol, 377 
Trional, 471. 473» 779 
Trismus, 821 
Triticin, 489 
Triticum, 124, 489 
Tritopine, 356 
Trituration, 531 
Triturationes, 563 
Triturations, their advantages, 564 

of Elaterin, 270 

Formulae, 564 

of Mercury, 564 
Troches, 564 
Trochisci, 564 
Tropacocaine, 238 
Tropical Fruit-Laxative, 438 
Tropine, 171 
Trypsin, 373, 374 
Tuberculin, 447 
Tuberculin-R, 447 
Tuberculocidin, 448 

Tuberculosis, 821, — See also Tuberculous 
Affections, etc.; also Lupus, Phthisis, 
Scrofulosis. 

Acute, 821 

Antitoxin, 450 
Tuberculous Affections, 821 

Laryngitis, 714 

Meningitis, 727 

Peritonitis, 753 
Tully's Powder, 358 
Tumenol, 475, 478 
Tumors, 822 

Diagnosis of, 870 

Uterine, 838 
Turnera aphrodisiaca, 260 
Turpentine, 91, 481 

as an Antidote, 768 

Antidotes and Antagonists, 780 
Turpeth Mineral, 301 
Tvmpanites, 822 
Typhlitis, 823 
Typhoid Fever, 823 

Diagnosis of, 873 

Temperature in, 813 
Typho-malarial Fever, — See Typhoid. 
Typhus Fever, 826 

Diagnosis of, 873 
Tyrotoxicon, Antidotes, etc., 780 



Ulcers and Sores, 826 
of Rectum, 789 
of Stomach, 669 
of Tonsils, 819 
of Uterus, 838 

Ulmus, 489 

■Umbelliferon, 287 

Unguenta, 565 



Unguentum, 211, 565 

Crede, 151 
Unna's Ointment, 717 

Paint, 290 

Paste, 290 
Urasol, 425 
Urates, Test for, 834 
Urea, Agents affecting, 36 

in Urine, Test for, 834 
Uremia, 828 
Urethane, 471, 473 
Urethral Stricture, 828 

Injections, 544, 676 
Urethritis, 829 
Urginea maritima, 435 
Uric Acid Diathesis, — See Lithemia, 718 

Test for, 835 
Uricedin, 462 
Urinary Acidifiers, 47 

Alkalinizers, 47 

Astringents, 47 

Disorders, 829 

Sedatives, 47 
Urine, Articles coloring, 83 r 

Color of, 831 

Composition of, 830 

Deposits in, 835 

Examination of, 830 
Urotropin, 284, 286 
Ursone, 489 
Urticaria, 836 
Ustilago, 271 
Uterine Affections, 836 

Alteratives, 48 

Cancer, 836 

Congestion, 837 

Depressants, 47 

Displacements, 838 

Extract, 136 

Hypertrophy, 837 

Prolapse, 781 

Tonics, 48 

Tumors, 838 

Ulceration, 838 
Uva Ursi, 489 
Uvula, 839 



Vaccination, 839 

Vaginismus, 839 

Vaginitis, 839 

Valerene, 490 

Valerian, 260, 490 

Valerates, 490 

Valerol, 299, 490 

Validol, 799 

Vallet's Mass, 277 

Van Buskirk's Sozodont, 861 

Vanilla, 491 

Vanillin, 491 

Vao, 259 

Vapores (Vapors), 543, 774 

Vaporization, 532 

Varicella, 840 



I\l>l \. 









Varicella, Diagnosis of, .S74 

Varicocelt 

Varii 

Variola, B 

Diagnosis of, 87a 
Varioloid, Diagnosis, 87 ; 
\ asi ular Contractors, \8 
Dilators, 48 
Sedatives, ; N 
Stimulant 
Tonics, , N 
Vaselin, 374 

Vegetable Drugs, their Constituents, 
Veins, -See Phlebitis, Phlegmasia, \ 

Transfusion by, 51 
Velatine, 236, 274 
Vellarine, 

Venice Turpentine, 48a 
Venom, Insect, Antidotes, 77; 

Serpent. Antidotes, etc., 779 
Venous Medication, 51 
Veratralbine, 402 
Veratrine. 49a 
Veratroidine, 49a 
Veratrum, 491 

Antidotes and Antagonists, 780 
Verbascum, 404 
Verbs, Latin, S62 
Verdigris, 258 
Vermicides, 19 
Vermifuges, 19 
Veronal, 472, 473 
Veronica Virginica, 327 
Verruca,— See Warts, S44 
Vertigo, S41 
Vesical Tonics, 40 
Sedatives, 49 
Vesicants, 38 
Viburnin, 495 
Viburnum. 494 
Vienna Mixture, 88 
Villate's Solution, 25S 
Vina (Wines), 104, 566 
Vinegar, 63 

Bitters, 86S 
Vinegars (Aceta), 533 
\ mum. 104 
Viola Cucullata, 495 

Tricolor, 495 
Violet, 495 
\ ioline, 495 
Viscum, 495 

Visions, Agents producing, 49 
Vita Xuova, S68 
Vitellin, 96 
Vitellus, 95 
Vitriol, Elixir of, 79 
Vleminck's Solution, 633 
Volatile or Essential Oils, 10 
Volkmann's Antiseptic Fluid, 4S7 
Vomiting, 842 

of Pregnancy, S43 
Vouacapoua Araroba, 228 
Vulva, 844 
Vulvitis, S44 



4 
aricosis. 



561 

i, 557 

1 - '75 
Walker' 
Walnut, \\ ■ 
w arh irg 1 ini ture, 231 

r's s.iie Cure, S 
84 1 
Wash, 5 15 

II iir, 575, 678 
I ead and ( >pium, 5 
Mouth, 678 
Nasal, 544, 
Yellow, 301 
Washing . 

Waste, Agents promoting, 99 
Wasting, See Atrophy, Ei 
Water, 1 15 

onated, 205, 207 
Cherry-laurel, 7 1, 70 
Chlorine, 225 
igne, 104 
of Crystallization, 526 

Distilled, 145 

Eye, Thompson's, S6S 

Hunyadi, 622 

Javelle, Antido 774 

Lavender, 327 

Lead. 307 

Lime, 192 

Oxygenated, 367 

Phenol, 376 

Sedative, 117, 196 

Soda, 205, 207 

Tar, 305 
Water-brash'— See Pyrosis, 788 

-pepper, 399 
Waters (Aqua), 534 

Mineral, 145, 205 

Xonienclature, 145 
Wax, 210 

Myrtle, 69, 210 
Waxes, 10 

Weakness, — See Adynamia, Exhaustion. 
Weight of a Drachm in Gr 
Weights and Measures, 502, 
ithecaries', 503, 875, 

British Pharmacopoeia!, ^02 

Metric. 503, S75 
Table for Converting, S76 
Wen, S45 
Wheat, 124 
Whisky, 103 

White-leg, — See Phlegmasia, 757 
White-swelling, — See Joints, Synovitis. 
Whitlow, — See Onychia. 741 
Whooping-cough, — See Pertussis, 754 
Willow. 423 
Wine, 104 

Wines (Vina - ), 104. 506 
WinsloVs Mrs.' Soothing Syrup, 
Wintergreen, 287, 423. 511 
Witch-haa 
Wolf's-bane 






59 



914 



INDEX. 



Wolff's Formula, 97 
Wood Oil, 296 

Spirit, 103 
Wool-fat, 85 
Woorara, 259 

Words and Phrases, Latin, 849, 863 
Worm-grass, 466 
Worms, 845 
Wormseed, 211 

Levant, 431 
Worm Tea, 466 
Wormwood, 58 
Wounds, 846 

Poisoned, Antidotes, etc., 780 
Writers' Cramp, — See Spasmodic Affections, 

802 
Wry-neck, — See Torticollis, 820 



Xanthine, 186 
Xanthoxyline, 495 
Xanthoxylum, 495 



Xeroderma, — See Ichthyosis, 700 
Xeroform, 177 



Yam, Wild, 266 
Yellow Fever, 847 

Diagnosis of, 874 
Yerba Santa, 274 
Yolk of Egg, 95, 101 
Yohimbine, 496 
Yvon's Hypnotic Elixir, 706 



Zea, 496 

Mays, 123, 421, 496 
Zinc, 496 

Salts, Antidotes, etc., 780 
Zincite, 496 
Zincum, 496 
Zingiber, 499 
Zinol, 115, 497 
Zona, — See Herpes Zoster, 697 



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